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Sample records for emergent realist evaluation

  1. Improving the performance of community health workers in humanitarian emergencies: a realist evaluation protocol for the PIECES programme

    PubMed Central

    Gilmore, Brynne; Adams, Ben Jack; Bartoloni, Alex; Alhaydar, Bana; McAuliffe, Eilish; Raven, Joanna; Taegtmeyer, Miriam; Vallières, Frédérique

    2016-01-01

    Introduction Understanding what enhances the motivation and performance of community health workers (CHWs) in humanitarian emergencies represents a key research gap within the field of human resources for health. This paper presents the research protocol for the Performance ImprovEment of CHWs in Emergency Settings (PIECES) research programme. Enhancing Learning and Research in Humanitarian Action (ELRHA) funded the development of this protocol as part of their Health in Humanitarian Crises (R2HC) call (No.19839). PIECES aims to understand what factors improve the performance of CHWs in level III humanitarian emergencies. Methods and analysis The suggested protocol uses a realist evaluation with multiple cases across the 3 country sites: Turkey, Iraq and Lebanon. Working with International Medical Corps (IMC), an initial programme theory was elicited through literature and document reviews, semistructured interviews and focus groups with IMC programme managers and CHWs. Based on this initial theory, this protocol proposes a combination of semistructured interviews, life histories and critical incident narratives, surveys and latent variable modelling of key constructs to explain how contextual factors work to trigger mechanisms for specific outcomes relating to IMC's 300+ CHWs' performance. Participants will also include programme staff, CHWs and programme beneficiaries. Realist approaches will be used to better understand ‘what works, for whom and under what conditions’ for improving CHW performance within humanitarian contexts. Ethics and dissemination Trinity College Dublin's Health Policy and Management/Centre for Global Health Research Ethics Committee gave ethical approval for the protocol development phase. For the full research project, additional ethical approval will be sought from: Université St. Joseph (Lebanon), the Ethics Committee of the Ministry of Health in Baghdad (Iraq) and the Middle East Technical University (Turkey). Dissemination

  2. Faculty Development for Educators: A Realist Evaluation

    ERIC Educational Resources Information Center

    Sorinola, Olanrewaju O.; Thistlethwaite, Jill; Davies, David; Peile, Ed

    2015-01-01

    The effectiveness of faculty development (FD) activities for educators in UK medical schools remains underexplored. This study used a realist approach to evaluate FD and to test the hypothesis that motivation, engagement and perception are key mechanisms of effective FD activities. The authors observed and interviewed 33 course participants at one…

  3. Emergent properties from organisms to ecosystems: towards a realistic approach

    PubMed Central

    Ponge, Jean-François

    2005-01-01

    More realistic approaches are needed to understand the complexity of ecological systems. Emergent properties of real systems can be used as a basis for a new, neither reductionist nor holistic, approach. Three systems, termed here BUBBLEs, WAVEs and CRYSTALs, have been identified as exhibiting emergent properties. They are non-hierarchical assemblages of individual components, with amplification and connectedness being two main principles that govern their build-up, maintenance and mutual relationships. Examples from various fields of biological and ecological science are referred to, ranging from individual organisms to landscapes. PMID:16094806

  4. Remembering and Celebrating a Realistic Evaluation Visionary

    ERIC Educational Resources Information Center

    Patton, Michael Quinn

    2013-01-01

    In this article, Michael Quinn Patton pays tribute to Carol Hirschon Weiss, a woman who brought passion to evaluation use. She also brought attention to it, publishing the first article on evaluation in 1967. Weiss' many contributions have come into evaluation currency and overtaken formerly taken-for-granted assumptions. Indeed, her insights…

  5. A realist evaluation of the management of a well- performing regional hospital in Ghana

    PubMed Central

    2010-01-01

    Background Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study. Methods We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews. Results We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment. Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development

  6. Considerations for realistic ECCS evaluation methodology for LWRs

    SciTech Connect

    Rohatgi, U.S.; Saha, P.; Chexal, V.K.

    1985-01-01

    This paper identifies the various phenomena which govern the course of large and small break LOCAs in LWRs, and affect the key parameters such as Peak Clad Temperature (PCT) and timing of the end of blowdown, beginning of reflood, PCT, and complete quench. A review of the best-estimate models and correlations for these phenomena in the current literature has been presented. Finally, a set of models have been recommended which may be incorporated in a present best-estimate code such as TRAC or RELAP5 in order to develop a realistic ECCS evaluation methodology for future LWRs and have also been compared with the requirements of current ECCS evaluation methodology as outlined in Appendix K of 10CFR50. 58 refs.

  7. Realistic assessment of the physician-staffed emergency services in Germany.

    PubMed

    Gries, A; Zink, W; Bernhard, M; Messelken, M; Schlechtriemen, T

    2006-10-01

    In Germany the emergency medical services, which include dispatching emergency physicians to the scene, are considered to be among the best in the world. However, the hospitals admitting these patients still report shortcomings in prehospital care. The quality of an emergency medical service depends on both formal qualification and experience in managing such emergencies. Therefore, we determined how frequently emergency medical service physicians in Germany actually encountered complex and demanding emergency situations outside the hospital and how often they had to carry out emergency interventions. We therefore evaluated data from more than 82,000 ground emergency medical service scene calls registered in the MIND ("minimaler Notarztdatensatz") data base of the state of Baden-Wuerttemberg, Germany and more than 47,000 helicopter emergency medical service scene calls from the "Luftrettungs-, Informations- und Kommunikationssystem" (LIKS) data base of the German ADAC air rescue service. The results, which were unexpectedly distinct, impressively demonstrate that in part emergency medical service staff only encountered some emergencies very rarely. In particular, patients with life-threatening conditions such as acute coronary syndrome, stroke, head trauma, as well as multiple trauma were only treated once every 0.4-14.5 months and cardiopulmonary resuscitation and intubation were only carried out once every 0.5-1.5 months. Furthermore, a time period of 6 months to more than 6 years may pass before a chest tube has to be placed. There are, of course, considerable differences between ground and helicopter emergency medical services. Particularly in areas where the frequency of such emergency cases is low, the clinical experience required to competently manage a demanding emergency situation cannot be gained or maintained just by working in the emergency medical system. As a result of the general pressure to cut costs and also of changes in hospital politics, however

  8. The work is never ending: uncovering teamwork sustainability using realistic evaluation.

    PubMed

    Frykman, Mandus; von Thiele Schwarz, Ulrica; Muntlin Athlin, Åsa; Hasson, Henna; Mazzocato, Pamela

    2017-03-20

    Purpose The purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork. Design/methodology/approach Realistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used. Findings The teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced. Practical implications The implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period. Originality/value By integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.

  9. Towards Modeling Realistic Mobility for Performance Evaluations in MANET

    NASA Astrophysics Data System (ADS)

    Aravind, Alex; Tahir, Hassan

    Simulation modeling plays crucial role in conducting research on complex dynamic systems like mobile ad hoc networks and often the only way. Simulation has been successfully applied in MANET for more than two decades. In several recent studies, it is observed that the credibility of the simulation results in the field has decreased while the use of simulation has steadily increased. Part of this credibility crisis has been attributed to the simulation of mobility of the nodes in the system. Mobility has such a fundamental influence on the behavior and performance of mobile ad hoc networks. Accurate modeling and knowledge of mobility of the nodes in the system is not only helpful but also essential for the understanding and interpretation of the performance of the system under study. Several ideas, mostly in isolation, have been proposed in the literature to infuse realism in the mobility of nodes. In this paper, we attempt a holistic analysis of creating realistic mobility models and then demonstrate creation and analysis of realistic mobility models using a software tool we have developed. Using our software tool, desired mobility of the nodes in the system can be specified, generated, analyzed, and then the trace can be exported to be used in the performance studies of proposed algorithms or systems.

  10. Realist complex intervention science: Applying realist principles across all phases of the Medical Research Council framework for developing and evaluating complex interventions

    PubMed Central

    Fletcher, Adam; Jamal, Farah; Moore, Graham; Evans, Rhiannon E.; Murphy, Simon; Bonell, Chris

    2016-01-01

    The integration of realist evaluation principles within randomised controlled trials (‘realist RCTs’) enables evaluations of complex interventions to answer questions about what works, for whom and under what circumstances. This allows evaluators to better develop and refine mid-level programme theories. However, this is only one phase in the process of developing and evaluating complex interventions. We describe and exemplify how social scientists can integrate realist principles across all phases of the Medical Research Council framework. Intervention development, modelling, and feasibility and pilot studies need to theorise the contextual conditions necessary for intervention mechanisms to be activated. Where interventions are scaled up and translated into routine practice, realist principles also have much to offer in facilitating knowledge about longer-term sustainability, benefits and harms. Integrating a realist approach across all phases of complex intervention science is vital for considering the feasibility and likely effects of interventions for different localities and population subgroups. PMID:27478401

  11. Evaluating Action Learning: A Critical Realist Complex Network Theory Approach

    ERIC Educational Resources Information Center

    Burgoyne, John G.

    2010-01-01

    This largely theoretical paper will argue the case for the usefulness of applying network and complex adaptive systems theory to an understanding of action learning and the challenge it is evaluating. This approach, it will be argued, is particularly helpful in the context of improving capability in dealing with wicked problems spread around…

  12. A Realistic Approach To Evaluating Digital Imaging Systems

    NASA Astrophysics Data System (ADS)

    Greinacher, C. F.; Bach, E.,; Muller, K.,; Patzelt, K.

    1984-06-01

    Current systems for the production of medical images and current development trends give a basis of experience for the design of a digital PACS including images and demographic data. Such a PACS must contain software and hardware concepts which permit the medical requirements, as presently understood, to be realized. As part of its research Siemens is designing and evaluating a hybrid network configuration which allows extensive flexibility and growth potential despite current limitations in available network bandwidth and storage capacity. As demand for digital data expands, additional installations can be added to the system. The modular concept permits incorporation of technological advances with minimal difficulty. The system allows different digital imaging modalities to communicate with a central data storage and processing system. Data display facilities both with and without manipulation capability are realized using high speed multi image storage devices. The human interface is designed to be ergono-metric, interactive, and user-friendly. Standardized, commercially available hardware has been included wherever possible to provide economical worldwide acceptance. Estimates of digital data per unit time under different conditions are presented and compared to the specifications of software and hardware elements both currently available and envisaged in the near future. Potential limitations of the design, as well as possible solutions incorporating expected technological developments, are discussed.

  13. Protocol—the RAMESES II study: developing guidance and reporting standards for realist evaluation

    PubMed Central

    Greenhalgh, Trisha; Wong, Geoff; Jagosh, Justin; Greenhalgh, Joanne; Manzano, Ana; Westhorp, Gill; Pawson, Ray

    2015-01-01

    Introduction Realist evaluation is an increasingly popular methodology in health services research. For realist evaluations (RE) this project aims to: develop quality and reporting standards and training materials; build capacity for undertaking and critically evaluating them; produce resources and training materials for lay participants, and those seeking to involve them. Methods To achieve our aims, we will: (1) Establish management and governance infrastructure; (2) Recruit an interdisciplinary Delphi panel of 35 participants with diverse relevant experience of RE; (3) Summarise current literature and expert opinion on best practice in RE; (4) Run an online Delphi panel to generate and refine items for quality and reporting standards; (5) Capture ‘real world’ experiences and challenges of RE—for example, by providing ongoing support to realist evaluations, hosting the RAMESES JISCmail list on realist research, and feeding problems and insights from these into the deliberations of the Delphi panel; (6) Produce quality and reporting standards; (7) Collate examples of the learning and training needs of researchers, students, reviewers and lay members in relation to RE; (8) Develop, deliver and evaluate training materials for RE and deliver training workshops; and (9) Develop and evaluate information and resources for patients and other lay participants in RE (eg, draft template information sheets and model consent forms) and; (10) Disseminate training materials and other resources. Planned outputs: (1) Quality and reporting standards and training materials for RE. (2) Methodological support for RE. (3) Increase in capacity to support and evaluate RE. (4) Accessible, plain-English resources for patients and the public participating in RE. Discussion The realist evaluation is a relatively new approach to evaluation and its overall place in the is not yet fully established. As with all primary research approaches, guidance on quality assurance and uniform

  14. Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh.

    PubMed

    Adams, Alayne; Sedalia, Saroj; McNab, Shanon; Sarker, Malabika

    2016-03-01

    Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming.

  15. A New Realistic Evaluation Analysis Method: Linked Coding of Context, Mechanism, and Outcome Relationships

    ERIC Educational Resources Information Center

    Jackson, Suzanne F.; Kolla, Gillian

    2012-01-01

    In attempting to use a realistic evaluation approach to explore the role of Community Parents in early parenting programs in Toronto, a novel technique was developed to analyze the links between contexts (C), mechanisms (M) and outcomes (O) directly from experienced practitioner interviews. Rather than coding the interviews into themes in terms of…

  16. How Do You Modernize a Health Service? A Realist Evaluation of Whole-Scale Transformation in London

    PubMed Central

    Greenhalgh, Trisha; Humphrey, Charlotte; Hughes, Jane; Macfarlane, Fraser; Butler, Ceri; Pawson, Ray

    2009-01-01

    Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to “modernize” these services with a view to making health care more efficient, effective, and patient centered. Methods: This organizational case study draws on the principles of realist evaluation, a largely qualitative approach that is centrally concerned with testing and refining program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. This approach used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the case and follow its fortunes over the three-year study period. The methods included ethnographic observation, semistructured interviews, and scrutiny of documents and other contemporaneous materials. As well as providing ongoing formative feedback to the change teams in specific areas of activity, we undertook a more abstract, interpretive analysis, which explored the context-mechanism-outcome relationship using the guiding question “what works, for whom, under what circumstances?” Findings: In this example of large-scale service transformation, numerous projects and subprojects emerged, fed into one another, and evolved over time. Six broad mechanisms appeared to be driving the efforts of change agents: integrating services across providers, finding and using evidence, involving service users in the modernization effort, supporting self-care, developing the workforce, and extending the range of services. Within each of these mechanisms, different teams chose widely differing approaches and met with differing success. The realist analysis

  17. Evaluation of Highly Realistic Training for Navy Corpsmen: Results for Field Medical Training Battalion-West

    DTIC Science & Technology

    2015-05-14

    administered about 1 week after the training . Thus, the time interval between the pretests and posttests was approximately 7–8 weeks. Pretests and...given that the time interval between the pretests and posttests was 7–8 weeks. However, it is likely that the training made a contribution to the...Naval Health Research Center Evaluation of Highly Realistic Training for Navy Corpsmen: Results for Field Medical Training Battalion−West

  18. Realistic numerical simulations of solar convection: emerging flux, pores, and Stokes spectra

    NASA Astrophysics Data System (ADS)

    Georgobiani, D.; Stein, R.; Nordlund, A.

    2012-12-01

    We report on magneto-convection simulations of magnetic flux emerging through the upper layers of the solar convection zone into the photosphere. Simulations by Georgobiani, Stein and Nordlund start from minimally structured, uniform, untwisted horizontal field advected into the computational domain by supergranule scale inflows at 20 Mm depth. At the opposite extreme, simulations by Cheung (2007, 2008, 2011) start with a coherent flux tube inserted into or forced into the bottom of the computational domain. Several robust results have emerged from the comparison of results from these two very different initial states. First, rising magnetic flux gets deformed into undulating, serpentine shapes by the influence of the convective up- and down-flows. The flux develops fine structure and appears at the surface first as a "pepper and salt" pattern of mixed polarity. Where magnetic flux approaches the surface, granules become darker and elongated in the direction of the field. Subsequently, the underlying large scale magnetic structures make the field collect into unipolar regions. Magneto-convection produces a complex, small-scale magnetic field topology, whatever the initial state. A heirarchy of magnetic loops corresponding to the different scales of convective motions are produced. Vertical vortex tubes form at intergranule lane vertices which can lead to tornado-like magnetic fields in the photosphere. Gradients in field strength and velocity produce asymmetric Stokes spectra. Where emerging Omega loops leave behind nearly vertical legs, long lived pores can spontaneously form. The field in the pores first becomes concentrated and evacuated near the surface and the evacuated flux concentration then extends downward.

  19. Emergency Exercise Participation and Evaluation

    ERIC Educational Resources Information Center

    Smith, Julie; Black, Lynette; Williams, Linda

    2012-01-01

    Extension is uniquely positioned to participate in emergency exercises, formally or informally, with the goal of engaging community members in emergency and disaster preparedness. With their knowledge of community needs, Extension personnel are valuable resources and can assist emergency managers in the process of identifying local risks and…

  20. Evaluating Adverse Effects of Inhaled Nanoparticles by Realistic In Vitro Technology

    PubMed Central

    Geiser, Marianne; Jeannet, Natalie; Fierz, Martin; Burtscher, Heinz

    2017-01-01

    The number of daily products containing nanoparticles (NP) is rapidly increasing. NP in powders, dispersions, or sprays are a yet unknown risk for incidental exposure, especially at workplaces during NP production and processing, and for consumers of any health status and age using NP containing sprays. We developed the nano aerosol chamber for in vitro toxicity (NACIVT), a portable instrument for realistic safety testing of inhaled NP in vitro and evaluated effects of silver (Ag) and carbon (C) NP—which belong to the most widely used nanomaterials—on normal and compromised airway epithelia. We review the development, physical performance, and suitability of NACIVT for short and long-term exposures with air-liquid interface (ALI) cell cultures in regard to the prerequisites of a realistic in vitro test system for inhalation toxicology and in comparison to other commercially available, well characterized systems. We also review doses applied to cell cultures in vitro and acknowledge that a single exposure to realistic doses of spark generated 20-nm Ag- or CNP results in small, similar cellular responses to both NP types and that cytokine release generally increased with increasing NP dose. PMID:28336883

  1. Conditions for production of interdisciplinary teamwork outcomes in oncology teams: protocol for a realist evaluation

    PubMed Central

    2014-01-01

    Background Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals’ participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. Methods This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients’ and professionals’ perspectives on ITW, using the guiding question, ‘What works, for whom, and under what circumstances?’ Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases’ CMO associations for a better understanding of the phenomenon under study. Discussion This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of

  2. The management challenge for household waste in emerging economies like Brazil: realistic source separation and activation of reverse logistics.

    PubMed

    Fehr, M

    2014-09-01

    Business opportunities in the household waste sector in emerging economies still evolve around the activities of bulk collection and tipping with an open material balance. This research, conducted in Brazil, pursued the objective of shifting opportunities from tipping to reverse logistics in order to close the balance. To do this, it illustrated how specific knowledge of sorted waste composition and reverse logistics operations can be used to determine realistic temporal and quantitative landfill diversion targets in an emerging economy context. Experimentation constructed and confirmed the recycling trilogy that consists of source separation, collection infrastructure and reverse logistics. The study on source separation demonstrated the vital difference between raw and sorted waste compositions. Raw waste contained 70% biodegradable and 30% inert matter. Source separation produced 47% biodegradable, 20% inert and 33% mixed material. The study on collection infrastructure developed the necessary receiving facilities. The study on reverse logistics identified private operators capable of collecting and processing all separated inert items. Recycling activities for biodegradable material were scarce and erratic. Only farmers would take the material as animal feed. No composting initiatives existed. The management challenge was identified as stimulating these activities in order to complete the trilogy and divert the 47% source-separated biodegradable discards from the landfills.

  3. Online Assessment, Measurement and Evaluation: Emerging Practices

    ERIC Educational Resources Information Center

    Williams, David, Ed.; Hricko, Mary, Ed.; Howell, Scott, Ed.

    2006-01-01

    "Online Assessment, Measurement and Evaluation: Emerging Practices" provides a view of the possibilities and challenges facing online educators and evaluators in the 21st Century. As technology evolves and online measurement and assessment follow, "Online Assessment, Measurement and Evaluation: Emerging Practices" uses…

  4. Green shoots of recovery: a realist evaluation of a team to support change in general practice

    PubMed Central

    Bartlett, Maggie; Basten, Ruth; McKinley, Robert K

    2017-01-01

    Objective A multidisciplinary support team for general practice was established in April 2014 by a local National Health Service (NHS) England management team. This work evaluates the team's effectiveness in supporting and promoting change in its first 2 years, using realist methodology. Setting Primary care in one area of England. Participants Semistructured interviews were conducted with staff from 14 practices, 3 key senior NHS England personnel and 5 members of the support team. Sampling of practice staff was purposive to include representatives from relevant professional groups. Intervention The team worked with practices to identify areas for change, construct action plans and implement them. While there was no specified timescale for the team's work with practices, it was tailored to each. Primary and secondary outcome measures In realist evaluations, outcomes are contingent on mechanisms acting in contexts, and both an understanding of how an intervention leads to change in a socially constructed system and the resultant changes are outcomes. Results The principal positive mechanisms leading to change were the support team's expertise and its relationships with practice staff. The ‘external view’ provided by the team via its corroborative and normalising effects was an important mechanism for increasing morale in some practice contexts. A powerful negative mechanism was related to perceptions of ‘being seen as a failing practice’ which included expressions of ‘shame’. Outcomes for practices as perceived by their staff were better communication, improvements in patients' access to appointments resulting from better clinical and managerial skill mix, and improvements in workload management. Conclusions The support team promoted change within practices leading to signs of the ‘green shoots of recovery’ within the time frame of the evaluation. Such interventions need to be tailored and responsive to practices' needs. The team's expertise and

  5. The power of the context map: Designing realistic outcome evaluation strategies and other unanticipated benefits.

    PubMed

    Renger, Ralph; Foltysova, Jirina; Becker, Karin L; Souvannasacd, Eric

    2015-10-01

    Developing a feasible evaluation plan is challenging when multiple activities, often sponsored by multiple agencies, work together toward a common goal. Often, resources are limited and not every agency's interest can be represented in the final evaluation plan. The article illustrates how the Antecedent Target Measurement (ATM) approach to logic modeling was adapted to meet this challenge. The key adaptation is the context map generated in the first step of the ATM approach. The context map makes visually explicit many of the underlying conditions contributing to a problem as possible. The article also shares how a prioritization matrix can assist the evaluator in filtering through the context map to prioritize the outcomes to be included in the final evaluation plan as well as creating realistic outcomes. This transparent prioritization process can be especially helpful in managing evaluation expectations of multiple agencies with competing interests. Additional strategic planning benefits of the context map include pinpointing redundancies caused by overlapping collaborative efforts, identifying gaps in coverage, and assisting the coordination of multiple stakeholders.

  6. Mechanisms for achieving adolescent-friendly services in Ecuador: a realist evaluation approach

    PubMed Central

    Goicolea, Isabel; Coe, Anna-Britt; Hurtig, Anna-Karin; San Sebastian, Miguel

    2012-01-01

    Background Despite evidence showing that adolescent-friendly health services (AFSs) increase young people's access to these services, health systems across the world are failing to integrate this approach. In Latin America, policies aimed at strengthening AFS abound. However, such services are offered only in a limited number of sites, and providers’ attitudes and respect for confidentiality have not been addressed to a sufficient extent. Methods The aim of this study was to explore the mechanisms that triggered the transformation of an ‘ordinary’ health care facility into an AFS in Ecuador. For this purpose, a realist evaluation approach was used in order to analyse three well-functioning AFSs. Information was gathered at the national level and from each of the settings including: (i) statistical information and unpublished reports; (ii) in-depth interviews and focus group discussions with policy makers, health care providers, users and adolescents participating in youth organisations and (iii) observations at the health care facilities. Thematic analysis was carried out, driven by the realist evaluation approach, namely exploring the connections between mechanisms, contexts and outcomes. Results The results highlighted that the development of the AFSs was mediated by four mechanisms: grounded self-confidence in trying new things, legitimacy, a transformative process and an integral approach to adolescents. Along this process, contextual factors at the national and institutional levels were further explored. Conclusion The Ministry of Health of Ecuador, based on the New Guidelines for Comprehensive Care of Adolescent Health, has started the scaling up of AFSs. Our research points towards the need to recognise and incorporate these mechanisms as part of the implementation strategy from the very beginning of the process. Although contextually limited to Ecuador, many mechanisms and good practices in these AFS may be relevant to the Latin American setting and

  7. Understanding integrated care pathways in palliative care using realist evaluation: a mixed methods study protocol

    PubMed Central

    Jones, Diana; Lhussier, Monique; Cunningham, Bill

    2012-01-01

    Introduction Policy- and evidence-based guidelines have highlighted the need for improved palliative and end-of-life care. However, there is still evidence of individuals dying undignified deaths with little pain control, therefore inflicting unnecessary suffering. New commissioning powers have enabled a 2-year pilot of an innovative integrated care pathway (ICP) designed to improve arrangements for individuals with life-limiting illnesses requiring palliative care. A novel feature of the ICP is its focus on palliative care over the last 6 months of life, aiming to intervene early to prepare for and ensure a good death. What is not known is if this pathway works, how it works and who it works for. Methods and analysis A realist evaluation and a complex analytical framework will investigate and discover context, mechanism and outcome conjectures and configurations of the ICP and thus facilitate exploration of how it works and who it works for. A mixed methods approach will be used with small sample sizes to capture the breadth of the ICP. Phase 1 will identify if the pathway works through analysis of NHS Morbidity Information Query and Export Syntax data, locality Death Audit data and the Quality of Dying and Death Questionnaire. Phase 2 employs soft systems methodology with data from focus groups with health professionals to identify how the pathway works. Phase 3 uses the Miller Behavioural Style Scale and interviews with palliative care patients and bereaved relatives to analyse communication in palliative care. Ethics and dissemination Ethical approval has been granted from the NHS local ethics committee (REC reference number: 11/NE/0318). Research & Development approval has been gained from four different trusts, and relevant voluntary organisations and the local council have been informed about the research. This protocol illustrates the complexity inherent in evaluating a palliative care ICP. Identification of whether the pathway works, how it works and who

  8. How do primary health care teams learn to integrate intimate partner violence (IPV) management? A realist evaluation protocol

    PubMed Central

    2013-01-01

    Background Despite the existence of ample literature dealing, on the one hand, with the integration of innovations within health systems and team learning, and, on the other hand, with different aspects of the detection and management of intimate partner violence (IPV) within healthcare facilities, research that explores how health innovations that go beyond biomedical issues—such as IPV management—get integrated into health systems, and that focuses on healthcare teams’ learning processes is, to the best of our knowledge, very scarce if not absent. This realist evaluation protocol aims to ascertain: why, how, and under what circumstances primary healthcare teams engage (if at all) in a learning process to integrate IPV management in their practices; and why, how, and under what circumstances team learning processes lead to the development of organizational culture and values regarding IPV management, and the delivery of IPV management services. Methods This study will be conducted in Spain using a multiple-case study design. Data will be collected from selected cases (primary healthcare teams) through different methods: individual and group interviews, routinely collected statistical data, documentary review, and observation. Cases will be purposively selected in order to enable testing the initial middle-range theory (MRT). After in-depth exploration of a limited number of cases, additional cases will be chosen for their ability to contribute to refining the emerging MRT to explain how primary healthcare learn to integrate intimate partner violence management. Discussion Evaluations of health sector responses to IPV are scarce, and even fewer focus on why, how, and when the healthcare services integrate IPV management. There is a consensus that healthcare professionals and healthcare teams play a key role in this integration, and that training is important in order to realize changes. However, little is known about team learning of IPV management, both in

  9. Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA): Introduction and overview

    PubMed Central

    Godleski, John J.; Rohr, Annette C.; Kang, Choong M.; Diaz, Edgar A.; Ruiz, Pablo A.; Koutrakis, Petros

    2013-01-01

    Determining the health impacts of sources and components of fine particulate matter (PM2.5) is an important scientific goal. PM2.5 is a complex mixture of inorganic and organic constituents that are likely to differ in their potential to cause adverse health outcomes. The Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA) study focused on two PM sources—coal-fired power plants and mobile sources—and sought to investigate the toxicological effects of exposure to emissions from these sources. The set of papers published here document the power plant experiments. TERESA attempted to delineate health effects of primary particles, secondary (aged) particles, and mixtures of these with common atmospheric constituents. TERESA involved withdrawal of emissions from the stacks of three coal-fired power plants in the United States. The emissions were aged and atmospherically transformed in a mobile laboratory simulating downwind power plant plume processing. Toxicological evaluations were carried out in laboratory rats exposed to different emission scenarios with extensive exposure characterization. The approach employed in TERESA was ambitious and innovative. Technical challenges included the development of stack sampling technology that prevented condensation of water vapor from the power plant exhaust during sampling and transfer, while minimizing losses of primary particles; development and optimization of a photochemical chamber to provide an aged aerosol for animal exposures; development and evaluation of a denuder system to remove excess gaseous components; and development of a mobile toxicology laboratory. This paper provides an overview of the conceptual framework, design, and methods employed in the study. PMID:21639692

  10. Exposing the impact of Citizens Advice Bureau services on health: a realist evaluation protocol

    PubMed Central

    Forster, N; Dalkin, S M; Lhussier, M; Hodgson, P; Carr, S M

    2016-01-01

    Introduction Welfare advice services can be used to address health inequalities, for example, through Citizens Advice Bureau (CAB). Recent reviews highlight evidence for the impact of advice services in improving people's financial position and improving mental health and well-being, daily living and social relationships. There is also some evidence for the impact of advice services in increasing accessibility of health services, and reducing general practitioner appointments and prescriptions. However, direct evidence for the impact of advice services on lifestyle behaviour and physical health is currently much less well established. There is a need for greater empirical testing of theories around the specific mechanisms through which advice services and associated financial or non-financial benefits may generate health improvements. Methods and analysis A realist evaluation will be conducted, operationalised in 5 phases: building the explanatory framework; refining the explanatory framework; testing the explanatory framework through empirical data (mixed methods); development of a bespoke data recording template to capture longer term impact; and verification of findings with a range of CAB services. This research will therefore aim to build, refine and test an explanatory framework about how CAB services can be optimally implemented to achieve health improvement. Ethics and dissemination The study was approved by the ethics committee at Northumbria University, UK. Project-related ethical issues are described and quality control aspects of the study are considered. A stakeholder mapping exercise will inform the dissemination of results in order to ensure all relevant institutions and organisations are targeted. PMID:26792219

  11. Toxicological evaluation of realistic emission source aerosols (TERESA): summary and conclusions

    PubMed Central

    Godleski, John J.; Rohr, Annette C.; Coull, Brent A.; Kang, Choong-Min; Diaz, Edgar A.; Koutrakis, Petros

    2013-01-01

    The toxicological evaluation of realistic emissions of source aerosols (TERESA) study seeks to delineate health effects of aerosols formed from emissions of particulate matter sources. This series of papers reports the findings of experiments using coal-fired power plants as the source of emissions and this paper summarizes the findings and knowledge acquired from these studies. Emissions were drawn directly from the stacks of three coal-fired power plants in the US, and photochemically aged in a mobile laboratory to simulate downwind power plant plume processing. The power plants used different sources of coal and had different emission controls. Exposure scenarios included primary particles, secondary particles and mixtures of these with common atmospheric constituents (α-pinene and ammonia). Extensive exposure characterization was carried out, and toxicological outcomes were evaluated in Sprague-Dawley rats exposed to different emission scenarios. Breathing pattern, pulmonary inflammatory responses, in vivo pulmonary and cardiac chemiluminescence and cardiac response in a model of acute myocardial infarction were assessed. The results showed no response or relatively mild responses to the inhaled aerosols studied; complex scenarios which included oxidized emissions and α-pinene to simulate biogenic secondary organic aerosol tended to induce more statistically significant responses than scenarios of oxidized and non-oxidized emissions alone. Relating adverse effects to specific components did not consistently identify a toxic constituent. These findings are consistent with most of the previously published studies using pure compounds to model secondary power plant emissions, but importantly add substantial complexity and thus have considerable merit in defining toxicological responses. PMID:21913822

  12. Realistic evaluation of Situation Awareness for Everyone (SAFE) on paediatric wards: study protocol

    PubMed Central

    Deighton, J; Edbrooke-Childs, J; Stapley, E; Sevdalis, N; Hayes, J; Gondek, D; Sharples, E; Lachman, P

    2016-01-01

    Introduction Evidence suggests that health outcomes for hospitalised children in the UK are worse than other countries in Europe, with an estimated 1500 preventable deaths in hospital each year. It is presumed that some of these deaths are due to unanticipated deterioration, which could have been prevented by earlier intervention, for example, sepsis. The Situation Awareness For Everyone (SAFE) intervention aims to redirect the ‘clinical gaze’ to encompass a range of prospective indicators of risk or deterioration, including clinical indicators and staff concerns, so that professionals can review relevant information for any given situation. Implementing the routine use of huddles is central to increasing situation awareness in SAFE. Methods and analysis In this article, we describe the realistic evaluation framework within which we are evaluating the SAFE programme. Multiple methods and data sources are used to help provide a comprehensive understanding of what mechanisms for change are triggered by an intervention and how they have an impact on the existing social processes sustaining the behaviour or circumstances that are being targeted for change. Ethics and dissemination Ethics approval was obtained from London—Dulwich Research Ethics Committee (14/LO/0875). It is anticipated that the findings will enable us to understand what the important elements of SAFE and the huddle are, the processes by which they might be effective and—given the short timeframes of the project—initial effects of the intervention on outcomes. The present research will add to the extant literature by providing the first evidence of implementation of SAFE and huddles in paediatric wards in the UK. PMID:28039297

  13. Gender equity programmes in academic medicine: a realist evaluation approach to Athena SWAN processes

    PubMed Central

    Caffrey, Louise; Mattingley, Helena; Williamson, Catherine; McKevitt, Christopher

    2016-01-01

    Objectives Gender inequity has persisted in academic medicine. Yet equity is vital for countries to achieve their full potential in terms of translational research and patient benefit. This study sought to understand how the gender equity programme, Athena SWAN, can be enabled and constrained by interactions between the programme and the context it is implemented into, and whether these interactions might produce unintended consequences. Design Multimethod qualitative case studies using a realist evaluation approach. Setting 5 departments from a university medical school hosting a Translational Research Organisation. Participants 25 hours of observations of gender equality committee meetings, 16 in-depth interviews with Heads of Departments, Committee Leads and key personnel involved in the initiative. 4 focus groups with 15 postdoctoral researchers, lecturers and senior lecturers. Results The implementation of Athena SWAN principles was reported to have created social space to address gender inequity and to have highlighted problematic practices to staff. However, a number of factors reduced the programme's potential to impact gender inequity. Gender inequity was reproduced in the programme's enactment as female staff was undertaking a disproportionate amount of Athena SWAN work, with potential negative impacts on individual women's career progression. Early career researchers experienced problems accessing Athena SWAN initiatives. Furthermore, the impact of the programme was perceived to be undermined by wider institutional practices, national policies and societal norms, which are beyond the programme's remit. Conclusions Gender equity programmes have the potential to address inequity. However, paradoxically, they can also unintentionally reproduce and reinforce gender inequity through their enactment. Potential programme impacts may be undermined by barriers to staff availing of career development and training initiatives, and by wider institutional practices

  14. Implementing accountability for reasonableness framework at district level in Tanzania: a realist evaluation

    PubMed Central

    2011-01-01

    Background Despite the growing importance of the Accountability for Reasonableness (A4R) framework in priority setting worldwide, there is still an inadequate understanding of the processes and mechanisms underlying its influence on legitimacy and fairness, as conceived and reflected in service management processes and outcomes. As a result, the ability to draw scientifically sound lessons for the application of the framework to services and interventions is limited. This paper evaluates the experiences of implementing the A4R approach in Mbarali District, Tanzania, in order to find out how the innovation was shaped, enabled, and constrained by the interaction between contexts, mechanisms and outcomes. Methods This study draws on the principles of realist evaluation -- a largely qualitative approach, chiefly concerned with testing and refining programme theories by exploring the complex interactions of contexts, mechanisms, and outcomes. Mixed methods were used in data collection, including individual interviews, non-participant observation, and document reviews. A thematic framework approach was adopted for the data analysis. Results The study found that while the A4R approach to priority setting was helpful in strengthening transparency, accountability, stakeholder engagement, and fairness, the efforts at integrating it into the current district health system were challenging. Participatory structures under the decentralisation framework, central government's call for partnership in district-level planning and priority setting, perceived needs of stakeholders, as well as active engagement between researchers and decision makers all facilitated the adoption and implementation of the innovation. In contrast, however, limited local autonomy, low level of public awareness, unreliable and untimely funding, inadequate accountability mechanisms, and limited local resources were the major contextual factors that hampered the full implementation. Conclusion This study

  15. Combining Campbell Standards and the Realist Evaluation Approach: The Best of Two Worlds?

    ERIC Educational Resources Information Center

    van der Knaap, Leontien M.; Leeuw, Frans L.; Bogaerts, Stefan; Nijssen, Laura T. J.

    2008-01-01

    This article presents an approach to systematic reviews that combines the Campbell Collaboration Crime and Justice standards and the realist notion of contexts-mechanisms-outcomes (CMO) configurations. Both approaches have their advantages and drawbacks, and the authors will make a case for combining both approaches to profit from their advantages…

  16. Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation

    PubMed Central

    2013-01-01

    Background Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context. Methods This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used. Results The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both

  17. Simulation Evaluation of Controller-Managed Spacing Tools under Realistic Operational Conditions

    NASA Technical Reports Server (NTRS)

    Callantine, Todd J.; Hunt, Sarah M.; Prevot, Thomas

    2014-01-01

    Controller-Managed Spacing (CMS) tools have been developed to aid air traffic controllers in managing high volumes of arriving aircraft according to a schedule while enabling them to fly efficient descent profiles. The CMS tools are undergoing refinement in preparation for field demonstration as part of NASA's Air Traffic Management (ATM) Technology Demonstration-1 (ATD-1). System-level ATD-1 simulations have been conducted to quantify expected efficiency and capacity gains under realistic operational conditions. This paper presents simulation results with a focus on CMS-tool human factors. The results suggest experienced controllers new to the tools find them acceptable and can use them effectively in ATD-1 operations.

  18. How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol

    PubMed Central

    McAuliffe, Eilish; Larkan, Fiona; Conteh, Magnus; Dunne, Nicola; Gaudrault, Michele; Mollel, Henry; Tumwesigye, Nazarius Mbona; Vallières, Frédérique

    2016-01-01

    Introduction The proposed research is part of ongoing operations research within World Vision's Access: Infant and Maternal Health Programme. This study aims to identify key context features and underlying mechanisms through which community health committees build community capacity within the field of maternal and child health. This may help to improve programme implementation by providing contextually informed and explanatory findings for how community health committees work, what works best and for whom do they work for best for. Though frequently used within health programmes, little research is carried out on such committees’ contribution to capacity building—a frequent goal or proposed outcome of these groups. Methods and analysis The scarce information that does exist often fails to explain ‘how, why, and for whom’ these committees work best. Since such groups typically operate within or as components of complex health interventions, they require a systems thinking approach and design, and thus so too does their evaluation. Using a mixed methods realist evaluation with intraprogramme case studies, this protocol details a proposed study on community health committees in rural Tanzania and Uganda to better understand underlying mechanisms through which these groups work (or do not) to build community capacity for maternal and child health. This research protocol follows the realist evaluation methodology of eliciting initial programme theories, to inform the field study design, which are detailed within. Thus far, the methodology of a realist evaluation has been well suited to the study of community health committees within these contexts. Implications for its use within these contexts are discussed within. Ethics and dissemination Institutional Review Boards and the appropriate research clearance bodies within Ireland, Uganda and Tanzania have approved this study. Planned dissemination activities include via academic and programme channels, as well as

  19. Evaluating real-time image reconstruction in diffuse optical tomography using physiologically realistic test data.

    PubMed

    Brigadoi, Sabrina; Powell, Samuel; Cooper, Robert J; Dempsey, Laura A; Arridge, Simon; Everdell, Nick; Hebden, Jeremy; Gibson, Adam P

    2015-12-01

    In diffuse optical tomography (DOT), real-time image reconstruction of oxy- and deoxy-haemoglobin changes occurring in the brain could give valuable information in clinical care settings. Although non-linear reconstruction techniques could provide more accurate results, their computational burden makes them unsuitable for real-time applications. Linear techniques can be employed under the assumption that the expected change in absorption is small. Several approaches exist, differing primarily in their handling of regularization and the noise statistics. In real experiments, it is impossible to compute the true noise statistics, because of the presence of physiological oscillations in the measured data. This is even more critical in real-time applications, where no off-line filtering and averaging can be performed to reduce the noise level. Therefore, many studies substitute the noise covariance matrix with the identity matrix. In this paper, we examined two questions: does using the noise model with realistic, imperfect data yield an improvement in image quality compared to using the identity matrix; and what is the difference in quality between online and offline reconstructions. Bespoke test data were created using a novel process through which simulated changes in absorption were added to real resting-state DOT data. A realistic multi-layer head model was used as the geometry for the reconstruction. Results validated our assumptions, highlighting the validity of computing the noise statistics from the measured data for online image reconstruction, which was performed at 2 Hz. Our results can be directly extended to a real application where real-time imaging is required.

  20. Cardiac autonomic functions and the emergence of violence in a highly realistic model of social conflict in humans

    PubMed Central

    Haller, Jozsef; Raczkevy-Deak, Gabriella; Gyimesine, Katalin P.; Szakmary, Andras; Farkas, Istvan; Vegh, Jozsef

    2014-01-01

    Among the multitude of factors that can transform human social interactions into violent conflicts, biological features received much attention in recent years as correlates of decision making and aggressiveness especially in critical situations. We present here a highly realistic new model of human aggression and violence, where genuine acts of aggression are readily performed and which at the same time allows the parallel recording of biological concomitants. Particularly, we studied police officers trained at the International Training Centre (Budapest, Hungary), who are prepared to perform operations under extreme conditions of stress. We found that aggressive arousal can transform a basically peaceful social encounter into a violent conflict. Autonomic recordings show that this change is accompanied by increased heart rates, which was associated earlier with reduced cognitive complexity of perceptions (“attentional myopia”) and promotes a bias toward hostile attributions and aggression. We also observed reduced heart rate variability in violent subjects, which is believed to signal a poor functioning of prefrontal-subcortical inhibitory circuits and reduces self-control. Importantly, these autonomic particularities were observed already at the beginning of social encounters i.e., before aggressive acts were initiated, suggesting that individual characteristics of the stress-response define the way in which social pressure affects social behavior, particularly the way in which this develops into violence. Taken together, these findings suggest that cardiac autonomic functions are valuable external symptoms of internal motivational states and decision making processes, and raise the possibility that behavior under social pressure can be predicted by the individual characteristics of stress responsiveness. PMID:25374519

  1. Rubric Evaluation of Pediatric Emergency Medicine Fellows

    PubMed Central

    Hsu, Deborah C.; Macias, Charles G.

    2010-01-01

    Objectives To develop and validate a rubric assessment instrument for use by pediatric emergency medicine (PEM) faculty to evaluate PEM fellows and for fellows to use to self-assess. Methods This is a prospective study at a PEM fellowship program. The assessment instrument was developed through a multistep process: (1) development of rubric format items, scaled on the modified Dreyfus model proficiency levels, corresponding to the 6 Accreditation Council for Graduate Medical Education core competencies; (2) determination of content and construct validity of the items through structured input and item refinement by subject matter experts and focus group review; (3) collection of data using a 61-item form; (4) evaluation of psychometrics; (5) selection of items for use in the final instrument. Results A total of 261 evaluations were collected from 2006 to 2007; exploratory factor analysis yielded 5 factors with Eigenvalues >1.0; each contained ≥4 items, with factor loadings >0.4 corresponding with the following competencies: (1) medical knowledge and practice-based learning and improvement, (2) patient care and systems-based practice, (3) interpersonal skills, (4) communication skills, and (5) professionalism. Cronbach α for the final 53-item instrument was 0.989. There was also significant responsiveness of the tool to the year of training. Conclusion A substantively and statistically validated rubric evaluation of PEM fellows is a reliable tool for formative and summative evaluation. PMID:22132272

  2. Evaluation of three-dimensional anisotropic head model for mapping realistic electromagnetic fields of brain tissues

    NASA Astrophysics Data System (ADS)

    Jeong, Woo Chul; Wi, Hun; Sajib, Saurav Z. K.; Oh, Tong In; Kim, Hyung Joong; Kwon, Oh In; Woo, Eung Je

    2015-08-01

    Electromagnetic fields provide fundamental data for the imaging of electrical tissue properties, such as conductivity and permittivity, in recent magnetic resonance (MR)-based tissue property mapping. The induced voltage, current density, and magnetic flux density caused by externally injected current are critical factors for determining the image quality of electrical tissue conductivity. As a useful tool to identify bio-electromagnetic phenomena, precise approaches are required to understand the exact responses inside the human body subject to an injected currents. In this study, we provide the numerical simulation results of electromagnetic field mapping of brain tissues using a MR-based conductivity imaging method. First, we implemented a realistic three-dimensional human anisotropic head model using high-resolution anatomical and diffusion tensor MR images. The voltage, current density, and magnetic flux density of brain tissues were imaged by injecting 1 mA of current through pairs of electrodes on the surface of our head model. The current density map of anisotropic brain tissues was calculated from the measured magnetic flux density based on the linear relationship between the water diffusion tensor and the electrical conductivity tensor. Comparing the current density to the previous isotropic model, the anisotropic model clearly showed the differences between the brain tissues. This originates from the enhanced signals by the inherent conductivity contrast as well as the actual tissue condition resulting from the injected currents.

  3. Emergency building temperature restrictions. Final evaluation

    SciTech Connect

    1980-11-01

    On July 5, 1979, DOE promulgated final regulations of the Emergency Building Temperature Restrictions program, placing emergency restrictions on thermostat settings for space heating, space cooling, and hot water in commercial, industrial, and nonresidential public buildings. The final regulations restricted space heating to a maximum of 65/sup 0/F, hot water temperature to a maximum of 105/sup 0/F, and cooling temperature to a minimum of 78/sup 0/F. A comprehensive evaluation of the entire EBTF program for a nine-month period from July 16, 1979 is presented. In Chapter 1, an estimate of the population of buildings covered by EBTR is presented. In Chapter 2, EBTR compliance by building type and region is reported. Exemptions are also discussed. In Chapter 3, the simulations of building energy use are explained and the relative impact of various building characteristics and effectiveness of different control strategies are estimated. Finally, in Chapter 4, the methodology for scaling the individual building energy savings to the national level is described, and estimated national energy savings are presented.

  4. Instructional Coaching Evaluation Using a Realist Approach: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Berlage, Claudia

    2015-01-01

    The necessity to evaluate professional development has become more pressing for districts in a time of increased accountability. A number of empirical studies had shown that it was difficult to measure the effects of professional development, especially its effect on transferring practice and student achievement. The purpose of this study was to…

  5. A Realist Evaluation Approach to Unpacking the Impacts of the Sentencing Guidelines

    ERIC Educational Resources Information Center

    Hunt, Kim Steven; Sridharan, Sanjeev

    2010-01-01

    Evaluations of complex interventions such as sentencing guidelines provide an opportunity to understand the mechanisms by which policies and programs can impact intermediate and long-term outcomes. There is limited previous discussion of the underlying frameworks by which sentencing guidelines can impact outcomes such as crime rates. Guided by a…

  6. Evaluation of an improved algorithm for producing realistic 3D breast software phantoms: Application for mammography

    PubMed Central

    Bliznakova, K.; Suryanarayanan, S.; Karellas, A.; Pallikarakis, N.

    2010-01-01

    Purpose: This work presents an improved algorithm for the generation of 3D breast software phantoms and its evaluation for mammography. Methods: The improved methodology has evolved from a previously presented 3D noncompressed breast modeling method used for the creation of breast models of different size, shape, and composition. The breast phantom is composed of breast surface, duct system and terminal ductal lobular units, Cooper’s ligaments, lymphatic and blood vessel systems, pectoral muscle, skin, 3D mammographic background texture, and breast abnormalities. The key improvement is the development of a new algorithm for 3D mammographic texture generation. Simulated images of the enhanced 3D breast model without lesions were produced by simulating mammographic image acquisition and were evaluated subjectively and quantitatively. For evaluation purposes, a database with regions of interest taken from simulated and real mammograms was created. Four experienced radiologists participated in a visual subjective evaluation trial, as they judged the quality of the simulated mammograms, using the new algorithm compared to mammograms, obtained with the old modeling approach. In addition, extensive quantitative evaluation included power spectral analysis and calculation of fractal dimension, skewness, and kurtosis of simulated and real mammograms from the database. Results: The results from the subjective evaluation strongly suggest that the new methodology for mammographic breast texture creates improved breast models compared to the old approach. Calculated parameters on simulated images such as β exponent deducted from the power law spectral analysis and fractal dimension are similar to those calculated on real mammograms. The results for the kurtosis and skewness are also in good coincidence with those calculated from clinical images. Comparison with similar calculations published in the literature showed good agreement in the majority of cases. Conclusions: The

  7. Evaluation of an improved algorithm for producing realistic 3D breast software phantoms: Application for mammography

    SciTech Connect

    Bliznakova, K.; Suryanarayanan, S.; Karellas, A.; Pallikarakis, N.

    2010-11-15

    Purpose: This work presents an improved algorithm for the generation of 3D breast software phantoms and its evaluation for mammography. Methods: The improved methodology has evolved from a previously presented 3D noncompressed breast modeling method used for the creation of breast models of different size, shape, and composition. The breast phantom is composed of breast surface, duct system and terminal ductal lobular units, Cooper's ligaments, lymphatic and blood vessel systems, pectoral muscle, skin, 3D mammographic background texture, and breast abnormalities. The key improvement is the development of a new algorithm for 3D mammographic texture generation. Simulated images of the enhanced 3D breast model without lesions were produced by simulating mammographic image acquisition and were evaluated subjectively and quantitatively. For evaluation purposes, a database with regions of interest taken from simulated and real mammograms was created. Four experienced radiologists participated in a visual subjective evaluation trial, as they judged the quality of the simulated mammograms, using the new algorithm compared to mammograms, obtained with the old modeling approach. In addition, extensive quantitative evaluation included power spectral analysis and calculation of fractal dimension, skewness, and kurtosis of simulated and real mammograms from the database. Results: The results from the subjective evaluation strongly suggest that the new methodology for mammographic breast texture creates improved breast models compared to the old approach. Calculated parameters on simulated images such as {beta} exponent deducted from the power law spectral analysis and fractal dimension are similar to those calculated on real mammograms. The results for the kurtosis and skewness are also in good coincidence with those calculated from clinical images. Comparison with similar calculations published in the literature showed good agreement in the majority of cases. Conclusions: The

  8. Using the Co-Production of Knowledge for Developing Realistic Natural Disaster Scenarios for Small-to-Medium Scale Emergency Management Exercises

    NASA Astrophysics Data System (ADS)

    Robinson, T.; Wilson, T. M.; Davies, T. R.; Orchiston, C.; Thompson, J.

    2014-12-01

    Disaster scenarios for Emergency Management (EM) exercises are a widely-used and effective tool for communicating hazard information to policy makers, EM personnel, lifelines operators and communities in general. It is crucial that the scenarios are as realistic as possible. Major disasters however, contain a series of cascading consequences, both environmental and social, which are difficult to model. Consequently, only recently have large-scale exercises included such processes; incorporating these in small- and medium-scale scenarios has yet to be attempted. This study details work undertaken in a recent medium-scale earthquake exercise in New Zealand to introduce such cascading processes into the disaster scenario. Given limited time, data, and funding, we show that the co-production of knowledge between natural disaster scientists, EM personnel, and governance and lifelines organisations can yield detailed, realistic scenarios. Using the co-production process, scenario development was able to identify where the pre-exercise state of knowledge was insufficient. This enabled a focussed research response driven by end-user needs. This found that in general, seismic hazard (ground shaking) and its likely impacts were well known and understood by all parties. However, subsequent landsliding and associated effects were poorly known and understood and their potential impacts unconsidered. Scenario development therefore focussed primarily on understanding these processes and their potential effects. This resulted in cascading hazards being included in a medium-scale NZ exercise for the first time. Further, all participants were able to focus on the potential impacts on their specific sectors, increasing the level of knowledge of cascading processes across all parties. Using group based discussions throughout the design process allowed a detailed scenario to be created, fostered stronger inter-disciplinary relationships, and identified areas for further research

  9. Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol

    PubMed Central

    Talbot, Lise R; Gaboury, Isabelle

    2017-01-01

    Background Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. Methods and analysis Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. Ethics and dissemination This research project has received approval from the Comité d’éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences. PMID:28237962

  10. What aspects of intentional rounding work in hospital wards, for whom and in what circumstances? A realist evaluation protocol

    PubMed Central

    Harris, Ruth; Sims, Sarah; Levenson, Ros; Gourlay, Stephen; Ross CBE, Fiona; Davies, Nigel; Brearley, Sally; Favato, Giampiero; Grant, Robert

    2017-01-01

    Introduction Intentional rounding (IR) is a structured process whereby nurses in hospitals carry out regular checks, usually hourly, with individual patients using a standardised protocol to address issues of positioning, pain, personal needs and placement of items. The widespread implementation of IR across the UK has been driven by the recommendations of the Francis Inquiry although empirical evidence of its effectiveness is poor. This paper presents a protocol of a multimethod study using a realist evaluation approach to investigate the impact and effectiveness of IR in hospital wards on the organisation, delivery and experience of care from the perspective of patients, their family members and staff. Methods and analysis The study will be conducted in four phases. Phase 1: theory development using realist synthesis to generate hypotheses about what the mechanisms of IR may be, what particular groups may benefit most or least and what contextual factors might be important to its success or failure which will be tested in subsequent phases of the study. Phase 2: a national survey of all NHS acute trusts to explore how IR is implemented and supported across England. Phase 3: case studies to explore how IR is implemented ‘on the ground’, including individual interviews with patients, family members and staff, non-participant observation, retrieval of routinely collected patient outcomes and cost analysis. Phase 4: accumulative data analysis across the phases to scrutinise data for patterns of congruence and discordance and develop an overall evaluation of what aspects of IR work, for whom and in what circumstances. Ethics and dissemination The study has been approved by NHS South East Coast—Surrey Research Ethics Committee. Findings will be published in a wide range of outputs targeted at key audiences, including patient and carer organisations, nursing staff and healthcare managers. PMID:28069627

  11. Challenges in Integrating Nondestructive Evaluation and Finite Element Methods for Realistic Structural Analysis

    NASA Technical Reports Server (NTRS)

    Abdul-Aziz, Ali; Baaklini, George Y.; Zagidulin, Dmitri; Rauser, Richard W.

    2000-01-01

    Capabilities and expertise related to the development of links between nondestructive evaluation (NDE) and finite element analysis (FEA) at Glenn Research Center (GRC) are demonstrated. Current tools to analyze data produced by computed tomography (CT) scans are exercised to help assess the damage state in high temperature structural composite materials. A utility translator was written to convert velocity (an image processing software) STL data file to a suitable CAD-FEA type file. Finite element analyses are carried out with MARC, a commercial nonlinear finite element code, and the analytical results are discussed. Modeling was established by building MSC/Patran (a pre and post processing finite element package) generated model and comparing it to a model generated by Velocity in conjunction with MSC/Patran Graphics. Modeling issues and results are discussed in this paper. The entire process that outlines the tie between the data extracted via NDE and the finite element modeling and analysis is fully described.

  12. Emergency department evaluation of child abuse.

    PubMed

    Leetch, Aaron N; Woolridge, Dale

    2013-08-01

    Child abuse presents commonly to emergency departments. Emergency providers are confronted with medical, social, and legal dilemmas with each case. A solid understanding of the definitions and risk factors of victims and perpetrators aids in identifying abuse cases. Forensic examination should be performed only after the child is medically stable. Emergency providers are mandatory reporters of a reasonable suspicion of abuse. The role of the emergency provider is to identify abuse, facilitate a thorough investigation, treat medical needs, protect the patient, provide an unbiased medical consultation to law enforcement, and to provide an ethical testimony if called to court.

  13. Development and evaluation of realistic microbioassays in freely suspended droplets on a chip

    PubMed Central

    Rastogi, Vinayak; Velev, Orlin D.

    2007-01-01

    A novel technique for biomolecular detection in microliter droplets floating on the surface of high density oil is presented. Each droplet was captured and manipulated dielectrophoretically and was used as a site for a microscopic bioassay based on agglutination of antibody-conjugated particles. The results were read out by the pattern of unagglomerated gold nanoparticles collected on the droplet surface. Two formats of bioassays, namely gold only agglutination and gold and latex agglutination, were investigated experimentally by varying analyte concentration, particle size and concentration, number of antigen binding sites per particle, time for incubation, and rate of particle collection on the droplet surface. The microbioassays performance was also evaluated with ricin antibodies and compared to the ricin assays in field use. It is estimated that the droplet based assays require 100× smaller sample volume and are ten times more sensitive, though they require longer times to complete. The experiments were interpreted by modeling the kinetics of particle agglutination and mass transfer processes inside the droplets. The incubation time and antigen concentration values calculated by the model correlate well with the experimental results. The results could allow for development of efficient immunoassays on a chip requiring even smaller sample volumes. PMID:19693356

  14. Realistic Subscale Evaluations of the Mechanical Properties of Advanced Disk Superalloys

    NASA Technical Reports Server (NTRS)

    Gabb, Timothy P.; Gayda, John; Telesman, Jack; Kantzos, Peter T.; Konkel, William A.

    2003-01-01

    A series of experimental powder metallurgy disk alloys were evaluated for their processing characteristics and high temperature mechanical properties. Powder of each alloy was hot compacted, extruded, and isothermally forged into subscale disks. Disks were subsolvus and supersolvus heat treated, then quenched using procedures designed to reproduce the cooling paths expected in large-scale disks. Mechanical tests were then performed at 538, 704, and 815 C. Several alloys had superior tensile and creep properties at 704 C and higher temperatures, but were difficult to process and prone to quench cracking, chiefly due to their high gamma prime solvus temperature. Several other alloys had more favorable processing characteristics due to their lower gamma prime solvus temperature and balanced time-dependent properties at 704 C. Results indicate an experimental low solvus, high refractory alloy can build upon the best attributes of all these alloys, giving exceptional tensile and creep properties at high temperatures with good processing characteristics due to a low gamma prime solvus.

  15. Evaluating the influence of the 'unity assumption' on the temporal perception of realistic audiovisual stimuli.

    PubMed

    Vatakis, Argiro; Spence, Charles

    2008-01-01

    Vatakis, A. and Spence, C. (in press) [Crossmodal binding: Evaluating the 'unity assumption' using audiovisual speech stimuli. Perception &Psychophysics] recently demonstrated that when two briefly presented speech signals (one auditory and the other visual) refer to the same audiovisual speech event, people find it harder to judge their temporal order than when they refer to different speech events. Vatakis and Spence argued that the 'unity assumption' facilitated crossmodal binding on the former (matching) trials by means of a process of temporal ventriloquism. In the present study, we investigated whether the 'unity assumption' would also affect the binding of non-speech stimuli (video clips of object action or musical notes). The auditory and visual stimuli were presented at a range of stimulus onset asynchronies (SOAs) using the method of constant stimuli. Participants made unspeeded temporal order judgments (TOJs) regarding which modality stream had been presented first. The auditory and visual musical and object action stimuli were either matched (e.g., the sight of a note being played on a piano together with the corresponding sound) or else mismatched (e.g., the sight of a note being played on a piano together with the sound of a guitar string being plucked). However, in contrast to the results of Vatakis and Spence's recent speech study, no significant difference in the accuracy of temporal discrimination performance for the matched versus mismatched video clips was observed. Reasons for this discrepancy are discussed.

  16. Implementing health research through academic and clinical partnerships: a realistic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

    PubMed Central

    2011-01-01

    Background The English National Health Service has made a major investment in nine partnerships between higher education institutions and local health services called Collaborations for Leadership in Applied Health Research and Care (CLAHRC). They have been funded to increase capacity and capability to produce and implement research through sustained interactions between academics and health services. CLAHRCs provide a natural 'test bed' for exploring questions about research implementation within a partnership model of delivery. This protocol describes an externally funded evaluation that focuses on implementation mechanisms and processes within three CLAHRCs. It seeks to uncover what works, for whom, how, and in what circumstances. Design and methods This study is a longitudinal three-phase, multi-method realistic evaluation, which deliberately aims to explore the boundaries around knowledge use in context. The evaluation funder wishes to see it conducted for the process of learning, not for judging performance. The study is underpinned by a conceptual framework that combines the Promoting Action on Research Implementation in Health Services and Knowledge to Action frameworks to reflect the complexities of implementation. Three participating CLARHCS will provide in-depth comparative case studies of research implementation using multiple data collection methods including interviews, observation, documents, and publicly available data to test and refine hypotheses over four rounds of data collection. We will test the wider applicability of emerging findings with a wider community using an interpretative forum. Discussion The idea that collaboration between academics and services might lead to more applicable health research that is actually used in practice is theoretically and intuitively appealing; however the evidence for it is limited. Our evaluation is designed to capture the processes and impacts of collaborative approaches for implementing research, and

  17. Notes on the Implementation of Non-Parametric Statistics within the Westinghouse Realistic Large Break LOCA Evaluation Model (ASTRUM)

    SciTech Connect

    Frepoli, Cesare; Oriani, Luca

    2006-07-01

    In recent years, non-parametric or order statistics methods have been widely used to assess the impact of the uncertainties within Best-Estimate LOCA evaluation models. The bounding of the uncertainties is achieved with a direct Monte Carlo sampling of the uncertainty attributes, with the minimum trial number selected to 'stabilize' the estimation of the critical output values (peak cladding temperature (PCT), local maximum oxidation (LMO), and core-wide oxidation (CWO A non-parametric order statistics uncertainty analysis was recently implemented within the Westinghouse Realistic Large Break LOCA evaluation model, also referred to as 'Automated Statistical Treatment of Uncertainty Method' (ASTRUM). The implementation or interpretation of order statistics in safety analysis is not fully consistent within the industry. This has led to an extensive public debate among regulators and researchers which can be found in the open literature. The USNRC-approved Westinghouse method follows a rigorous implementation of the order statistics theory, which leads to the execution of 124 simulations within a Large Break LOCA analysis. This is a solid approach which guarantees that a bounding value (at 95% probability) of the 95{sup th} percentile for each of the three 10 CFR 50.46 ECCS design acceptance criteria (PCT, LMO and CWO) is obtained. The objective of this paper is to provide additional insights on the ASTRUM statistical approach, with a more in-depth analysis of pros and cons of the order statistics and of the Westinghouse approach in the implementation of this statistical methodology. (authors)

  18. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2006-03-01

    TERESA (Toxicological Evaluation of Realistic Emissions of Source Aerosols) involves exposing laboratory rats to realistic coal-fired power plant and mobile source emissions to help determine the relative toxicity of these PM sources. There are three coal-fired power plants in the TERESA program; this report describes the results of fieldwork conducted at the first plant, located in the Upper Midwest. The project was technically challenging by virtue of its novel design and requirement for the development of new techniques. By examining aged, atmospherically transformed aerosol derived from power plant stack emissions, we were able to evaluate the toxicity of PM derived from coal combustion in a manner that more accurately reflects the exposure of concern than existing methodologies. TERESA also involves assessment of actual plant emissions in a field setting--an important strength since it reduces the question of representativeness of emissions. A sampling system was developed and assembled to draw emissions from the stack; stack sampling conducted according to standard EPA protocol suggested that the sampled emissions are representative of those exiting the stack into the atmosphere. Two mobile laboratories were then outfitted for the study: (1) a chemical laboratory in which the atmospheric aging was conducted and which housed the bulk of the analytical equipment; and (2) a toxicological laboratory, which contained animal caging and the exposure apparatus. Animal exposures were carried out from May-November 2004 to a number of simulated atmospheric scenarios. Toxicological endpoints included (1) pulmonary function and breathing pattern; (2) bronchoalveolar lavage fluid cytological and biochemical analyses; (3) blood cytological analyses; (4) in vivo oxidative stress in heart and lung tissue; and (5) heart and lung histopathology. Results indicated no differences between exposed and control animals in any of the endpoints examined. Exposure concentrations for the

  19. [Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

    PubMed

    Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

    2015-06-01

    Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany.

  20. Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS

    PubMed Central

    Checkland, Kath; Coleman, Anna; Osipovič, Dorota; Petsoulas, Christina; Perkins, Neil

    2016-01-01

    Objectives To explore the ‘added value’ that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP ‘added value’ in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the ‘added value’ that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services. PMID:27151153

  1. Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)

    PubMed Central

    2010-01-01

    as the core mechanisms underlying the changes taking place at Ho Municipal Hospital. Conclusions This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work. PMID:21184678

  2. More than a checklist: a realist evaluation of supervision of mid-level health workers in rural Guatemala

    PubMed Central

    2014-01-01

    Background Mid-level health workers (MLHWs) form the front-line of service delivery in many low- and middle-income countries. Supervision is a critical institutional intervention linking their work to the health system, and it consists of activities intended to support health workers’ motivation and enable them to perform. However its impact depends not only on the frequency of these activities but also how they are carried out and received. This study aims to deepen understanding of the mechanisms through which supervision activities support the performance of auxiliary nurses, a cadre of MLHWs, in rural Guatemala. Methods A multiple case study was conducted to examine the operation of supervision of five health posts using a realist evaluation approach. A program theory was formulated describing local understanding of how supervision activities are intended to work. Data was collected through interviews and document review to test the theory. Analysis focused on comparison of activities, outcomes, mechanisms and the influence of context across cases, leading to revision of the program theory. Results The supervisor’s orientation was identified as the main mechanism contributing to variation observed in activities and their outcomes. Managerial control was the dominant orientation, reflecting the influence of standardized performance criteria and institutional culture. Humanized support was present in one case where the auxiliary nurse was motivated by the sense that the full scope of her work was valued. This orientation reflected the supervisor’s integration of her professional identity as a nurse. Conclusions The nature of the support health workers received was shaped by supervisors’ orientation, and in this study, nursing principles were central to humanized support. Efforts to strengthen the support that supervision provides to MLHWs should promote professional ethos as a means of developing shared performance goals and orient supervisors to a more

  3. Stroke patients’ utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation

    PubMed Central

    2014-01-01

    Background Evidence indicates that post − stroke rehabilitation improves function, independence and quality of life. A key aspect of rehabilitation is the provision of appropriate information and feedback to the learner. Advances in information and communications technology (ICT) have allowed for the development of various systems to complement stroke rehabilitation that could be used in the home setting. These systems may increase the provision of rehabilitation a stroke survivor receives and carries out, as well as providing a learning platform that facilitates long-term self-managed rehabilitation and behaviour change. This paper describes the application of an innovative evaluative methodology to explore the utilisation of feedback for post-stroke upper-limb rehabilitation in the home. Methods Using the principles of realistic evaluation, this study aimed to test and refine intervention theories by exploring the complex interactions of contexts, mechanisms and outcomes that arise from technology deployment in the home. Methods included focus groups followed by multi-method case studies (n = 5) before, during and after the use of computer-based equipment. Data were analysed in relation to the context-mechanism-outcome hypotheses case by case. This was followed by a synthesis of the findings to answer the question, ‘what works for whom and in what circumstances and respects?’ Results Data analysis reveals that to achieve desired outcomes through the use of ICT, key elements of computer feedback, such as accuracy, measurability, rewarding feedback, adaptability, and knowledge of results feedback, are required to trigger the theory-driven mechanisms underpinning the intervention. In addition, the pre-existing context and the personal and environmental contexts, such as previous experience of service delivery, personal goals, trust in the technology, and social circumstances may also enable or constrain the underpinning theory-driven mechanisms

  4. Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol

    PubMed Central

    2014-01-01

    Background Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to

  5. Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol

    PubMed Central

    Mukumbang, Ferdinand C; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian

    2016-01-01

    Introduction Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Community-based approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. Methods and analysis In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme's primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the context-mechanism-outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. Ethics and dissemination The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the

  6. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette C. Rohr; Petros Koutrakis; John Godleski

    2011-03-31

    Determining the health impacts of different sources and components of fine particulate matter (PM2.5) is an important scientific goal, because PM is a complex mixture of both inorganic and organic constituents that likely differ in their potential to cause adverse health outcomes. The TERESA (Toxicological Evaluation of Realistic Emissions of Source Aerosols) study focused on two PM sources - coal-fired power plants and mobile sources - and sought to investigate the toxicological effects of exposure to realistic emissions from these sources. The DOE-EPRI Cooperative Agreement covered the performance and analysis of field experiments at three power plants. The mobile source component consisted of experiments conducted at a traffic tunnel in Boston; these activities were funded through the Harvard-EPA Particulate Matter Research Center and will be reported separately in the peer-reviewed literature. TERESA attempted to delineate health effects of primary particles, secondary (aged) particles, and mixtures of these with common atmospheric constituents. The study involved withdrawal of emissions directly from power plant stacks, followed by aging and atmospheric transformation of emissions in a mobile laboratory in a manner that simulated downwind power plant plume processing. Secondary organic aerosol (SOA) derived from the biogenic volatile organic compound {alpha}-pinene was added in some experiments, and in others ammonia was added to neutralize strong acidity. Specifically, four scenarios were studied at each plant: primary particles (P); secondary (oxidized) particles (PO); oxidized particles + secondary organic aerosol (SOA) (POS); and oxidized and neutralized particles + SOA (PONS). Extensive exposure characterization was carried out, including gas-phase and particulate species. Male Sprague Dawley rats were exposed for 6 hours to filtered air or different atmospheric mixtures. Toxicological endpoints included (1) breathing pattern; (2) bronchoalveolar lavage

  7. Acute Chest Pain: Emergency Evaluation and Management

    PubMed Central

    Walker, David M. C.

    1982-01-01

    Since cardiovascular and pulmonary disorders have significant morbidity and mortality, triage of patients who complain of chest pain is paramount. The less sophisticated the triage system, the more important the protocol should be to have these patients evaluated immediately. History and physical are still the most important diagnostic tools; information should be gathered from all available sources. Advanced cardiac life support training is most useful. Eight diagnostic classifications are described, together with the distinctions of onset, duration, location, radiation, precipitating and relieving factors, character and associated symptoms. The protocol for initial management is outlined, emphasizing coincident management wherever possible. Imagesp2005-a PMID:21286539

  8. Towards a Holistic Framework for the Evaluation of Emergency Plans in Indoor Environments

    PubMed Central

    Serrano, Emilio; Poveda, Geovanny; Garijo, Mercedes

    2014-01-01

    One of the most promising fields for ambient intelligence is the implementation of intelligent emergency plans. Because the use of drills and living labs cannot reproduce social behaviors, such as panic attacks, that strongly affect these plans, the use of agent-based social simulation provides an approach to evaluate these plans more thoroughly. (1) The hypothesis presented in this paper is that there has been little interest in describing the key modules that these simulators must include, such as formally represented knowledge and a realistic simulated sensor model, and especially in providing researchers with tools to reuse, extend and interconnect modules from different works. This lack of interest hinders researchers from achieving a holistic framework for evaluating emergency plans and forces them to reconsider and to implement the same components from scratch over and over. In addition to supporting this hypothesis by considering over 150 simulators, this paper: (2) defines the main modules identified and proposes the use of semantic web technologies as a cornerstone for the aforementioned holistic framework; (3) provides a basic methodology to achieve the framework; (4) identifies the main challenges; and (5) presents an open and free software tool to hint at the potential of such a holistic view of emergency plan evaluation in indoor environments. PMID:24662453

  9. An Emerging Model for Student Feedback: Electronic Distributed Evaluation

    ERIC Educational Resources Information Center

    Brunk-Chavez, Beth; Arrigucci, Annette

    2012-01-01

    In this article we address several issues and challenges that the evaluation of writing presents individual instructors and composition programs as a whole. We present electronic distributed evaluation, or EDE, as an emerging model for feedback on student writing and describe how it was integrated into our program's course redesign. Because the…

  10. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2004-12-02

    slightly higher. Exposure concentrations were about 249 {micro}g/m{sup 3} PM, of which 87 {micro}g/m{sup 3} was sulfate and approximately 110 {micro}g/m{sup 3} was secondary organic material ({approx}44%). Results indicated subtle differences in breathing pattern between exposed and control (sham) animals, but no differences in other endpoints (in vivo chemiluminescence, blood cytology, bronchoalveolar lavage fluid analysis). It was suspected that primary particle losses may have been occurring in the venturi aspirator/orifice sampler; therefore, the stack sampling system was redesigned. The modified system resulted in no substantial increase in particle concentration in the emissions, leading us to conclude that the electrostatic precipitator at the power plant has high efficiency, and that the sampled emissions are representative of those exiting the stack into the atmosphere. This is important, since the objective of the Project is to carry out exposures to realistic coal combustion-derived secondary PM arising from power plants. During the next reporting period, we will document and describe the remainder of the fieldwork at Plant 0, which we expect to be complete by mid-November 2004. This report will include detailed Phase I toxicological findings for all scenarios run, and Phase II toxicological findings for one selected scenario. Depending upon the outcome of the ongoing fieldwork at Plant 0 (i.e. the biological effects observed), not all the proposed scenarios may be evaluated. The next report is also expected to include preliminary field data for Plant 1, located in the Southeast.

  11. The New Mexico School Nurse and Emergency Medical Services Emergency Preparedness Course: Program Description and Evaluation

    ERIC Educational Resources Information Center

    Elgie, Robert; Sapien, Robert E.; Fullerton-Gleason, Lynne

    2005-01-01

    Illness and injuries are common among students and school staff. Therefore, school nurses must be prepared. In this study, a 16-hour scenario-based emergency preparedness course for school nurses was evaluated for its effectiveness. Effectiveness was measured by (a) traditional methods (written exams and confidence surveys) and (b) skills and…

  12. Evaluation of an online discussion forum for emergency practitioners.

    PubMed

    Curran, Janet A; Abidi, Syed Sibte Raza

    2007-12-01

    Knowledge is a critical element in the delivery of quality healthcare. In a busy emergency department (ED) clinicians attempting clinically relevant discussion with their peers face multiple interruptions and a lack of sustained meaningful interactions. Information and communication technologies such as online discussion forums enable practitioners to share practice knowledge at times that fit into their daily workflow. We conducted an experiment in which we provided emergency clinicians with access to an asynchronous discussion forum as a medium to support development of an online social network for information exchange. The outcomes were evaluated using a social network perspective to better understand the knowledge seeking and sharing behaviors among rural and urban emergency practitioners participating in the online discussion forum. The online discussion forum created an opportunity for emergency practitioners from multiple ED sites to engage in dialogue around topics that were relevant to their practice learning needs.

  13. Evaluation of the Emergency Response Dose Assessment System(ERDAS)

    NASA Technical Reports Server (NTRS)

    Evans, Randolph J.; Lambert, Winifred C.; Manobianco, John T.; Taylor, Gregory E.; Wheeler, Mark M.; Yersavich, Ann M.

    1996-01-01

    The emergency response dose assessment system (ERDAS) is a protype software and hardware system configured to produce routine mesoscale meteorological forecasts and enhanced dispersion estimates on an operational basis for the Kennedy Space Center (KSC)/Cape Canaveral Air Station (CCAS) region. ERDAS provides emergency response guidance to operations at KSC/CCAS in the case of an accidental hazardous material release or an aborted vehicle launch. This report describes the evaluation of ERDAS including: evaluation of sea breeze predictions, comparison of launch plume location and concentration predictions, case study of a toxic release, evaluation of model sensitivity to varying input parameters, evaluation of the user interface, assessment of ERDA's operational capabilities, and a comparison of ERDAS models to the ocean breeze dry gultch diffusion model.

  14. Toxicological Evaluation of Realistic Emissions of Source Aerosols (TERESA): Application to Power Plant-Derived PM2.5

    SciTech Connect

    Annette Rohr

    2004-02-29

    This report documents progress made on the subject project during the period of September 1, 2003 through February 28, 2004. The TERESA Study is designed to investigate the role played by specific emissions sources and components in the induction of adverse health effects by examining the relative toxicity of coal combustion and mobile source (gasoline and/or diesel engine) emissions and their oxidative products. The study involves on-site sampling, dilution, and aging of coal combustion emissions at three coal-fired power plants, as well as mobile source emissions, followed by animal exposures incorporating a number of toxicological endpoints. The DOE-EPRI Cooperative Agreement (henceforth referred to as ''the Agreement'') for which this technical progress report has been prepared covers the analysis and interpretation of the field data collected at the first power plant (located in the Upper Midwest), followed by the performance and analysis of similar field experiments at two additional coal-fired power plants utilizing different coal types and with different plant configurations. Modifications to the original study design, which will improve the atmospheric aging component of the project and ensure that emissions are as realistic as possible, have resulted in project delays, and, at the time of report preparation, fieldwork at the Upper Midwest plant had not begun. However, such activities are imminent. This report therefore does not present data for activities covered by the Agreement, but does present results for the laboratory methods development work. This work is critical for the future success of the project. In particular, the atmospheric reaction simulation system is of paramount importance to the TERESA study design, since the basis for the toxicity assessment lies in the generation of realistic exposure atmospheres. The formation, composition, and toxicity of particles will be related to different atmospheric conditions and plume dilution scenarios

  15. Emergency Medical Technician Performance Evaluation. NCHSR Research Report Series.

    ERIC Educational Resources Information Center

    Frazier, William H.; Cannon, Joseph F.

    An evaluation was conducted of the diagnostic accuracy and treatment appropriateness of emergency medical technicians (EMTs) in caring for 4,455 consecutive patients during a four-and-one-half month period. Data on EMT diagnosis and treatment and physician diagnosis were collected, and EMT data validated by observers. There were fifty-eight…

  16. Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation protocol

    PubMed Central

    Vareilles, Gaëlle; Pommier, Jeanine; Kane, Sumit; Pictet, Gabriel; Marchal, Bruno

    2015-01-01

    Introduction The recruitment of community health volunteers to support the delivery of health programmes is a well-established approach in many countries, particularly where health services are not readily available. However, studies on management of volunteers are scarce and current research on human resource management of volunteers faces methodological challenges. This paper presents the protocol of a realist evaluation that aims at identifying the factors influencing the performance of community health volunteers involved in the delivery of a Red Cross immunisation programme in Kampala (Uganda) with a specific focus on motivation. Methods and analysis The realist evaluation cycle structures the protocol. To develop the theoretical basis for the evaluation, the authors conducted interviews and reviewed the literature on community health volunteers’ performance, management and organisational behaviour. This led to the formulation of the initial programme theory, which links the intervention inputs (capacity-building strategies) to the expected outcomes (positive work behaviour) with mechanisms that point in the direction of drivers of motivation. The contextual elements include components such as organisational culture, resource availability, etc. A case study design will be adopted. We define a case as a Red Cross branch, run by a programme manager, and will select two cases at the district level in Kampala. Mixed methods will be used in data collection, including individual interviews of volunteers, participant observation and document review. The thematic analysis will be based on the initial programme theory and will seek for context-mechanism-outcome configurations. Findings from the two cases will be compared. Discussion We discuss the scope for applying realist evaluation and the methodological challenges we encountered in developing this protocol. Ethics and dissemination The study was approved by the Ethical Committee at Rennes University Hospital

  17. Postpositivist Realist Theory: Identity and Representation Revisited

    ERIC Educational Resources Information Center

    Gilpin, Lorraine S.

    2006-01-01

    In postpositivist realist theory, people like Paula Moya (2000) and Satya Mohanty (2000) make a space that at once reflects and informs my location as a Third-World woman of color and a Black-immigrant educator in the United States. In postpositivist realist theory, understanding emerges from one's past and present experiences and interactions as…

  18. Understanding the acceptability and adherence to paediatric antiretroviral treatment in the new formulation of pellets (LPV/r): the protocol of a realist evaluation

    PubMed Central

    Nöstlinger, Christiana; Lee, Janice; Salami, Olawale; Lallemant, Marc; Ouma, Onyango; Nyamongo, Isaac; Marchal, Bruno

    2017-01-01

    Background Improving access to paediatric HIV treatment requires both large-scale treatment programmes and medication that is adapted to infants and children's needs. The WHO recommends lopinavir/ritonavir as first-line antiretroviral therapy for all HIV-infected children younger than 3 years. There is currently little evidence on the acceptability of, and adherence to, a formulation of this combination treatment if given in the form of pellets. This protocol presents how we will carry a realist evaluation to assess the factors that contribute to the acceptability and adherence to the new pellets formulation in 3 hospitals in Kenya. Methods We structured the protocol along the realist evaluation cycle following 4 steps: (1) the initial programme theory, (2) the study design, (3) the data collection methods and (4) the data analysis plan. Theories of behavioural sciences were reviewed for frames that could provide insights into how using such new formulations may contribute to better acceptability and adherence. Ethics and dissemination This study was approved by the Institutional Review Board of the Institute of Tropical Medicine, the Ethical Committee of the University Hospital Antwerp and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee. We aim to disseminate the findings through international conferences and peer-reviewed journals and to share them with Drugs for Neglected Diseases initiative's (DNDi) programme managers and with the Kenyan healthcare providers. Discussion In developing this study, we encountered some challenges. First, methods to measure the acceptability of any formulation and adherence to it are not standardised. The second challenge is common in realist evaluation and relates to how to choose from different potentially interesting theoretical frameworks. We identified relevant and empirically tested theories from behavioural science that may be helpful in our study. We will test them in 3 settings by

  19. Development of Metrics to Evaluate Effectiveness of Emergency Response Operations

    DTIC Science & Technology

    2005-06-01

    00-00-2005 4. TITLE AND SUBTITLE Development of Metrics to Evaluate Efectiveness of Emergency Response Operations 5a. CONTRACT NUMBER 5b. GRANT...population and/or property. Furthermore, the disaster will be characterized as being large enough that the resources the community has to mitigate the...disaster are stretched beyond the limits of their capacity. Such events that a community can readily cope with, such as small fires, individual

  20. The development and initial evaluation of a realistic simulated SPECT dataset with simultaneous respiratory and cardiac motion for gated myocardial perfusion SPECT

    NASA Astrophysics Data System (ADS)

    Lee, Taek-Soo; Tsui, Benjamin M. W.

    2015-02-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modeled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24  ×  48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into ungated, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion

  1. The Development and Initial Evaluation of a Realistic Simulated SPECT Dataset with Simultaneous Respiratory and Cardiac Motion for Gated Myocardial Perfusion SPECT

    PubMed Central

    Lee, Taek-Soo; Tsui, Benjamin M. W.

    2015-01-01

    We developed a realistic simulation dataset for simultaneous respiratory and cardiac (R&C) gated SPECT/CT using the 4D NURBS-based Cardiac-Torso (NCAT) Phantom and Monte Carlo simulation methods, and evaluated it for a sample application study. The 4D NCAT phantom included realistic respiratory motion and beating heart motion based on respiratory gated CT and cardiac tagged MRI data of normal human subjects. To model the respiratory motion, a set of 24 separate 3D NCAT phantoms excluding the heart was generated over a respiratory cycle. The beating heart motion was modelled separately with 48 frames per cardiac cycle for each of the 24 respiratory phases. The resultant set of 24×48 3D NCAT phantoms provides a realistic model of a normal human subject at different phases of combined R&C motions. An almost noise-free SPECT projection dataset for each of the 1,152 3D NCAT phantoms was generated using Monte Carlo simulation techniques and the radioactivity uptake distribution of 99mTc sestamibi in different organs. By grouping and summing the separate projection datasets, separate or simultaneous R&C gated acquired data with different gating schemes could be simulated. In the initial evaluation, we combined the projection datasets into no gating, 6 respiratory-gates only, 8 cardiac-gates only, and combined 6 respiratory-gates & 8 cardiac-gates projection datasets. Each dataset was reconstructed using 3D OS-EM without and with attenuation correction using the averaged and respiratory-gated attenuation maps, and the resulting reconstructed images were compared. These results were used to demonstrate the effects of R&C motions and the reduction of image artifact due to R&C motions by gating and attenuation corrections. We concluded that the realistic 4D NCAT phantom and Monte Carlo simulated SPECT projection datasets with R&C motions are powerful tools in the study of the effects of R&C motions, as well as in the development of R&C gating schemes and motion correction

  2. Information technology model for evaluating emergency medicine teaching

    NASA Astrophysics Data System (ADS)

    Vorbach, James; Ryan, James

    1996-02-01

    This paper describes work in progress to develop an Information Technology (IT) model and supporting information system for the evaluation of clinical teaching in the Emergency Medicine (EM) Department of North Shore University Hospital. In the academic hospital setting student physicians, i.e. residents, and faculty function daily in their dual roles as teachers and students respectively, and as health care providers. Databases exist that are used to evaluate both groups in either academic or clinical performance, but rarely has this information been integrated to analyze the relationship between academic performance and the ability to care for patients. The goal of the IT model is to improve the quality of teaching of EM physicians by enabling the development of integrable metrics for faculty and resident evaluation. The IT model will include (1) methods for tracking residents in order to develop experimental databases; (2) methods to integrate lecture evaluation, clinical performance, resident evaluation, and quality assurance databases; and (3) a patient flow system to monitor patient rooms and the waiting area in the Emergency Medicine Department, to record and display status of medical orders, and to collect data for analyses.

  3. The Evaluation of Elderly Patients by a Psychiatric Emergency Service

    PubMed Central

    Baker, F. M.; Scholhamer, Nanne

    1988-01-01

    A retrospective descriptive study of older patients evaluated by the psychiatric emergency service (PES) of a general hospital was implemented. The medical records of all patients aged 65 years and older evaluated by the PES during the 1980 calendar year were reviewed. Seventy-four patients were identified, 38 male and 36 female. Forty-three percent of the sample had no medical problems, 59 percent had a prior psychiatric history, and 38 percent had a diagnosis of organic brain syndrome. After their evaluation, 43 percent of these older patients were discharged home with a referral for outpatient treatment. In contrast to prior studies, only 35 percent of the sample were taking two or more psychoactive medications. Only two patients were referred for evaluation from skilled nursing homes. PMID:3404560

  4. Emergency Oxygen System Evaluation for Exploration PLSS Applications

    NASA Technical Reports Server (NTRS)

    Heather, Paul; Vonau, Walt, Jr.; Conger, Bruce

    2006-01-01

    The Portable Life Support System (PLSS) emergency oxygen system is being reexamined for the next generation of suits. These suits will be used for transit to Low Earth Orbit, the Moon and to Mars as well as on the surface of the Moon and Mars. Currently, the plan is that there will be two different sets of suits, but there is a strong desire for commonality between them for construction purposes. The main purpose of this paper is to evaluate what the emergency PLSS requirements are and how they might best be implemented. Options under consideration are enlarging the tanks on the PLSS, finding an alternate method of storage/delivery, or providing additional O2 from an external source. The system that shows the most promise is the cryogenic oxygen system with a composite dewar which uses a buddy system to split the necessary oxygen between two astronauts.

  5. Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation

    PubMed Central

    Vareilles, Gaëlle; Marchal, Bruno; Kane, Sumit; Petrič, Taja; Pictet, Gabriel; Pommier, Jeanine

    2015-01-01

    Objectives This paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacity-building intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda. Method Given the complexity of the intervention, we adopted realist evaluation as our methodological approach and the case study as our study design. Data collection included document review, participant observation and interviews. The constant comparative method was used for the analysis. Two contrasted cases were selected within the five Kampala districts. Each case covers the management of the immunisation programme implemented at a RC branch. In each case, a programme manager and 15 RC volunteers were interviewed. The selection of the volunteers was purposive. Results We found that a capacity-building programme including supervision supportive of autonomy, skills and knowledge enhancement, and adapted to the different subgroups of volunteers, leads to satisfaction of the three key drivers of volunteer motivation: feelings of autonomy, competence and connectedness. This contributes to higher retention, and better task performance and well-being among the volunteers. Enabling contextual conditions include the responsiveness of the Uganda Red Cross Society (URCS) to community needs, and recognition of the work of the volunteers, from the URCS and the community. Conclusions A management approach that caters for the different motivational states and changing needs of the volunteers will lead to better performance. The findings will inform not only the management of community health volunteers, but also the management of all kinds of health workers. PMID:26525721

  6. Toxicological Evaluation of Realistic Emission Source Aerosols (TERESA)—Power plant studies: assessment of breathing pattern

    PubMed Central

    Diaz, Edgar A.; Lemos, Miriam; Coull, Brent; Long, Mark S.; Rohr, Annette C.; Ruiz, Pablo; Gupta, Tarun; Kang, Choong-Min; Godleski, John J.

    2013-01-01

    Our approach to study multi-pollutant aerosols isolates a single emissions source, evaluates the toxicity of primary and secondary particles derived from this source, and simulates chemical reactions that occur in the atmosphere after emission. Three U.S. coal-fired power plants utilizing different coals and with different emission controls were evaluated. Secondary organic aerosol (SOA) derived from α-pinene and/or ammonia was added in some experiments. Male Sprague-Dawley rats were exposed for 6 h to filtered air or different atmospheric mixtures. Scenarios studied at each plant included the following: primary particles (P); secondary (oxidized) particles (PO); oxidized particles + SOA (POS); and oxidized and neutralized particles + SOA (PONS); additional control scenarios were also studied. Continuous respiratory data were obtained during exposures using whole body plethysmography chambers. Of the 12 respiratory outcomes assessed, each had statistically significant changes at some plant and with some of the 4 scenarios. The most robust outcomes were found with exposure to the PO scenario (increased respiratory frequency with decreases in inspiratory and expiratory time); and the PONS scenario (decreased peak expiratory flow and expiratory flow at 50%). PONS findings were most strongly associated with ammonium, neutralized sulfate, and elemental carbon (EC) in univariate analyses, but only with EC in multivariate analyses. Control scenario O (oxidized without primary particles) had similar changes to PO. Adjusted R2 analyses showed that scenario was a better predictor of respiratory responses than individual components, suggesting that the complex atmospheric mixture was responsible for respiratory effects. PMID:21639693

  7. Bridging the gap between real-life data and simulated data by providing a highly realistic fall dataset for evaluating camera-based fall detection algorithms.

    PubMed

    Baldewijns, Greet; Debard, Glen; Mertes, Gert; Vanrumste, Bart; Croonenborghs, Tom

    2016-03-01

    Fall incidents are an important health hazard for older adults. Automatic fall detection systems can reduce the consequences of a fall incident by assuring that timely aid is given. The development of these systems is therefore getting a lot of research attention. Real-life data which can help evaluate the results of this research is however sparse. Moreover, research groups that have this type of data are not at liberty to share it. Most research groups thus use simulated datasets. These simulation datasets, however, often do not incorporate the challenges the fall detection system will face when implemented in real-life. In this Letter, a more realistic simulation dataset is presented to fill this gap between real-life data and currently available datasets. It was recorded while re-enacting real-life falls recorded during previous studies. It incorporates the challenges faced by fall detection algorithms in real life. A fall detection algorithm from Debard et al. was evaluated on this dataset. This evaluation showed that the dataset possesses extra challenges compared with other publicly available datasets. In this Letter, the dataset is discussed as well as the results of this preliminary evaluation of the fall detection algorithm. The dataset can be downloaded from www.kuleuven.be/advise/datasets.

  8. 75 FR 22817 - Emerging Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-30

    ... HUMAN SERVICES Food and Drug Administration Emerging Infectious Diseases: Evaluation to Implementation... Infectious Diseases: Evaluation to Implementation for Transfusion and Transplantation Safety'' (EID public... of risk from, and prioritization of response to, emerging infectious diseases relevant to...

  9. Compact Multi-Gas Monitor for Life Support Systems Control in Space: Evaluation Under Realistic Environmental Conditions

    NASA Technical Reports Server (NTRS)

    Alonso, Jesus Delgado; Phillips, Straun; Chullen, Cinda; Mendoza, Edgar

    2014-01-01

    Advanced space life support systems require lightweight, low-power, durable sensors for monitoring critical gas components. A luminescence-based optical flow-through cell to monitor carbon dioxide, oxygen, and humidity has been developed and was demonstrated using bench-top instrumentation under environmental conditions relevant to portable life support systems, including initially pure oxygen atmosphere, temperature range from 50 F to 150 F, and humidity from dry to 100% RH and under conditions of water condensation. This paper presents the most recent progress in the development of this sensor technology. Trace gas contaminants in a space suit, originating from hardware and material off-gassing and crew member metabolism, are from many chemical families. The result is a gas mix much more complex than the pure oxygen fed into the space suit, and this complexity may interfere with gas sensor readings. This paper presents an evaluation of optical sensor performance when exposed to the most significant trace gases reported to be found in space suits. A study of the calibration stability of the sensors is also presented. For that purpose, a profile of temperature, pressure, humidity, and gas composition for the duration of an EVA has been defined, and the performance of sensors operated repeatedly under those conditions has been studied. Finally, this paper presents the first compact readout unit for these optical sensors, designed for the volume, power, and weight restrictions of a PLSS.

  10. Evaluation of a micro-scale wind model's performance over realistic building clusters using wind tunnel experiments

    NASA Astrophysics Data System (ADS)

    Zhang, Ning; Du, Yunsong; Miao, Shiguang; Fang, Xiaoyi

    2016-08-01

    The simulation performance over complex building clusters of a wind simulation model (Wind Information Field Fast Analysis model, WIFFA) in a micro-scale air pollutant dispersion model system (Urban Microscale Air Pollution dispersion Simulation model, UMAPS) is evaluated using various wind tunnel experimental data including the CEDVAL (Compilation of Experimental Data for Validation of Micro-Scale Dispersion Models) wind tunnel experiment data and the NJU-FZ experiment data (Nanjing University-Fang Zhuang neighborhood wind tunnel experiment data). The results show that the wind model can reproduce the vortexes triggered by urban buildings well, and the flow patterns in urban street canyons and building clusters can also be represented. Due to the complex shapes of buildings and their distributions, the simulation deviations/discrepancies from the measurements are usually caused by the simplification of the building shapes and the determination of the key zone sizes. The computational efficiencies of different cases are also discussed in this paper. The model has a high computational efficiency compared to traditional numerical models that solve the Navier-Stokes equations, and can produce very high-resolution (1-5 m) wind fields of a complex neighborhood scale urban building canopy (~ 1 km ×1 km) in less than 3 min when run on a personal computer.

  11. TOXICOLOGICAL EVALUATION OF REALISTIC EMISSIONS OF SOURCE AEROSOLS (TERESA): APPLICATION TO POWER PLANT-DERIVED PM2.5

    SciTech Connect

    Annette Rohr

    2005-03-31

    emissions were performed. Stage I toxicological assessments were carried out in Sprague-Dawley rats. Biological endpoints included breathing pattern/pulmonary function; in vivo chemiluminescence (an indicator of oxidative stress); blood cytology; bronchoalveolar lavage (BAL) fluid analysis; and histopathology. No significant differences between exposed animals and sham animals (exposed to filtered air) were observed for any of the endpoints; histopathological results are pending and will be reported in the next semiannual report. The scenarios evaluated during this reporting period were slightly modified from those originally proposed. We substituted a new scenario, secondary aerosol + SOA, to investigate the effects of a strongly acidic aerosol with a biogenic component. Since we did not observe any biological response to this scenario, the neutralized secondary aerosol scenario (i.e., oxidized emissions + ammonia) was deemed unnecessary. Moreover, in light of the lack of response observed in the Stage I assessment, it was decided that a Stage II assessment (evaluation of cardiac function in a compromised rat model) was unlikely to provide useful information. However, this model will be employed at Plant 1 and/or 2. During this reporting period, significant progress was made in planning for fieldwork at Plant 1. Stack sampling was carried out at the plant in mid-December to determine the concentration of primary particles. It was found that PM{sub 2.5} mass concentrations were approximately three times higher than those observed at Plant 0. In mid-February, installation and setup for the mobile laboratories began. Animal exposures are scheduled to begin at this plant on March 21, 2005. During the next reporting period, we will initiate fieldwork at Plant 1. At either or both Plants 1 and 2, a detailed Stage II assessment will be performed, even if no significant findings are observed in Stage I. The next semiannual report is expected to include a detailed description of

  12. Compact Multi-Gas Monitor for Life Support Systems Control in Space: Evaluation Under Realistic Environmental Conditions

    NASA Technical Reports Server (NTRS)

    Delgado, Jesus; Chullen, Cinda; Mendoza, Edgar

    2014-01-01

    Advanced space life support systems require lightweight, low-power, durable sensors for monitoring critical gas components. A luminescence-based optical flow-through cell to monitor carbon dioxide, oxygen, and humidity has been developed and was demonstrated using bench top instrumentation under environmental conditions relevant to portable life support systems, including initially pure oxygen atmosphere, pressure range from 3.5 to 14.7 psi, temperature range from 50 F to 150 F, and humidity from dry to 100% RH and under liquid water saturation. This paper presents the first compact readout unit for these optical sensors, designed for the volume, power, and weight restrictions of a spacesuit portable Life support system and the analytical characterization of the optical sensors interrogated by the novel optoelectronic system. Trace gas contaminants in a space suit, originating from hardware and material off-gassing and crew member metabolism, are from many chemical families. The result is a gas mix much more complex than the pure oxygen fed into the spacesuit, which may interfere with gas sensor readings. The paper also presents an evaluation of optical sensor performance when exposed to the most significant trace gases reported to be found in spacesuits. The studies were conducted with the spacecraft maximum allowable concentrations for those trace gases and the calculated 8-hr. concentrations resulting from having no trace contaminant control system in the ventilation loop. Finally, a profile of temperature, pressure, humidity, and gas composition for a typical EVA mission has been defined, and the performance of sensors operated repeatedly under simulated EVA mission conditions has been studied.

  13. Can a sustainability and health scenario provide a realistic challenge to student nurses and provoke changes in practice? An evaluation of a training intervention.

    PubMed

    Grose, J; Richardson, J

    2016-06-01

    Climate change and limited natural resources will impact on the sustainable supply and disposal of materials used in health care. Healthcare students need opportunities to reflect on the ecological footprint of health services to mitigate against negative effects on service delivery. In order to raise awareness of these issues, there is a need for evidence-based teaching tools which are relevant and meaningful to nursing practice. An evidence-based sustainability skills teaching session was delivered to 293 nursing students from child and adult health disciplines. Following the sessions, evaluation sheets were distributed to the participants, of which 290 responded. The majority of nurses valued both the delivery and the content of the training and some were motivated to complete further study. The evaluation provided valuable information on how to deliver sustainability education and important insights into where more information and support was needed in order to change practice. Embedding sustainability teaching in skill sessions appears to be a realistic way of informing and motivating learners to consider current and best practice. Following training, further evaluation of practice-based behaviour is needed.

  14. Evaluation of phytotoxicity and ecotoxicity potentials of a cyanobacterial extract containing microcystins under realistic environmental concentrations and in a soil-plant system.

    PubMed

    Corbel, Sylvain; Mougin, Christian; Martin-Laurent, Fabrice; Crouzet, Olivier; Bru, David; Nélieu, Sylvie; Bouaïcha, Noureddine

    2015-06-01

    The impact of a crude extract of Microcystis aeruginosa (PCC7820) containing 14 microcystin variants was investigated on seeds germination and radicles development of four agricultural plants: two tomato varieties Solanum lycopersicum (MicroTom and Saint-Pierre), the wheat Triticum aestivum and the lettuce Lactuca sativa. In addition, the effect of 14 d-exposure to irrigation water containing realistic concentrations of microcystins (0-0.1 mg eq. microcystin-LRL(-1)) on the tomato MicroTom seedling growth was further evaluated on roots and aerial part biomasses. Impacts on soil bacterial parameters, as such extracellular enzymatic activities, nitrification activity and abundances of ammonia-oxidizing microorganisms were also investigated. In germination-test, the cyanobacterial extract inhibited only the germination of the wheat seeds, with an EC50 of 11 mg eq. microcystin-LRL(-1); which is 13 times lower than that of the cadmium chloride (EC50 of 145 mg L(-1)). Moreover, the cyanobacterial extract containing low concentrations of microcystins increased the growth of primary roots; however, high concentrations decreased it for all plants except for the wheat. In the soil-plant approach, only aerial part biomass of the tomato MicroTom was enhanced significantly. In addition, only soil nitrification potential and ammonia-oxidizing bacterial abundances were consistently impacted. A significant positive correlation (r=0.56) was found between the increase of nitrification potential and abundances of ammonia-oxidizing bacteria. This work suggested, that exposure to a cyanobacterial extract containing realistic environmental microcystins concentrations could affect seed germination, depending plant species. It was also highlighted, for the first time, disturbances in soil bacteria functioning, evidences on soil nitrification process.

  15. MO-AB-BRA-09: Temporally Realistic Manipulation a 4D Biomechanical Lung Phantom for Evaluation of Simultaneous Registration and Segmentation

    SciTech Connect

    Markel, D; Levesque, I R.; Larkin, J; Leger, P; El Naqa, I

    2015-06-15

    Purpose: To produce multi-modality compatible, realistic datasets for the joint evaluation of segmentation and registration with a reliable ground truth using a 4D biomechanical lung phantom. The further development of a computer controlled air flow system for recreation of real patient breathing patterns is incorporated for additional evaluation of motion prediction algorithms. Methods: A pair of preserved porcine lungs was pneumatically manipulated using an in-house computer controlled respirator. The respirator consisted of a set of bellows actuated by a 186 W computer controlled industrial motor. Patient breathing traces were recorded using a respiratory bellows belt during CT simulation and input into a control program incorporating a proportional-integral-derivative (PID) feedback controller in LabVIEW. Mock tumors were created using dual compartment vacuum sealed sea sponges. 65% iohexol,a gadolinium-based contrast agent and 18F-FDG were used to produce contrast and thus determine a segmentation ground truth. The intensity distributions of the compartments were then digitally matched for the final dataset. A bifurcation tracking pipeline provided a registration ground truth using the bronchi of the lung. The lungs were scanned using a GE Discovery-ST PET/CT scanner and a Phillips Panorama 0.23T MRI using a T1 weighted 3D fast field echo (FFE) protocol. Results: The standard deviation of the error between the patient breathing trace and the encoder feedback from the respirator was found to be ±4.2%. Bifurcation tracking error using CT (0.97×0.97×3.27 mm{sup 3} resolution) was found to be sub-voxel up to 7.8 cm displacement for human lungs and less than 1.32 voxel widths in any axis up to 2.3 cm for the porcine lungs. Conclusion: An MRI/PET/CT compatible anatomically and temporally realistic swine lung phantom was developed for the evaluation of simultaneous registration and segmentation algorithms. With the addition of custom software and mock tumors, the

  16. Anemia in the emergency department: evaluation and treatment.

    PubMed

    Janz, Timothy G; Johnson, Roy L; Rubenstein, Scott D

    2013-11-01

    Anemia is a common worldwide problem that is associated with nonspecific complaints. The initial focus for the emergency evaluation of anemia is to determine whether the problem is acute or chronic. Acute anemia is most commonly associated with blood loss, and the patient is usually symptomatic. Chronic anemia is usually well tolerated and is often discovered coincidentally. Once diagnosed, the etiology of anemia can often be determined by applying a systematic approach to its evaluation. The severity of the anemia impacts clinical outcomes, particularly in critically ill patients; however, the specific threshold to transfuse is uncertain. Evaluation of the current literature and clinical guidelines does not settle this controversy, but it does help clarify that a restrictive transfusion strategy (ie, for patients with a hemoglobin < 6-8 g/dL) is associated with better outcomes than a more liberal transfusion strategy. Certain anemias may have well-defined treatment options (eg, sickle cell disease), but empiric use of nutritional supplements to treat anemia of uncertain etiology is discouraged.

  17. Performance evaluation of two emerging media processors: VIRAM and imagine

    SciTech Connect

    Oliker, Leonid; Duell, Jason; Narayanan, Manikandan; Chatterji, Sourav

    2003-01-01

    This work presents two emerging media microprocessors, VIRAM and Imagine, and compares the implementation strategies and performance results of these unique architectures. VIRAM is a complete system on a chip which uses PIM technology to combine vector processing with embedded DRAM. Imagine is a programmable streaming architecture with a specialized memory hierarchy designed for computationally intensive data-parallel codes. First, we present a simple and effective approach for understanding and optimizing vector/stream applications. Performance results are then presented from a number of multimedia benchmarks and a computationally intensive scientific kernel. We explore the complex interact ions between programming paradigms, the architectural support at the ISA lever and the underlying microarchitecture of these two systems. Our long term goal is to evaluate leading media microprocessors as possible building blocks for future high performance systems.

  18. Evaluation of quantitative imaging methods for organ activity and residence time estimation using a population of phantoms having realistic variations in anatomy and uptake

    SciTech Connect

    He Bin; Du Yong; Segars, W. Paul; Wahl, Richard L.; Sgouros, George; Jacene, Heather; Frey, Eric C.

    2009-02-15

    Estimating organ residence times is an essential part of patient-specific dosimetry for radioimmunotherapy (RIT). Quantitative imaging methods for RIT are often evaluated using a single physical or simulated phantom but are intended to be applied clinically where there is variability in patient anatomy, biodistribution, and biokinetics. To provide a more relevant evaluation, the authors have thus developed a population of phantoms with realistic variations in these factors and applied it to the evaluation of quantitative imaging methods both to find the best method and to demonstrate the effects of these variations. Using whole body scans and SPECT/CT images, organ shapes and time-activity curves of 111In ibritumomab tiuxetan were measured in dosimetrically important organs in seven patients undergoing a high dose therapy regimen. Based on these measurements, we created a 3D NURBS-based cardiac-torso (NCAT)-based phantom population. SPECT and planar data at realistic count levels were then simulated using previously validated Monte Carlo simulation tools. The projections from the population were used to evaluate the accuracy and variation in accuracy of residence time estimation methods that used a time series of SPECT and planar scans. Quantitative SPECT (QSPECT) reconstruction methods were used that compensated for attenuation, scatter, and the collimator-detector response. Planar images were processed with a conventional (CPlanar) method that used geometric mean attenuation and triple-energy window scatter compensation and a quantitative planar (QPlanar) processing method that used model-based compensation for image degrading effects. Residence times were estimated from activity estimates made at each of five time points. The authors also evaluated hybrid methods that used CPlanar or QPlanar time-activity curves rescaled to the activity estimated from a single QSPECT image. The methods were evaluated in terms of mean relative error and standard deviation of the

  19. Volume overview: Working with assumptions. Existing and emerging approaches for improved program design, monitoring and evaluation.

    PubMed

    Nkwake, Apollo M; Morrow, Nathan

    2016-12-01

    This volume attempts to systematically capture the state of practice, highlight commonalities linking existing and emerging approaches to assumption-making and evaluation. It tries to organize existing and emerging knowledge, tools and terminology into an emergent but useful typology for working with assumptions and complexity in program designs, monitoring and evaluation.

  20. Evaluation of Rugged Wireless Mesh Nodes for Use In Emergency Response

    SciTech Connect

    Kevin L Young; Alan M Snyder

    2007-11-01

    During the summer of 2007, engineers at the Idaho National Laboratory (INL) conducted a two-day evaluation of commercially available battery powered, wireless, self-forming mesh nodes for use in emergency response. In this paper, the author describes the fundamentals of this emerging technology, applciations for emergency response and specific results of the technology evaluation conducted at the Idaho National Laboratory.

  1. How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong.

    PubMed

    Wong, Eliza L Y; Yeoh, Eng-Kiong; Chau, Patsy Y K; Yam, Carrie H K; Cheung, Annie W L; Fung, Hong

    2015-12-01

    The World Health Organization advocates the goal of universal coverage of health systems to ensure that everyone can avail the services they need and are protected from the associated financial risks. Governments are increasingly engaging and interacting with the private sector in initiatives collectively referred to as public-private partnerships (PPPs) to enhance the capacity of health systems to meet this objective. Understanding the values that motivate partners and demonstrating commitment for building relationships were found to be key lessons in building effective PPPs; however there, remain many research gaps. This study focusses on the practice of PPPs at the inter-organisational (meso) level and interpersonal (micro) level in Hong Kong Special Administrative Region (HKSAR). The influence of the structural components of different PPPs on stakeholder interpretation and actions, as well as the eventual outcomes of the PPPs, is examined, in terms of a realist evaluation, which applies a context-mechanism-outcome configuration as the research methodology. Seven key factors initiating commitment in a partnership, critical for sustainable PPPs, were identified as follows: (1) building of trust; (2) clearly defined objectives and roles; (3) time commitment; (4) transparency and candid information, particularly in relation to risk and benefit; (5) contract flexibility; (6) technical assistance or financial incentive behind procedural arrangements; and (7) the awareness and acceptability of structural changes related to responsibility and decisions (power and authority).

  2. Supporting Sustainable Markets Through Life Cycle Assessment: Evaluating emerging technologies, incorporating uncertainty and the consumer perspective

    NASA Astrophysics Data System (ADS)

    Merugula, Laura

    As civilization's collective knowledge grows, we are met with the realization that human-induced physical and biological transformations influenced by exogenous psychosocial and economic factors affect virtually every ecosystem on the planet. Despite improvements in energy generation and efficiencies, demand of material goods and energy services increases with no sign of a slowing pace. Sustainable development requires a multi-prong approach that involves reshaping demand, consumer education, sustainability-oriented policy, and supply chain management that does not serve the expansionist mentality. Thus, decision support tools are needed that inform developers, consumers, and policy-makers for short-term and long-term planning. These tools should incorporate uncertainty through quantitative methods as well as qualitatively informing the nature of the model as imperfect but necessary and adequate. A case study is presented of the manufacture and deployment of utility-scale wind turbines evaluated for a proposed change in blade manufacturing. It provides the first life cycle assessment (LCA) evaluating impact of carbon nanofibers, an emerging material, proposed for integration to wind power generation systems as blade reinforcement. Few LCAs of nanoproducts are available in scientific literature due to research and development (R&D) for applications that continues to outpace R&D for environmental, health, and safety (EHS) and life cycle impacts. LCAs of emerging technologies are crucial for informing developers of potential impacts, especially where market growth is swift and dissipative. A second case study is presented that evaluates consumer choice between disposable and reusable beverage cups. While there are a few studies that attempt to make the comparison using LCA, none adequately address uncertainty, nor are they representative for the typical American consumer. By disaggregating U.S. power generation into 26 subregional grid production mixes and evaluating

  3. Performance Evaluation of Emerging High Performance Computing Technologies using WRF

    NASA Astrophysics Data System (ADS)

    Newby, G. B.; Morton, D.

    2008-12-01

    The Arctic Region Supercomputing Center (ARSC) has evaluated multicore processors and other emerging processor technologies for a variety of high performance computing applications in the earth and space sciences, especially climate and weather applications. A flagship effort has been to assess dual core processor nodes on ARSC's Midnight supercomputer, in which two-socket systems were compared to eight-socket systems. Midnight is utilized for ARSC's twice-daily weather research and forecasting (WRF) model runs, available at weather.arsc.edu. Among other findings on Midnight, it was found that the Hypertransport system for interconnecting Opteron processors, memory, and other subsystems does not scale as well on eight-socket (sixteen processor) systems as well as two-socket (four processor) systems. A fundamental limitation is the cache snooping operation performed whenever a computational thread accesses main memory. This increases memory latency as the number of processor sockets increases. This is particularly noticeable on applications such as WRF that are primarily CPU-bound, versus applications that are bound by input/output or communication. The new Cray XT5 supercomputer at ARSC features quad core processors, and will host a variety of scaling experiments for WRF, CCSM4, and other models. Early results will be presented, including a series of WRF runs for Alaska with grid resolutions under 2km. ARSC will discuss a set of standardized test cases for the Alaska domain, similar to existing test cases for CONUS. These test cases will provide different configuration sizes and resolutions, suitable for single processors up to thousands. Beyond multi-core Opteron-based supercomputers, ARSC has examined WRF and other applications on additional emerging technologies. One such technology is the graphics processing unit, or GPU. The 9800-series nVidia GPU was evaluated with the cuBLAS software library. While in-socket GPUs might be forthcoming in the future, current

  4. Realistic collective nuclear Hamiltonian

    NASA Astrophysics Data System (ADS)

    Dufour, Marianne; Zuker, Andrés P.

    1996-10-01

    The residual part of the realistic forces-obtained after extracting the monopole terms responsible for bulk properties-is strongly dominated by pairing and quadrupole interactions, with important στ.στ, octupole, and hexadecapole contributions. Their forms retain the simplicity of the traditional pairing plus multipole models, while eliminating their flaws through a normalization mechanism dictated by a universal A-1/3 scaling. Coupling strengths and effective charges are calculated and shown to agree with empirical values. Comparisons between different realistic interactions confirm the claim that they are very similar.

  5. Realistic and Schematic Visuals.

    ERIC Educational Resources Information Center

    Heuvelman, Ard

    1996-01-01

    A study examined three different visual formats (studio presenter only, realistic visuals, or schematic visuals) of an educational television program. Recognition and recall of the abstract subject matter were measured in 101 adult viewers directly after the program and 3 months later. The schematic version yielded better recall of the program,…

  6. Emergency Department Crowding: Time for Interventions and Policy Evaluations

    PubMed Central

    Boyle, Adrian; Beniuk, Kathleen; Higginson, Ian; Atkinson, Paul

    2012-01-01

    This paper summarises the consequences of emergency department crowding. It provides a comparison of the scales used to measure emergency department crowding. We discuss the multiple causes of crowding and present an up-to-date literature review of the interventions that reduce the adverse consequences of crowding. We consider interventions at the level of an individual hospital and a policy level. PMID:22454772

  7. Investigating the organisational impacts of quality improvement: a protocol for a realist evaluation of improvement approaches drawing on the Resource Based View of the Firm

    PubMed Central

    Burton, Christopher R; Rycroft Malone, Jo; Robert, Glenn; Willson, Alan; Hopkins, Angela

    2014-01-01

    Introduction Little is understood about the role of quality improvement in enabling health organisations to survive and thrive in the contemporary context of financial and economic challenges. We will draw on the theoretical foundations of the ‘Resource Based View of the Firm’ (RBV) to develop insights into why health organisations engage in improvement work, how impacts are conceptualised, and ‘what works’ in delivering these impacts. Specifically, RBV theorises that the mix and use of resources across different organisations may explain differences in performance. Whether improvement work influences these resources is unclear. Methods and analysis Case study research will be conducted across health organisations participating in four approaches to improvement, including: a national improvement programme; a multiorganisational partnership around implementation; an organisational strategy for quality improvement; and a coproduction project designed to enhance the experience of a clinical service from the perspective of patients. Data will comprise in-depth interviews with key informants, observation of key events and documents; analysed within and then across cases. Adopting a realist perspective, the core tenets of RBV will be evaluated as a programme theory, focusing on the interplay between organisational conditions and behavioural or resource responses that are reported through engagement in improvement. Ethics and dissemination The study has been approved by Bangor University Ethics Committee. The investigation will not judge the relative merits of different approaches to healthcare quality improvement. Rather, we will develop unique insights into the organisational consequences, and dependencies of quality improvement, providing an opportunity to add to the explanatory potential of RBV in this and other contexts. In addition to scientific and lay reports of the study findings, research outputs will include a framework for constructing the economic

  8. Before the Emergency: A Framework for Evaluating Emergency Preparedness Alternatives at Higher Education Institutions

    DTIC Science & Technology

    2010-09-01

    preparedness, emergency management, campus, decision analysis, Stanford University 15. NUMBER OF PAGES 193 16. PRICE CODE 17. SECURITY CLASSIFICATION...potential loss from hazards. Measures may include zoning and building codes, floodplain buyouts , and analysis of hazard-related data to determine where it...organizational structure of the University of Oregon emergency management program, it is worth noting how the evolution took place. The Web site

  9. Simulation of realistic retinoscopic measurement

    NASA Astrophysics Data System (ADS)

    Tan, Bo; Chen, Ying-Ling; Baker, K.; Lewis, J. W.; Swartz, T.; Jiang, Y.; Wang, M.

    2007-03-01

    Realistic simulation of ophthalmic measurements on normal and diseased eyes is presented. We use clinical data of ametropic and keratoconus patients to construct anatomically accurate three-dimensional eye models and simulate the measurement of a streak retinoscope with all the optical elements. The results show the clinical observations including the anomalous motion in high myopia and the scissors reflex in keratoconus. The demonstrated technique can be applied to other ophthalmic instruments and to other and more extensively abnormal eye conditions. It provides promising features for medical training and for evaluating and developing ocular instruments.

  10. 1992 UPDATE OF U.S. EPA'S SUPERFUND INNOVATIVE TECHNOLOGY EVALUATION (SITE) EMERGING TECHNOLOGY PROGRAM

    EPA Science Inventory

    The Superfund Innovative Technology Evaluation (SITE) Emerging Technology Program (ETP) has encouraged and financially supported further development of bench- and pilot-scale testing and evaluation of innovative technologies suitable for use at hazardous waste sites for five year...

  11. Evaluation of a Tabletop Emergency Preparedness Exercise for Pharmacy Students

    PubMed Central

    Bratberg, Jeffrey P.; Robertson, Courtney; Smith, Gregory

    2016-01-01

    Objective. To describe the implementation and effect of an emergency preparedness laboratory activity on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist’s role in disaster response. Design. Second-year pharmacy students in the infectious disease module participated in a laboratory activity based on a basic disaster response tabletop exercise format. Three case-based scenarios involving infectious diseases were created by participating faculty members. Assessment. Surveys before and after the laboratory were used to assess the activity’s effect on student knowledge, willingness to participate in emergency preparedness training, current level of preparedness, and the importance of a pharmacist’s role in disaster response. In addition, the postsurvey assessed student perceptions of the activity’s success at accomplishing faculty-specified outcomes from Appendix B of the Accreditation Council for Pharmacy Education’s (ACPE) Standards. Conclusion. Implementation of an emergency response laboratory activity may improve overall students’ knowledge of, confidence in, and understanding of their role as pharmacists in an emergency response, while incorporating a variety of skills and knowledge outcomes. PMID:27170821

  12. Emergency department evaluation and treatment of cervical spine injuries.

    PubMed

    Kanwar, Rajdeep; Delasobera, Bronson E; Hudson, Korin; Frohna, William

    2015-05-01

    Most spinal cord injuries involve the cervical spine, highlighting the importance of recognition and proper management by emergency physicians. Initial cervical spine injury management should follow the ABCDE (airway, breathing, circulation, disability, exposure) procedure detailed by Advanced Trauma Life Support. NEXUS (National Emergency X-Radiography Utilization Study) criteria and Canadian C-spine Rule are clinical decision-making tools providing guidelines of when to obtain imaging. Computed tomography scans are the preferred initial imaging modality. Consider administering intravenous methylprednisolone after discussion with the neurosurgical consultant in patients who present with spinal cord injuries within 8 hours.

  13. Evaluating the Emergence of Reverse Intraverbals in Children with Autism

    ERIC Educational Resources Information Center

    Allan, Alicia C.; Vladescu, Jason C.; Kisamore, April N.; Reeve, Sharon A.; Sidener, Tina M.

    2015-01-01

    Verbal behavior plays a fundamental role in the development of complex social and communication skills. Many children diagnosed with autism spectrum disorder exhibit profound deficiencies in intraverbal repertoires and the development of social relationships. Recent studies that investigated the effects of intraverbal training on the emergence of…

  14. A realistic lattice example

    SciTech Connect

    Courant, E.D.; Garren, A.A.

    1985-10-01

    A realistic, distributed interaction region (IR) lattice has been designed that includes new components discussed in the June 1985 lattice workshop. Unlike the test lattices, the lattice presented here includes utility straights and the mechanism for crossing the beams in the experimental straights. Moreover, both the phase trombones and the dispersion suppressors contain the same bending as the normal cells. Vertically separated beams and 6 Tesla, 1-in-1 magnets are assumed. Since the cells are 200 meters long, and have 60 degree phase advance, this lattice has been named RLD1, in analogy with the corresponding test lattice, TLD1. The quadrupole gradient is 136 tesla/meter in the cells, and has similar values in other quadrupoles except in those in the IR`s, where the maximum gradient is 245 tesla/meter. RLD1 has distributed IR`s; however, clustered realistic lattices can easily be assembled from the same components, as was recently done in a version that utilizes the same type of experimental and utility straights as those of RLD1.

  15. Evaluation of the need for emergency heat exchangers for long term emergency cooling of the Advanced Neutron Source Reactor

    SciTech Connect

    Khayat, M.I.; Anderson, J.L.; Battle, R.E.; March-Leuba, J.

    1994-05-01

    This report summarizes the work performed to evaluate the heat transferred to the light water pools from the primary piping system for the Advanced Neutron Source reactor (ANSR) conceptual design. It has been determined that the ANSR primary piping system will remove sufficient heat from the primary coolant system to the pools for certain design basis event accidents without the emergency heat exchangers if the design parameters, such as pool volumes and pipe sizes (length and surface area), are selected appropriately. Based on this analysis, the emergency heat exchangers might be removed, and their function can be performed by the primary piping passing through the light water pools described in the conceptual design report. This study also shows that connecting the pipe chase pool and the heat exchanger pools improve performance for ANSR emergency heat removal.

  16. A preliminary evaluation of the emergence of novel mand forms.

    PubMed

    Hernandez, Emma; Hanley, Gregory P; Ingvarsson, Einar T; Tiger, Jeffrey H

    2007-01-01

    Strategies that produce generalized responding are valuable, especially with regard to language acquisition, because relatively little training may result in large behavior changes. Conditions that result in generalized manding were analyzed in the current study. We demonstrated in reversal designs that undesirable or single-word responses were the predominant mand forms of 3 preschool children. Multiple baseline designs with 2 participants and a reversal design with 1 participant were then used to demonstrate the extent to which differential reinforcement of single-word mands (e.g., "cars") or framed mands (e.g., "I want the cars, please") would result in the emergence of other single-word and framed mands for different items (e.g., mands for music, puppets, or puzzles). Results showed that prompting and differential reinforcement of one or two mand frames resulted in the emergence of other framed mands for all participants.

  17. Emerging technologies in healthcare: navigating risks, evaluating rewards.

    PubMed

    McGrady, Elizabeth; Conger, Sue; Blanke, Sandra; Landry, Brett J L

    2010-01-01

    The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.

  18. Forecasting Emergency Department Crowding: A Prospective, Real-time Evaluation

    PubMed Central

    Hoot, Nathan R.; LeBlanc, Larry J.; Jones, Ian; Levin, Scott R.; Zhou, Chuan; Gadd, Cynthia S.; Aronsky, Dominik

    2009-01-01

    Objective Emergency department crowding threatens quality and access to health care, and a method of accurately forecasting near-future crowding should enable novel ways to alleviate the problem. The authors sought to implement and validate the previously developed ForecastED discrete event simulation for real-time forecasting of emergency department crowding. Design and Measurements The authors conducted a prospective observational study during a three-month period (5/1/07–8/1/07) in the adult emergency department of a tertiary care medical center. The authors connected the forecasting tool to existing information systems to obtain real-time forecasts of operational data, updated every 10 minutes. The outcome measures included the emergency department waiting count, waiting time, occupancy level, length of stay, boarding count, boarding time, and ambulance diversion; each forecast 2, 4, 6, and 8 hours into the future. Results The authors obtained crowding forecasts at 13,239 10-minute intervals, out of 13,248 possible (99.9%). The R2 values for predicting operational data 8 hours into the future, with 95% confidence intervals, were 0.27 (0.26, 0.29) for waiting count, 0.11 (0.10, 0.12) for waiting time, 0.57 (0.55, 0.58) for occupancy level, 0.69 (0.68, 0.70) for length of stay, 0.61 (0.59, 0.62) for boarding count, and 0.53 (0.51, 0.54) for boarding time. The area under the receiver operating characteristic curve for predicting ambulance diversion 8 hours into the future, with 95% confidence intervals, was 0.85 (0.84, 0.86). Conclusions The ForecastED tool provides accurate forecasts of several input, throughput, and output measures of crowding up to 8 hours into the future. The real-time deployment of the system should be feasible at other emergency departments that have six patient-level variables available through information systems. PMID:19261948

  19. Wargame Simulation Theory and Evaluation Method for Emergency Evacuation of Residents from Urban Waterlogging Disaster Area

    PubMed Central

    Chen, Peng; Zhang, Jiquan; Sun, Yingyue; Liu, Xiaojing

    2016-01-01

    Urban waterlogging seriously threatens the safety of urban residents and properties. Wargame simulation research on resident emergency evacuation from waterlogged areas can determine the effectiveness of emergency response plans for high risk events at low cost. Based on wargame theory and emergency evacuation plans, we used a wargame exercise method, incorporating qualitative and quantitative aspects, to build an urban waterlogging disaster emergency shelter using a wargame exercise and evaluation model. The simulation was empirically tested in Daoli District of Harbin. The results showed that the wargame simulation scored 96.40 points, evaluated as good. From the simulation results, wargame simulation of urban waterlogging emergency procedures for disaster response can improve the flexibility and capacity for command, management and decision-making in emergency management departments. PMID:28009805

  20. Evaluating the Impact of Emerging Contaminants Using ECAT(SM) and ICAT(SM)

    DTIC Science & Technology

    2007-05-01

    TYPE 3. DATES COVERED 00-00-2007 to 00-00-2007 4. TITLE AND SUBTITLE Evaluating the Impact of Emerging Contaminants Using ECATSM and ICATSm 5a... Contaminants (ECs) Tools – Objectives – Emerging Contaminants Assessment Tool (ECATSM) – Impact Criteria Assessment Tool (ICATSM) Application...Naphthalene INSERT EVENT TITLE – INSERT MONTH & YEAR3National Defense Center for Environmental Excellence Emerging Contaminants (ECs) Chemical or material

  1. Assessment and Evaluation of National Human Resource Development System Competitiveness in Emerging Countries

    ERIC Educational Resources Information Center

    Oh, HunSeok; Seo, DongIn; Kim, JuSeuk; Yoo, SangOk; Seong, HeeChang

    2015-01-01

    This study assessed and evaluated the competitiveness of national human resource development (NHRD) systems in emerging countries with potential for growth. The literature on emerging countries and NHRD systems was reviewed. The study developed a model mechanism with forty-one indices and nine sub-components for the NHRD system assessment in…

  2. Transient Global Amnesia: Emergency Department Evaluation And Management.

    PubMed

    Faust, Jeremy Samuel; Nemes, Andreea

    2016-08-01

    Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation. In witnessed transient global amnesia with classic features, a minimalist approach is reasonable, avoiding overtesting, inappropriate medication, and medical interventions in favor of observation, ensuring patient safety, and reassuring patients and their families. This review provides a detailed framework for distinguishing transient global amnesia from its dangerous mimics and managing its course in the emergency department.

  3. Evaluating the Emergency Notification Systems of the NASA White Sands Test

    NASA Technical Reports Server (NTRS)

    Chavez, Alfred Paul

    2004-01-01

    The problem was that the NASA Fire and Emergency Services did not know if the current emergency notification systems on the NASA White Sands Test Facility were appropriate for alerting the employees of an emergency. The purpose of this Applied Research Project was to determine if the current emergency notification systems of the White Sands Test Facility are appropriate for alerting the employees of an emergency. This was a descriptive research project. The research questions were: 1) What are similar facilities using to alert the employees of an emergency?; 2) Are the current emergency notification systems suitable for the community hazards on the NASA White Sands Test Facility?; 3) What is the NASA Fire and Emergency Services currently using to measure the effectiveness of the emergency notification systems?; and 4) What are the current training methods used to train personnel to the emergency notification systems at the NASA White Sands Test Facility? The procedures involved were to research other established facilities, research published material from credible sources, survey the facility to determine the facility perception of the emergency notification systems, and evaluate the operating elements of the established emergency notification systems for the facility. The results were that the current systems are suitable for the type of hazards the facility may endure. The emergency notification systems are tested frequently to ensure effectiveness in the event of an emergency. Personnel are trained and participate in a yearly drill to make certain personnel are educated on the established systems. The recommendations based on the results were to operationally improve the existing systems by developing and implementing one system that can overall notify the facility of a hazard. Existing procedures and training should also be improved to ensure that all personnel are educated on what to do when the emergency notification systems are activated.

  4. Realistic Sensor Tasking Strategies

    NASA Astrophysics Data System (ADS)

    Frueh, C.; Fiedler, H.; Herzog, J.

    2016-09-01

    Efficient sensor tasking is a crucial step in building up and maintaining a catalog of space objects at the highest possible orbit quality. Sensor resources are limited; sensor location and setup (hardware and processing software) influence the quality of observations for initial orbit determination or orbit improvement that can be obtained. Furthermore, improved sensing capabilities are expected to lead to an increase of objects that are sought to be maintained in a catalog, easily reaching over 100'000 objects. Sensor tasking methods hence need to be computationally efficient in order to be successfully applied to operational systems, and need to take realistic constraints, such as limited visibility of objects, time-varying probability of detection and the specific capabilities in software and hardware for the specific sensors into account. This paper shows a method to formulate sensor tasking as an optimization problem and introduces a new method to provide fast and computationally efficient real time, near optimal sensor tasking solutions. Simulations are preformed using the USSTRATCOM TLE catalog of all geosynchronous objects. The results are compared to state of the art observation strategies.

  5. [Evaluation of the Mobile Emergency Care Service in Santa Catarina State, Brazil].

    PubMed

    Ortiga, Angela Maria Blatt; Lacerda, Josimari Telino de; Natal, Sonia; Calvo, Maria Cristina Marino

    2016-12-15

    This case study evaluated the Mobile Emergency Care Service (SAMU) in Santa Catarina State, Brazil, in 2013/2014. The theoretical log frame and evaluation matrix were validated by expert consensus workshops. Two dimensions were proposed: emergency care management and emergency care, analyzed with 22 indicators. Data collection used interviews, direct observation in the eight regional SAMU dispatches, and a questionnaire sent to the coordinators of the municipal SAMU. The analysis and value judgment according to separate dimensions, sub-dimensions, and indicators allowed identifying strengths and weaknesses amenable to intervention. No regional dispatch performed well in both dimensions; all were classified as "fair" in emergency care and "bad" in emergency management. An important strength was agile communication with callers for help, standardization, and external support for care. The mechanisms for internal and external linkage and communication need to be effectively implemented. The quality of advanced support units requires improvement.

  6. The emergence of mixing methods in the field of evaluation.

    PubMed

    Greene, Jennifer C

    2015-06-01

    When and how did the contemporary practice of mixing methods in social inquiry get started? What events transpired to catalyze the explosive conceptual development and practical adoption of mixed methods social inquiry over recent decades? How has this development progressed? What "next steps" would be most constructive? These questions are engaged in this personally narrative account of the beginnings of the contemporary mixed methods phenomenon in the field of evaluation from the perspective of a methodologist who was there.

  7. Use of field experimental studies to evaluate emergency response models

    SciTech Connect

    Gudiksen, P.H.; Lange, R.; Rodriguez, D.J.; Nasstrom, J.S.

    1985-07-16

    The three-dimensional diagnostic wind field model (MATHEW) and the particle-in-cell atmospheric transport and diffusion model (ADPIC) are used by the Atmospheric Release Advisory Capability to estimate the environmental consequences of accidental releases of radioactivity into the atmosphere. These models have undergone extensive evaluations against field experiments conducted in a variety of environmental settings ranging from relatively flat to very complex terrain areas. Simulations of tracer experiments conducted in a complex mountain valley setting revealed that 35 to 50% of the comparisons between calculated and measured tracer concentrations were within a factor of 5. This may be compared with a factor of 2 for 50% of the comparisons for relatively flat terrain. This degradation of results in complex terrain is due to a variety of factors such as the limited representativeness of measurements in complex terrain, the limited spatial resolution afforded by the models, and the turbulence parameterization based on sigma/sub theta/ measurements to evaluate the eddy diffusivities. Measurements of sigma/sub theta/ in complex terrain exceed those measured over flat terrain by a factor of 2 to 3 leading to eddy diffusivities that are unrealistically high. The results of model evaluations are very sensitive to the quality and the representativeness of the meteorological data. This is particularly true for measurements near the source. The capability of the models to simulate the dispersion of an instantaneously produced cloud of particulates was illustrated to be generally within a factor of 2 over flat terrain. 19 refs., 16 figs.

  8. Physical evaluation and the prevention of medical emergencies: vital signs.

    PubMed

    Malamed, S F

    1993-01-01

    It was assumed that dentists employ a complete system of physical evaluation for all new patients in their dental practices. Results of a survey of 1,588 dentists demonstrated that the use of a written medical history questionnaire was commonplace; however, recording of blood pressure and heart rate and rhythm on all new patients was quite limited. A greater percentage of dentists monitored blood pressure when there was a history of cardiovascular disease or high blood pressure. Monitoring of the heart rate and rhythm, even in patients with cardiovascular disease or high blood pressure, was severely limited in scope. A significant number of dentists still employ racemic epinephrine impregnated gingival retraction cord, and of these, 40% had observed "epinephrine-reactions."

  9. Life cycle evaluation of emerging lignocellulosic ethanol conversion technologies.

    PubMed

    Spatari, Sabrina; Bagley, David M; MacLean, Heather L

    2010-01-01

    Lignocellulosic ethanol holds promise for addressing climate change and energy security issues associated with personal transportation through lowering the fuel mixes' carbon intensity and petroleum demand. We compare the technological features and life cycle environmental impacts of near- and mid-term ethanol bioconversion technologies in the United States. Key uncertainties in the major processes: pre-treatment, hydrolysis, and fermentation are evaluated. The potential to reduce fossil energy use and greenhouse gas (GHG) emissions varies among bioconversion processes, although all options studied are considerably more attractive than gasoline. Anticipated future performance is found to be considerably more attractive than that published in the literature as being achieved to date. Electricity co-product credits are important in characterizing the GHG impacts of different ethanol production pathways; however, in the absence of near-term liquid transportation fuel alternatives to gasoline, optimizing ethanol facilities to produce ethanol (as opposed to co-products) is important for reducing the carbon intensity of the road transportation sector and for energy security.

  10. Emergent Challenges in Determining Costs for Economic Evaluations.

    PubMed

    Jacobs, Josephine C; Barnett, Paul G

    2017-02-01

    This paper describes methods of determining costs for economic evaluations of healthcare and considers how cost determination is being affected by recent developments in healthcare. The literature was reviewed to identify the strengths and weaknesses of the four principal methods of cost determination: micro-costing, activity-based costing, charge-based costing, and gross costing. A scoping review was conducted to identify key trends in healthcare delivery and to identify costing issues associated with these changes. Existing guidelines provide information on how to implement various costing methods. Bottom-up costing is needed when accuracy is paramount, but top-down approaches are often the only feasible approach. We describe six healthcare trends that have important implications for costing methodology: (1) reform in payment mechanisms; (2) care delivery in less restrictive settings; (3) the growth of telehealth interventions; (4) the proliferation of new technology; (5) patient privacy concerns; and (6) growing efforts to implement guidelines. Some costs are difficult to measure and have been overlooked. These include physician services for inpatients, facility costs for outpatient services, the cost of developing treatment innovations, patient and caregiver costs, and the indirect costs of organizational interventions. Standardized methods are needed to determine social welfare and productivity costs. In the future, cost determination will be facilitated by technological advances but hindered by the shift to capitated payment, to the provision of care in less restrictive settings, and by heightened concern for medical record privacy.

  11. National Evaluation of the Emergency School Aid Act (ESAA): Summary of the Second-Year Studies.

    ERIC Educational Resources Information Center

    Coulson, John E.

    This document summarizes in non-technical terms the preliminary policy-relevant findings of a national evaluation of the Emergency School Aid Act (ESAA) Basic and Pilot Programs during the second year of program operations, 1974-75. An attempt is also made to relate the second year results to findings in the first evaluation year, 1973-74. A major…

  12. The Emergence of Contesting Motives for Student Feedback-Based Evaluation in Australian Higher Education

    ERIC Educational Resources Information Center

    Darwin, Stephen

    2016-01-01

    Student feedback-based evaluation performs a significant social role in framing perceptions of the quality of teaching in contemporary Australian higher education. Yet its emergence is a relatively recent phenomenon, having only been in widespread application since the mid-1980s. The early manifestations of student feedback-based evaluation came…

  13. Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change

    PubMed Central

    2013-01-01

    Background Variation in effectiveness of continuous quality improvement (CQI) interventions between services is commonly reported, but with little explanation of how contextual and other factors may interact to produce this variation. Therefore, there is scant information available on which policy makers can draw to inform effective implementation in different settings. In this paper, we explore how patterns of change in delivery of services may have been achieved in a diverse range of health centers participating in a wide-scale program to achieve improvements in quality of care for Indigenous Australians. Methods We elicited key informants’ interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies. Results Several context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the

  14. Evaluation of guidelines for emergency triage assessment and treatment in developing countries

    PubMed Central

    Tamburlini, G.; Di, M; Maggi, R. S.; Vilarim, J. N.; Gove, S.

    1999-01-01

    AIM—To evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries.
METHODS—All infants aged 7 days to 5 years presenting to an accident and emergency department were simultaneously triaged and assessed by a nurse and a senior paediatrician. Nurse ETAT assessment was compared to standard emergency advanced paediatric life support (APLS) assessment by the paediatrician. Sensitivity, specificity, and predictive values were calculated and appropriateness of nurse treatments was evaluated.
RESULTS—The ETAT algorithm as used by nurses identified 731/3837 patients (19.05%); 98 patients (2.6%) were classified as needing emergency treatment and 633 (16.5%) as needing priority assessment. Sensitivity was 96.7% with respect to APLS assessment, 91.7% with respect to all patients given priority by the paediatrician, and 85.7% with respect to patients ultimately admitted. Specificity was 90.6%, 91.0%, and 85.2%, respectively. Nurse administered treatment was appropriate in 94/102 (92.2%) emergency conditions.
CONCLUSIONS—The ETAT algorithm and treatment instructions, when carried out by nurses after a short specific training period, performed well as a screening tool to identify priority cases and as a treatment guide for emergency conditions.

 PMID:10569961

  15. Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

    PubMed Central

    Gustafson, D H; Sainfort, F; Johnson, S W; Sateia, M

    1993-01-01

    OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services. PMID:8514497

  16. Retinal vein occlusion: evaluation of "classic" and "emerging" risk factors and treatment.

    PubMed

    Turello, Marina; Pasca, Samantha; Daminato, Roberto; Dello Russo, Patrizia; Giacomello, Roberta; Venturelli, Ugo; Barillari, Giovanni

    2010-05-01

    Retinal vein occlusion (RVO) is the second most common retinal vein disease and an important cause of blindness and visual morbidity. Systemic risk factors are commonly associated with RVO, while unclear it is the role of the thrombophilic and coagulation disorders. To evaluate "classic" and "emerging" risk factors, and to establish a good treatment for RVO. Fifty patients, 31 males and 19 females, with RVO were selected for our study. RVO patients were divided into two groups: those with central retinal vein occlusion (CRVO) and those with branch retinal vein occlusion (BRVO). All patients were subjected to an anamnestic investigation and were tested for thrombophilia, coagulation disorders and hyperlipidemia. Treatment and prophylaxis were evaluated. We have named "classic" the systemic risk factors associated with RVO and "emerging" those risk factors, haemostasis related, not clearly associated with RVO. RVO occurs more commonly in patients aged over 50. "Emerging" risk factors were more frequent in CRVO, "classic" in BRVO. Hyperhomocysteinemia is the most common "emerging" risk factor related to RVO. 71.4% of tested patients had hypercholesterolemia. Treatment with LMWH would appear to be safe and effective, but the small number of patients considered not allow us a definitive evaluation of its efficacy. Although our study has shown the correlation between RVO and the "emerging" risk factors, more studies are necessary to better know the real role of thrombophilic and coagulation disorders in this disease and to determine a specific protocol for the treatment and prophylaxis of RVO.

  17. Maintaining Realistic Uncertainty in Model and Forecast

    DTIC Science & Technology

    2000-09-30

    Maintaining Realistic Uncertainty in Model and Forecast Leonard Smith Pembroke College Oxford University St. Aldates Oxford OX1 1DW United Kingdom...5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Pembroke College, Oxford University ,,St...evaluation: l-shadowing, probabilistic prediction and weather forecasting. D.Phil Thesis, Oxford University . Lorenz, E. (1995) Predictability-a Partially

  18. Role of Feedback during Evaluation in Improving Emergency Medicine Residents’ Skills; an Experimental Study

    PubMed Central

    Vafaei, Ali; Heidari, Kamran; Hosseini, Mohammad-Ali; Alavi-Moghaddam, Mostafa

    2017-01-01

    Introduction: Evaluation of students’ learning in clinical education system is one of the most important and challenging issues that facilities in this field have been facing. The present study aimed to evaluate the role of feedback during evaluation in increasing emergency medicine residents’ clinical skills. Method: The present experimental study was performed on all second year emergency medicine residents of two educational hospitals, Tehran, Iran, with switching replications design and before-after method. They were randomly allocated to two groups (with or without feedback) and evaluated three times regarding chest ultrasonography for trauma patients, using direct observation of procedural skills (DOPS) and valid and reliable checklist. Data were analyzed using SPSS 20. Results: 30 emergency medicine residents with the mean age of 36.63 ± 30.30 years were allocated to two equal groups (56.7% male). Studied groups were similar regarding the baseline characteristics. In both groups, obtained scores showed a significant increase from the first to the third evaluation (p < 0.001). Mean scores of first and second evaluations were 10.24 ± 0.77, 17.73 ± 0.46 in feedback receivers and 9.73 ± 0.77 and 12.13 ± 0.47 in others (p < 0.001). Mean third score after switching groups were 18.53 ± 0.22 in feedback receivers and 18.99 ± 0.22 in others (p = 0.213). Conclusion: Based on the findings of the present study, giving feedback after evaluating the second year emergency medicine residents regarding chest ultrasonography for trauma patients, led to a significant improvement in their scores in future evaluations and consequently their skill. PMID:28286835

  19. Mentoring Australian Emerging Researchers in Aging: Evaluation of a Pilot Mentoring Scheme

    ERIC Educational Resources Information Center

    Henwood, Tim; Bartlett, Helen; Carroll, Matthew

    2011-01-01

    A survey of Australian emerging researchers in aging identified the need for greater professional development and networking opportunities. To address this, a formal mentorship scheme was developed and evaluated. Fourteen postgraduate researchers (proteges) were matched by discipline and research interest to experienced academics (mentors).…

  20. Design for the Evaluation of the San Francisco Home Health Services. Emergency Family Care Services Program.

    ERIC Educational Resources Information Center

    Remy, Linda L.

    This is a design for the evaluation of emergency family care programs of the San Francisco, California Home Health Services administration. The design objectives are qiven as the promotion of the health and welfare of the family unit and the reduction of the number of out-of-home placements of children and subsequent crises. The objectives of the…

  1. Realistic Radio Communications in Pilot Simulator Training

    NASA Technical Reports Server (NTRS)

    Burki-Cohen, Judith; Kendra, Andrew J.; Kanki, Barbara G.; Lee, Alfred T.

    2000-01-01

    Simulators used for total training and evaluation of airline pilots must satisfy stringent criteria in order to assure their adequacy for training and checking maneuvers. Air traffic control and company radio communications simulation, however, may still be left to role-play by the already taxed instructor/evaluators in spite of their central importance in every aspect of the flight environment. The underlying premise of this research is that providing a realistic radio communications environment would increase safety by enhancing pilot training and evaluation. This report summarizes the first-year efforts of assessing the requirement and feasibility of simulating radio communications automatically. A review of the training and crew resource/task management literature showed both practical and theoretical support for the need for realistic radio communications simulation. A survey of 29 instructor/evaluators from 14 airlines revealed that radio communications are mainly role-played by the instructor/evaluators. This increases instructor/evaluators' own workload while unrealistically lowering pilot communications load compared to actual operations, with a concomitant loss in training/evaluation effectiveness. A technology review searching for an automated means of providing radio communications to and from aircraft with minimal human effort showed that while promising, the technology is still immature. Further research and the need for establishing a proof-of-concept are also discussed.

  2. Mechanisms that Trigger a Good Health-Care Response to Intimate Partner Violence in Spain. Combining Realist Evaluation and Qualitative Comparative Analysis Approaches

    PubMed Central

    Goicolea, Isabel; Vives-Cases, Carmen; Hurtig, Anna-Karin; Marchal, Bruno; Briones-Vozmediano, Erica; Otero-García, Laura; García-Quinto, Marta; San Sebastian, Miguel

    2015-01-01

    Background Health care professionals, especially those working in primary health-care services, can play a key role in preventing and responding to intimate partner violence. However, there are huge variations in the way health care professionals and primary health care teams respond to intimate partner violence. In this study we tested a previously developed programme theory on 15 primary health care center teams located in four different Spanish regions: Murcia, C Valenciana, Castilla-León and Cantabria. The aim was to identify the key combinations of contextual factors and mechanisms that trigger a good primary health care center team response to intimate partner violence. Methods A multiple case-study design was used. Qualitative and quantitative information was collected from each of the 15 centers (cases). In order to handle the large amount of information without losing familiarity with each case, qualitative comparative analysis was undertaken. Conditions (context and mechanisms) and outcomes, were identified and assessed for each of the 15 cases, and solution formulae were calculated using qualitative comparative analysis software. Results The emerging programme theory highlighted the importance of the combination of each team’s self-efficacy, perceived preparation and women-centredness in generating a good team response to intimate partner violence. The use of the protocol and accumulated experience in primary health care were the most relevant contextual/intervention conditions to trigger a good response. However in order to achieve this, they must be combined with other conditions, such as an enabling team climate, having a champion social worker and having staff with training in intimate partner violence. Conclusions Interventions to improve primary health care teams’ response to intimate partner violence should focus on strengthening team’s self-efficacy, perceived preparation and the implementation of a woman-centred approach. The use of the

  3. Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators

    PubMed Central

    2011-01-01

    Background There is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland. Methods A retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations. Results A total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data. Conclusion After implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in

  4. Development and use of consolidated criteria for evaluation of emergency preparedness plans for DOE facilities

    SciTech Connect

    Lerner, K.; Kier, P.H.; Baldwin, T.E.

    1995-07-01

    Emergency preparedness at US Department of Energy (DOE) facilities is promoted by development and quality control of response plans. To promote quality control efforts, DOE has developed a review document that consolidates requirements and guidance pertaining to emergency response planning from various DOE and regulatory sources. The Criteria for Evaluation of Operational Emergency Plans (herein referred to as the Criteria document) has been constructed and arranged to maximize ease of use in reviewing DOE response plans. Although developed as a review instrument, the document also serves as a de facto guide for plan development, and could potentially be useful outside the scope of its original intended DOE clientele. As regulatory and DOE requirements are revised and added in the future, the document will be updated to stay current.

  5. Usability evaluation of an emergency department information system prototype designed using cognitive systems engineering techniques.

    PubMed

    Clark, Lindsey N; Benda, Natalie C; Hegde, Sudeep; McGeorge, Nicolette M; Guarrera-Schick, Theresa K; Hettinger, A Zachary; LaVergne, David T; Perry, Shawna J; Wears, Robert L; Fairbanks, Rollin J; Bisantz, Ann M

    2017-04-01

    This article presents an evaluation of novel display concepts for an emergency department information system (EDIS) designed using cognitive systems engineering methods. EDISs assist emergency medicine staff with tracking patient care and ED resource allocation. Participants performed patient planning and orientation tasks using the EDIS displays and rated the display's ability to support various cognitive performance objectives along with the usability, usefulness, and predicted frequency of use for 18 system components. Mean ratings were positive for cognitive performance support objectives, usability, usefulness, and frequency of use, demonstrating the successful application of design methods to create useful and usable EDIS concepts that provide cognitive support for emergency medicine staff. Nurse and provider roles had significantly different perceptions of the usability and usefulness of certain EDIS components, suggesting that they have different information needs while working.

  6. Evaluation of local electric fields generated by transcranial direct current stimulation with an extracephalic reference electrode based on realistic 3D body modeling

    NASA Astrophysics Data System (ADS)

    Im, Chang-Hwan; Park, Ji-Hye; Shim, Miseon; Chang, Won Hyuk; Kim, Yun-Hee

    2012-04-01

    In this study, local electric field distributions generated by transcranial direct current stimulation (tDCS) with an extracephalic reference electrode were evaluated to address extracephalic tDCS safety issues. To this aim, we generated a numerical model of an adult male human upper body and applied the 3D finite element method to electric current conduction analysis. In our simulations, the active electrode was placed over the left primary motor cortex (M1) and the reference electrode was placed at six different locations: over the right temporal lobe, on the right supraorbital region, on the right deltoid, on the left deltoid, under the chin, and on the right buccinator muscle. The maximum current density and electric field intensity values in the brainstem generated by the extracephalic reference electrodes were comparable to, or even less than, those generated by the cephalic reference electrodes. These results suggest that extracephalic reference electrodes do not lead to unwanted modulation of the brainstem cardio-respiratory and autonomic centers, as indicated by recent experimental studies. The volume energy density was concentrated at the neck area by the use of deltoid reference electrodes, but was still smaller than that around the active electrode locations. In addition, the distributions of elicited cortical electric fields demonstrated that the use of extracephalic reference electrodes might allow for the robust prediction of cortical modulations with little dependence on the reference electrode locations.

  7. Evaluation of local electric fields generated by transcranial direct current stimulation with an extracephalic reference electrode based on realistic 3D body modeling.

    PubMed

    Im, Chang-Hwan; Park, Ji-Hye; Shim, Miseon; Chang, Won Hyuk; Kim, Yun-Hee

    2012-04-21

    In this study, local electric field distributions generated by transcranial direct current stimulation (tDCS) with an extracephalic reference electrode were evaluated to address extracephalic tDCS safety issues. To this aim, we generated a numerical model of an adult male human upper body and applied the 3D finite element method to electric current conduction analysis. In our simulations, the active electrode was placed over the left primary motor cortex (M1) and the reference electrode was placed at six different locations: over the right temporal lobe, on the right supraorbital region, on the right deltoid, on the left deltoid, under the chin, and on the right buccinator muscle. The maximum current density and electric field intensity values in the brainstem generated by the extracephalic reference electrodes were comparable to, or even less than, those generated by the cephalic reference electrodes. These results suggest that extracephalic reference electrodes do not lead to unwanted modulation of the brainstem cardio-respiratory and autonomic centers, as indicated by recent experimental studies. The volume energy density was concentrated at the neck area by the use of deltoid reference electrodes, but was still smaller than that around the active electrode locations. In addition, the distributions of elicited cortical electric fields demonstrated that the use of extracephalic reference electrodes might allow for the robust prediction of cortical modulations with little dependence on the reference electrode locations.

  8. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    PubMed Central

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period. PMID:27147865

  9. Time management: a realistic approach.

    PubMed

    Jackson, Valerie P

    2009-06-01

    Realistic time management and organization plans can improve productivity and the quality of life. However, these skills can be difficult to develop and maintain. The key elements of time management are goals, organization, delegation, and relaxation. The author addresses each of these components and provides suggestions for successful time management.

  10. The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services, 2001.

    ERIC Educational Resources Information Center

    Goodyear, Leslie, Ed.; Bohan-Baker, Marielle, Ed.

    2001-01-01

    This document is comprised of the two 2001 issues of a newsletter of the Harvard Family Research Project, designed to share new ideas and experiences in evaluating systems reform and comprehensive child and family services. The first issue focuses on strategic communications and efforts of nonprofit agencies to evaluate strategic communication…

  11. Evaluation of lung tumor response to therapy: Current and emerging techniques.

    PubMed

    Coche, E

    2016-10-01

    Lung tumor response to therapy may be evaluated in most instances by morphological criteria such as RECIST 1.1 on computed tomography (CT) or magnetic resonance imaging (MRI). However, those criteria are limited because they are based on tumoral dimensional changes and do not take into account other morphologic criteria such as density evaluation, functional or metabolic changes that may occur following conventional or targeted chemotherapy. New techniques such as dual-energy CT, PET-CT, MRI including diffusion-weighted MRI has to be considered into the new technical armamentarium for tumor response evaluation. Integration of all informations provided by the different imaging modalities has to be integrated and represents probably the future goal of tumor response evaluation. The aim of the present paper is to review the current and emerging imaging criteria used to evaluate the response of therapy in the field of lung cancer.

  12. The Potential and Challenges of Critical Realist Ethnography

    ERIC Educational Resources Information Center

    Barron, Ian

    2013-01-01

    This article revisits the critical realist ethnographic process that was adopted in my doctoral thesis, which was concerned with the experiences of ethnic identity of white British and Pakistani British children as they started kindergarten in the northwest of England. The article focuses on the ethnography that emerged from the visits that I…

  13. True-to-Life? Realistic Fiction.

    ERIC Educational Resources Information Center

    Jordan, Anne Devereaux

    1995-01-01

    Suggests that modern realistic fiction for young readers is intensely moralistic and directive at the spoken and unspoken behest of the adults who write, select, and buy that literature. Discusses moral tales, early realistic fiction, modern realistic fiction, and choosing realistic fiction. (RS)

  14. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    PubMed Central

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated. PMID:25635201

  15. Making sense of the emerging conversation in evaluation about systems thinking and complexity science.

    PubMed

    Gates, Emily F

    2016-12-01

    In the last twenty years, a conversation has emerged in the evaluation field about the potential of systems thinking and complexity science (STCS) to transform the practice of evaluating social interventions. Documenting and interpreting this conversation are necessary to advance our understanding of the significance of using STCS in planning, implementing, and evaluating social interventions. Guided by a generic framework for evaluation practice, this paper reports on an inter-disciplinary literature review and argues that STCS raises some new ways of thinking about and carrying out the following six activities: 1) supporting social problem solving; 2) framing interventions and contexts; 3) selecting and using methods; 4) engaging in valuing; 5) producing and justifying knowledge; and 6) facilitating use. Following a discussion of these issues, future directions for research and practice are suggested.

  16. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    PubMed

    Heng, Kenneth Wj

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated.

  17. Realistic models of paracrystalline silicon

    NASA Astrophysics Data System (ADS)

    Nakhmanson, S. M.; Voyles, P. M.; Mousseau, Normand; Barkema, G. T.; Drabold, D. A.

    2001-06-01

    We present a procedure for the preparation of physically realistic models of paracrystalline silicon based on a modification of the bond-switching method of Wooten, Winer, and Weaire. The models contain randomly oriented c-Si grains embedded in a disordered matrix. Our technique creates interfaces between the crystalline and disordered phases of Si with an extremely low concentration of coordination defects. The resulting models possess structural and vibrational properties comparable with those of good continuous random network models of amorphous silicon and display realistic optical properties, correctly reproducing the electronic band gap of amorphous silicon. The largest of our models also shows the best agreement of any atomistic model structure that we tested with fluctuation microscopy experiments, indicating that this model has a degree of medium-range order closest to that of the real material.

  18. Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events

    PubMed Central

    2017-01-01

    Emergency events can influence a child’s kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs–MADYMO 6 and 10 year-old models–were evaluated and compared with child volunteers’ data during emergency events–braking and steering–with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control. PMID:28099505

  19. Emergency Department redirection to primary care: a prospective evaluation of practice.

    PubMed

    Bentley, James A; Thakore, Shobhan; Morrison, William; Wang, Weijie

    2017-02-01

    Background and aim Non-urgent Emergency Department presentations contribute to overcrowding, which can adversely affect patient care. Redirecting patients to a more appropriate service is an option to help address this. We conducted a prospective evaluation of a major Scottish hospital's Emergency Department redirection policy to assess its safety. Methods and results Over two months, 620 patients triggered senior assessment for redirection with 444 (72%) redirected to primary care. Information on presentation was collected with subsequent management and outcome of redirection provided by the patient's general practitioner. Those who required admission within seven days of redirection triggered review. This was carried out independently by an Emergency Department Consultant and a GP Principal to assess the incidence of sub-optimal care or harm as a consequence of redirection. Most patients presented during daytime hours with no significant variation between days. 'Patient factors' accounted for 74% of presentations with 'convenience' (20%) cited as the most common reason. Twenty-two patients were subsequently admitted, with one case of sub-optimal care (incidence 0.23%) and no cases of harm. Conclusions Our redirection policy provides a safe and effective means of directing patients to more appropriate care. The authors believe this to be in the patient s best interest as Emergency Department clinicians are not specifically trained to manage primary care issues.

  20. Evaluation of 6 and 10 Year-Old Child Human Body Models in Emergency Events.

    PubMed

    Gras, Laure-Lise; Stockman, Isabelle; Brolin, Karin

    2017-01-01

    Emergency events can influence a child's kinematics prior to a car-crash, and thus its interaction with the restraint system. Numerical Human Body Models (HBMs) can help understand the behaviour of children in emergency events. The kinematic responses of two child HBMs-MADYMO 6 and 10 year-old models-were evaluated and compared with child volunteers' data during emergency events-braking and steering-with a focus on the forehead and sternum displacements. The response of the 6 year-old HBM was similar to the response of the 10 year-old HBM, however both models had a different response compared with the volunteers. The forward and lateral displacements were within the range of volunteer data up to approximately 0.3 s; but then, the HBMs head and sternum moved significantly downwards, while the volunteers experienced smaller displacement and tended to come back to their initial posture. Therefore, these HBMs, originally intended for crash simulations, are not too stiff and could be able to reproduce properly emergency events thanks, for instance, to postural control.

  1. Visualizing realistic 3D urban environments

    NASA Astrophysics Data System (ADS)

    Lee, Aaron; Chen, Tuolin; Brunig, Michael; Schmidt, Hauke

    2003-05-01

    Visualizing complex urban environments has been an active research topic due to its wide variety of applications in city planning: road construction, emergency facilities planning, and optimal placement of wireless carrier base stations. Traditional 2D visualizations have been around for a long time but they only provide a schematic line-drawing bird's eye view and are sometimes confusing to understand due to the lack of depth information. Early versions of 3D systems have been developed for very expensive graphics workstations which seriously limited the availability. In this paper we describe a 3D visualization system for a desktop PC which integrates multiple resolutions of data and provides a realistic view of the urban environment.

  2. What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance

    PubMed Central

    Pan, Chih-Long; Chang, Chin-Fu; Chiu, Chun-Wen; Chi, Chih-Hsien; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

    2016-01-01

    Abstract This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate ( ), whereas the patients who depart the EDs as product ( ). Therefore, the average ED departure velocity ( ) can be presented as   divided by a given time (t) of the ED length of stay (LOS). The   and   plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the   plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the   plots adapted from the lower curves show the best linear regression of   on   with a good coefficient of determination (R2). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of   plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU TON may not only be a reliable

  3. ANALYSIS OF EMERGING NDE TECHNIQUES: METHODS FOR EVALUATING AND IMPLEMENTING CONTINUOUS ONLINE MONITORING

    SciTech Connect

    Cumblidge, Stephen E.; Doctor, Steven R.; Bond, Leonard J.; Taylor, Theodore T.; Lupold, Timothy R.; Hull, Amy; Malik, Shah

    2009-08-05

    One of the goals of the program for the proactive management of materials degradation (PMMD) is to manage proactively the in-service degradation of metallic components in aging NPPs. As some forms of degradation, such as stress corrosion cracking, are characterized by a long initiation time followed by a rapid growth phase, new inspection or monitoring technologies may be required. New nondestructive evaluation (NDE) techniques that may be needed include techniques to find stress corrosion cracking (SCC) precursors, on-line monitoring techniques to detect cracks as they initiate and grow, as well as advances in NDE technologies. This paper reports on the first part of the development of a methodology to determine the effectiveness of these emerging NDE techniques for managing metallic degradation. This methodology will draw from experience derived from evaluating techniques that have "emerged" in the past. The methodology will follow five stages: a definition of inspection parameters, a technical evaluation, laboratory testing, round robin testing, and the design of a performance demonstration program. This methodology will formalize the path taken for previous techniques and set a predictable course for future NDE techniques. This paper then applies the expert review section of the methodology to the acoustic emission technique to evaluate the use of acoustic emission in performing continuous online monitoring of reactor components.

  4. Emergency department evaluation of febrile children after the introduction of Prevnar.

    PubMed

    Colmenares, John P; Craig, Allen S; Chu, Patricia S; Schaffner, William

    2005-04-01

    The Emergency Department work-up of febrile children is largely driven by the risk of occult bacteremia. This study was designed to determine if emergency medicine doctors had changed their work-up of febrile children after introduction of the pneumococcal conjugate vaccine (PCV) in 2000. We surveyed 411 licensed emergency doctors in Tennessee in 2001. Participants were presented with a hypothetical eight-month-old, well-appearing child with a temperature of 102.2 degrees F with no source of infection. They were asked about practice setting, years in practice, laboratory evaluation and whether their work-up of febrile children had changed in the past year. Of those surveyed, 238 (58%) of 411 completed a survey. Of these, 39 were excluded, leaving a study group of 199. Thirty-two (16%) of 196 respondents to the practice-setting question worked in university-affiliated hospitals, and 164 (84%) worked in community hospitals. Twenty-seven (14%) of 196 respondents had been in practice for five years or less, and 169 (86%) respondents had been in practice for greater than five years. One-hundred-and-thirty-eight (69%) of 199 respondents chose to order a complete blood count and 92 (46%) respondents ordered blood cultures. Overall, 22 (11%) respondents stated that they had changed their work-up in the past year. This survey of emergency doctors demonstrates that changes in the work-up of the febrile child were beginning to occur in the year after the introduction of PCV. Because of the dramatic decrease in invasive pneumococcal disease since introduction of the vaccine, future surveys will be needed to determine if the evaluation of febrile children has changed since this survey was conducted.

  5. Emergency medical services data for cardiovascular disease surveillance, program planning, and evaluation in Maine.

    PubMed

    Meyer, Katie A; Decker, Kathy; Mervis, Cynthia A; Louder, Danielle; Bradshaw, Jay; DeVader, Shannon; Wigand, Debra

    2008-04-01

    Rapid access to medical treatment is a key determinant of outcomes for cardiovascular events. Emergency medical services (EMS) play an important role in delivering early treatment for acute cardiovascular events. Attention has increased on the potential for EMS data to contribute to our understanding of prehospital treatment. Maine recently began to explore the possible role of EMS data in cardiovascular disease surveillance and cardiovascular health program planning and evaluation. We describe the Maine EMS data system, discuss findings on ease of data use and data quality, provide a sample of findings, and share how we plan to use EMS data for program planning and evaluation of community-level interventions and to partner with EMS provider organizations to improve treatment. Our objective is to increase understanding of the promise and limitations of using EMS data for cardiovascular disease surveillance and program planning and evaluation.

  6. Early economic evaluation of emerging health technologies: protocol of a systematic review

    PubMed Central

    2014-01-01

    Background The concept of early health technology assessment, discussed well over a decade, has now been collaboratively implemented by industry, government, and academia to select and expedite the development of emerging technologies that may address the needs of patients and health systems. Early economic evaluation is essential to assess the value of emerging technologies, but empirical data to inform the current practice of early evaluation is limited. We propose a systematic review of early economic evaluation studies in order to better understand the current practice. Methods/design This protocol describes a systematic review of economic evaluation studies of regulated health technologies in which the evaluation is conducted prior to regulatory approval and when the technology effectiveness is not well established. Included studies must report an economic evaluation, defined as the comparative analysis of alternatives with respect to their associated costs and health consequences, and must evaluate some regulated health technology such as pharmaceuticals, biologics, high-risk medical devices, or biomarkers. We will conduct the literature search on multiple databases, including MEDLINE, EMBASE, the Centre for Reviews and Dissemination Databases, and EconLit. Additional citations will be identified via scanning reference lists and author searching. We suspect that many early economic evaluation studies are unpublished, especially those conducted for internal use only. Additionally, we use a chain-referral sampling approach to identify authors of unpublished studies who work in technology discovery and development, starting out with our contact lists and authors who published relevant studies. Citation screening and full-text review will be conducted by pairs of reviewers. Abstracted data will include those related to the decision context and decision problem of the early evaluation, evaluation methods (e.g., data sources, methods, and assumptions used to

  7. Nurse Staffing and Hospital Characteristics Predictive of Time to Diagnostic Evaluation for Patients in the Emergency Department.

    PubMed

    Shindul-Rothschild, Judith; Read, Catherine Y; Stamp, Kelly D; Flanagan, Jane

    2016-10-20

    In the 2014 Emergency Department Benchmarking Alliance Summit, for the first time, participants recommended tracking nursing and advanced practice nurse hours. Performance data from the Centers for Medicare and Medicaid Services provides an opportunity to analyze factors associated with delays in emergency care. The purpose of this study was to investigate hospital characteristics associated with time to a diagnostic evaluation in 67 Massachusetts emergency departments from 2013 to 2014.

  8. Evaluation of emergency-locator-transmitter performance in real and simulated crash tests

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1981-01-01

    Emergency locator transmitter (ELT) activation problems were investigated by testing a sampling of ELT units in actual airplane crashes and in a special test apparatus which simulated longitudinal crash pulses with superimposed local structural resonances. Probable causes of excessive false alarms and nonactivations of ELT's during crash situations were determined and solutions to the current operational and technical problems were obtained. The results, which considered placement, mounting, and activation of ELT's under simulated crash impacts, and an evaluation of the sensitivity of ELT impact switches to orientation and to local structural vibrations are discussed.

  9. Electromagnetic Scattering from Realistic Targets

    NASA Technical Reports Server (NTRS)

    Lee, Shung- Wu; Jin, Jian-Ming

    1997-01-01

    The general goal of the project is to develop computational tools for calculating radar signature of realistic targets. A hybrid technique that combines the shooting-and-bouncing-ray (SBR) method and the finite-element method (FEM) for the radiation characterization of microstrip patch antennas in a complex geometry was developed. In addition, a hybridization procedure to combine moment method (MoM) solution and the SBR method to treat the scattering of waveguide slot arrays on an aircraft was developed. A list of journal articles and conference papers is included.

  10. Applications of emerging imaging techniques for meat quality and safety detection and evaluation: A review.

    PubMed

    Xiong, Zhenjie; Sun, Da-Wen; Pu, Hongbin; Gao, Wenhong; Dai, Qiong

    2017-03-04

    With improvement in people's living standards, many people nowadays pay more attention to quality and safety of meat. However, traditional methods for meat quality and safety detection and evaluation, such as manual inspection, mechanical methods, and chemical methods, are tedious, time-consuming, and destructive, which cannot meet the requirements of modern meat industry. Therefore, seeking out rapid, non-destructive, and accurate inspection techniques is important for the meat industry. In recent years, a number of novel and noninvasive imaging techniques, such as optical imaging, ultrasound imaging, tomographic imaging, thermal imaging, and odor imaging, have emerged and shown great potential in quality and safety assessment. In this paper, a detailed overview of advanced applications of these emerging imaging techniques for quality and safety assessment of different types of meat (pork, beef, lamb, chicken, and fish) is presented. In addition, advantages and disadvantages of each imaging technique are also summarized. Finally, future trends for these emerging imaging techniques are discussed, including integration of multiple imaging techniques, cost reduction, and developing powerful image-processing algorithms.

  11. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department.

    PubMed

    Lawhn-Heath, Courtney; Buckle, Christopher; Christoforidis, Gregory; Straus, Christopher

    2013-01-01

    Acute dizziness (including vertigo) is a common reason to visit the emergency room, and imaging with head CT is often performed initially to exclude a central cause. In this study, consecutive patients presenting with dizziness and undergoing head CT were retrospectively reviewed to determine diagnostic yield. Four hundred forty-eight consecutive head CTs in a representative sample of dizzy emergency room (ER) patients, including patients with other neurological symptoms, were reviewed to identify an acute or subacute cause for acute dizziness along with the frequency and modalities used in follow-up imaging. The diagnostic yield for head CT ordered in the ER for acute dizziness is low (2.2 %; 1.6 % for emergent findings), but MRI changes the diagnosis up to 16 % of the time, acutely in 8 % of cases. Consistent with the American College of Radiology appropriateness criteria and the literature, this study suggests a low diagnostic yield for CT in the evaluation of acute dizziness but an important role for MRI in appropriately selected cases.

  12. Multidetector computed tomography in the evaluation of pediatric acute abdominal pain in the emergency department.

    PubMed

    Lin, Wei-Ching; Lin, Chien-Heng

    2016-06-01

    The accurate diagnosis of pediatric acute abdominal pain is one of the most challenging tasks in the emergency department (ED) due to its unclear clinical presentation and non-specific findings in physical examinations, laboratory data, and plain radiographs. The objective of this study was to evaluate the impact of abdominal multidetector computed tomography (MDCT) performed in the ED on pediatric patients presenting with acute abdominal pain. A retrospective chart review of children aged <18 years with acute abdominal pain who visited the emergency department and underwent MDCT between September 2004 and June 2007 was conducted. Patients with a history of trauma were excluded. A total of 156 patients with acute abdominal pain (85 males and 71 females, age 1-17 years; mean age 10.9 ± 4.6 years) who underwent abdominal MDCT in the pediatric ED during this 3-year period were enrolled in the study. One hundred and eighteen patients with suspected appendicitis underwent abdominal MDCT. Sixty four (54.2%) of them had appendicitis, which was proven by histopathology. The sensitivity of abdominal MDCT for appendicitis was found to be 98.5% and the specificity was 84.9%. In this study, the other two common causes of nontraumatic abdominal emergencies were gastrointestinal tract (GI) infections and ovarian cysts. The most common etiology of abdominal pain in children that requires imaging with abdominal MDCT is appendicitis. MDCT has become a preferred and invaluable imaging modality in evaluating uncertain cases of pediatric acute abdominal pain in ED, in particular for suspected appendicitis, neoplasms, and gastrointestinal abnormalities.

  13. Evaluating oversight systems for emerging technologies: a case study of genetically engineered organisms.

    PubMed

    Kuzma, Jennifer; Najmaie, Pouya; Larson, Joel

    2009-01-01

    The U.S. oversight system for genetically engineered organisms (GEOs) was evaluated to develop hypotheses and derive lessons for oversight of other emerging technologies, such as nanotechnology. Evaluation was based upon quantitative expert elicitation, semi-standardized interviews, and historical literature analysis. Through an interdisciplinary policy analysis approach, blending legal, ethical, risk analysis, and policy sciences viewpoints, criteria were used to identify strengths and weaknesses of GEOs oversight and explore correlations among its attributes and outcomes. From the three sources of data, hypotheses and broader conclusions for oversight were developed. Our analysis suggests several lessons for oversight of emerging technologies: the importance of reducing complexity and uncertainty in oversight for minimizing financial burdens on small product developers; consolidating multi-agency jurisdictions to avoid gaps and redundancies in safety reviews; consumer benefits for advancing acceptance of GEO products; rigorous and independent pre- and post-market assessment for environmental safety; early public input and transparency for ensuring public confidence; and the positive role of public input in system development, informed consent, capacity, compliance, incentives, and data requirements and stringency in promoting health and environmental safety outcomes, as well as the equitable distribution of health impacts. Our integrated approach is instructive for more comprehensive analyses of oversight systems, developing hypotheses for how features of oversight systems affect outcomes, and formulating policy options for oversight of future technological products, especially nanotechnology products.

  14. Realistic Ground Motion Scenarios: Methodological Approach

    SciTech Connect

    Nunziata, C.; Peresan, A.; Romanelli, F.; Vaccari, F.; Zuccolo, E.; Panza, G. F.

    2008-07-08

    The definition of realistic seismic input can be obtained from the computation of a wide set of time histories, corresponding to possible seismotectonic scenarios. The propagation of the waves in the bedrock from the source to the local laterally varying structure is computed with the modal summation technique, while in the laterally heterogeneous structure the finite difference method is used. The definition of shear wave velocities within the soil cover is obtained from the non-linear inversion of the dispersion curve of group velocities of Rayleigh waves, artificially or naturally generated. Information about the possible focal mechanisms of the sources can be obtained from historical seismicity, based on earthquake catalogues and inversion of isoseismal maps. In addition, morphostructural zonation and pattern recognition of seismogenic nodes is useful to identify areas prone to strong earthquakes, based on the combined analysis of topographic, tectonic, geological maps and satellite photos. We show that the quantitative knowledge of regional geological structures and the computation of realistic ground motion can be a powerful tool for a preventive definition of the seismic hazard in Italy. Then, the formulation of reliable building codes, based on the evaluation of the main potential earthquakes, will have a great impact on the effective reduction of the seismic vulnerability of Italian urban areas, validating or improving the national building code.

  15. Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation.

    PubMed

    Grudnikoff, Eugene; Taneli, Tolga; Correll, Christoph U

    2015-07-01

    We aimed to describe the characteristics and disposition of youth referred from schools to the emergency department (ED) for psychiatric evaluations. Consecutive 12-month records of ED psychiatric consultations at a large urban hospital from 07.01.2009 to 06.30.2010 were retrospectively analyzed. School-initiated referrals were deemed inappropriate if youth were discharged from the ED without any recommended mental health follow-up. Of the 551 psychiatric ED evaluations, 243 (44.1%) were initiated by schools. Of all school referrals, only 19 (7.8%) children were psychiatrically hospitalized, 108 (44.4%) were discharged from the ED with a follow-up appointment; and 116 (47.7%) were discharged without arranged follow-up. Those with a chief complaint of "suicidality" (n = 109, 44.9%) were more likely to be discharged without arranged follow-up than youth with other presenting complaints (56.0 vs. 41.0%, p = 0.021). Altogether, only 37 (18.5%) of 200 school-referred youth with information were evaluated by a school nurse, social worker, or other professional before being sent to the ED. Students without in-school screening were significantly more frequently discharged without follow-up than students with in-school evaluations prior to the ED referral (51.5 vs. 27.0%, p = 0.0070; odds ratio = 2.87 (95% CI 1.30-6.31). Multivariate predictors of inappropriate school referrals of youth discharged without any outpatient follow-up were higher Children's Global Assessment Scale score (p < 0.0001), absent in-school evaluation (p = 0.0069), absent prior psychiatric history (p = 0.011) and absent current psychotropic medication treatment (p = 0.012) (r(2) = 0.264%, p < 0.0001). Altogether 44.1% of ED consultations were school referred, of which 47.7% were potentially inappropriate for the emergency setting. In-school screening, which occurred infrequently, reduced unnecessary evaluations by 52%.

  16. Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

    PubMed Central

    Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

    2017-01-01

    Objectives To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. Design A cross-sectional study using a community-based survey. Setting Yaoundé, Cameroon. Participants All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Primary outcome measures Unmet needs for emergency care. Results Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Conclusions Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. PMID:28167749

  17. Emergency and backup power supplies at Department of Energy facilities: Augmented Evaluation Team -- Final report

    SciTech Connect

    Not Available

    1993-11-01

    This report documents the results of the Defense Programs (DP) Augmented Evaluation Team (AET) review of emergency and backup power supplies (i.e., generator, uninterruptible power supply, and battery systems) at DP facilities. The review was conducted in response to concerns expressed by former Secretary of Energy James D. Watkins over the number of incidents where backup power sources failed to provide electrical power during tests or actual demands. The AET conducted a series of on-site reviews for the purpose of understanding the design, operation, maintenance, and safety significance of emergency and backup power (E&BP) supplies. The AET found that the quality of programs related to maintenance of backup power systems varies greatly among the sites visited, and often among facilities at the same site. No major safety issues were identified. However, there are areas where the AET believes the reliability of emergency and backup power systems can and should be improved. Recommendations for improving the performance of E&BP systems are provided in this report. The report also discusses progress made by Management and Operating (M&O) contractors to improve the reliability of backup sources used in safety significant applications. One area that requires further attention is the analysis and understanding of the safety implications of backup power equipment. This understanding is needed for proper graded-approach implementation of Department of Energy (DOE) Orders, and to help ensure that equipment important to the safety of DOE workers, the public, and the environment is identified, classified, recognized, and treated as such by designers, users, and maintainers. Another area considered important for improving E&BP system performance is the assignment of overall ownership responsibility and authority for ensuring that E&BP equipment performs adequately and that reliability and availability are maintained at acceptable levels.

  18. Evaluating the Potential Usefulness of new Hurricane Indices for Emergency Management and Other Decision Makers

    NASA Astrophysics Data System (ADS)

    Jordan, M. R.; Clayson, C. A.

    2006-12-01

    Over the past 35 years, the Saffir-Simpson scale has used wind speed as a means for categorizing damage and surge risks associated with hurricanes. Time has shown, however, that hurricanes with the same wind speed do not necessarily cause equal damage values and storm-surge heights. Therefore, it is prudent to now consider a different method for categorizing storms so that emergency management officials in a coastal location can have a better idea as to the potential hazards posed by a particular hurricane. Recognizing this need, three new indices were developed by Lakshmi Kantha in 2005 for evaluating hurricane intensity, hurricane damage potential, and hurricane surge potential. This paper applies these indices to a twenty-year database (1986-2005) of Atlantic, U.S.-landfalling hurricanes and compares the relative indices to known damage estimates and surge heights. Some general conclusions will be made regarding the possible usefulness of these indices for emergency management officials in areas prone to landfalling tropical cyclones.

  19. Simulator Evaluation of Simplified Propulsion-Only Emergency Flight Control Systems on Transport Aircraft

    NASA Technical Reports Server (NTRS)

    Burcham, Frank W., Jr.; Kaneshige, John; Bull, John; Maine, Trindel A.

    1999-01-01

    With the advent of digital engine control systems, considering the use of engine thrust for emergency flight control has become feasible. Many incidents have occurred in which engine thrust supplemented or replaced normal aircraft flight controls. In most of these cases, a crash has resulted, and more than 1100 lives have been lost. The NASA Dryden Flight Research Center has developed a propulsion-controlled aircraft (PCA) system in which computer-controlled engine thrust provides emergency flight control capability. Using this PCA system, an F-15 and an MD-11 airplane have been landed without using any flight controls. In simulations, C-17, B-757, and B-747 PCA systems have also been evaluated successfully. These tests used full-authority digital electronic control systems on the engines. Developing simpler PCA systems that can operate without full-authority engine control, thus allowing PCA technology to be installed on less capable airplanes or at lower cost, is also a desire. Studies have examined simplified ?PCA Ultralite? concepts in which thrust control is provided using an autothrottle system supplemented by manual differential throttle control. Some of these concepts have worked well. The PCA Ultralite study results are presented for simulation tests of MD-11, B-757, C-17, and B-747 aircraft.

  20. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications.

    PubMed

    Boccardo, Piero; Chiabrando, Filiberto; Dutto, Furio; Tonolo, Fabio Giulio; Lingua, Andrea

    2015-07-02

    Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author's group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications.

  1. Evaluation of Emerging Energy-Efficient Heterogeneous Computing Platforms for Biomolecular and Cellular Simulation Workloads

    PubMed Central

    Stone, John E.; Hallock, Michael J.; Phillips, James C.; Peterson, Joseph R.; Luthey-Schulten, Zaida; Schulten, Klaus

    2016-01-01

    Many of the continuing scientific advances achieved through computational biology are predicated on the availability of ongoing increases in computational power required for detailed simulation and analysis of cellular processes on biologically-relevant timescales. A critical challenge facing the development of future exascale supercomputer systems is the development of new computing hardware and associated scientific applications that dramatically improve upon the energy efficiency of existing solutions, while providing increased simulation, analysis, and visualization performance. Mobile computing platforms have recently become powerful enough to support interactive molecular visualization tasks that were previously only possible on laptops and workstations, creating future opportunities for their convenient use for meetings, remote collaboration, and as head mounted displays for immersive stereoscopic viewing. We describe early experiences adapting several biomolecular simulation and analysis applications for emerging heterogeneous computing platforms that combine power-efficient system-on-chip multi-core CPUs with high-performance massively parallel GPUs. We present low-cost power monitoring instrumentation that provides sufficient temporal resolution to evaluate the power consumption of individual CPU algorithms and GPU kernels. We compare the performance and energy efficiency of scientific applications running on emerging platforms with results obtained on traditional platforms, identify hardware and algorithmic performance bottlenecks that affect the usability of these platforms, and describe avenues for improving both the hardware and applications in pursuit of the needs of molecular modeling tasks on mobile devices and future exascale computers. PMID:27516922

  2. UAV Deployment Exercise for Mapping Purposes: Evaluation of Emergency Response Applications

    PubMed Central

    Boccardo, Piero; Chiabrando, Filiberto; Dutto, Furio; Giulio Tonolo, Fabio; Lingua, Andrea

    2015-01-01

    Exploiting the decrease of costs related to UAV technology, the humanitarian community started piloting the use of similar systems in humanitarian crises several years ago in different application fields, i.e., disaster mapping and information gathering, community capacity building, logistics and even transportation of goods. Part of the author’s group, composed of researchers in the field of applied geomatics, has been piloting the use of UAVs since 2006, with a specific focus on disaster management application. In the framework of such activities, a UAV deployment exercise was jointly organized with the Regional Civil Protection authority, mainly aimed at assessing the operational procedures to deploy UAVs for mapping purposes and the usability of the acquired data in an emergency response context. In the paper the technical features of the UAV platforms will be described, comparing the main advantages/disadvantages of fixed-wing versus rotor platforms. The main phases of the adopted operational procedure will be discussed and assessed especially in terms of time required to carry out each step, highlighting potential bottlenecks and in view of the national regulation framework, which is rapidly evolving. Different methodologies for the processing of the acquired data will be described and discussed, evaluating the fitness for emergency response applications. PMID:26147728

  3. No effect of lunar cycle on psychiatric admissions or emergency evaluations.

    PubMed

    McLay, Robert N; Daylo, Amado A; Hammer, Paul S

    2006-12-01

    It is a popularly held belief that psychiatric behavior worsens during a full moon. Research in this area has yielded mixed results. Records from Naval Medical Center San Diego for 1993-2001 were examined to see whether there were higher rates of psychiatric admission associated with particular phases of the moon. Records from 8,473 admissions revealed that there were no more admission on days with a full moon, a new moon, any quarter of the moon, a waxing moon, or a waning moon. This held true for psychiatric patients as a whole, as well as for individuals with particular diagnoses, such as those with a mood disorder or psychotic disorder. Records from 1,909 emergency psychiatric evaluations that occurred between 2002 and 2003 were also examined to see whether a higher percentage of patients might present, but not require hospitalization, during a particular phase of the moon. Once again, no significant effect was found. In summary, lunar phase was not associated in any significant way with psychiatric admissions or emergency presentation.

  4. Evaluation of Emerging Energy-Efficient Heterogeneous Computing Platforms for Biomolecular and Cellular Simulation Workloads.

    PubMed

    Stone, John E; Hallock, Michael J; Phillips, James C; Peterson, Joseph R; Luthey-Schulten, Zaida; Schulten, Klaus

    2016-05-01

    Many of the continuing scientific advances achieved through computational biology are predicated on the availability of ongoing increases in computational power required for detailed simulation and analysis of cellular processes on biologically-relevant timescales. A critical challenge facing the development of future exascale supercomputer systems is the development of new computing hardware and associated scientific applications that dramatically improve upon the energy efficiency of existing solutions, while providing increased simulation, analysis, and visualization performance. Mobile computing platforms have recently become powerful enough to support interactive molecular visualization tasks that were previously only possible on laptops and workstations, creating future opportunities for their convenient use for meetings, remote collaboration, and as head mounted displays for immersive stereoscopic viewing. We describe early experiences adapting several biomolecular simulation and analysis applications for emerging heterogeneous computing platforms that combine power-efficient system-on-chip multi-core CPUs with high-performance massively parallel GPUs. We present low-cost power monitoring instrumentation that provides sufficient temporal resolution to evaluate the power consumption of individual CPU algorithms and GPU kernels. We compare the performance and energy efficiency of scientific applications running on emerging platforms with results obtained on traditional platforms, identify hardware and algorithmic performance bottlenecks that affect the usability of these platforms, and describe avenues for improving both the hardware and applications in pursuit of the needs of molecular modeling tasks on mobile devices and future exascale computers.

  5. Using the /phi/resund experimental data to evaluate the ARAC emergency response models

    SciTech Connect

    Gudiksen, P.H.; Gryning, S.E.

    1988-07-01

    A series of meteorological and tracer experiments, was conducted during May and June 1984 over the 20-km wide /O/resund strait between Denmark and Sweden for the purpose of studying atmospheric dispersion processes over cold water and warm land surfaces and providing the data needed to evaluate meso-scale models in a coastal environment. In concert with these objectives the data from these experiments have been used as part of a continuing effort to evaluate the capability of the three-dimensional MATHEW/ADPIC (M/A) atmospheric dispersion models to simulate pollutant transport and diffusion characteristics of the atmospheric during a wide variety of meteorological conditions. Since previous studies have focused primarily on M/A model evaluations over rolling and complex terrain at inland sites, the /O/resund experiments provide a unique opportunity to evaluate the models in a coastal environment. The M/A models are used by the Atmospheric Release Advisory Capability (ARAC), developed by the Lawrence Livermore National Laboratory, for performing real-time assessments of the environmental consequences of potential or actual releases of radioactivity into the atmosphere. These assessments include estimation of radiation doses to nearby population centers and of the extent of surface contamination. Model evaluations, using field experimental data such as those generated by the /O/resund experiments, serve as a basis for providing emergency response managers with estimated of the uncertainties associated with accident consequence assessments. This report provides a brief description of the /O/resund experiments, the current understanding of the meteorological processes governing pollutant dispersion over the /O/resund strait, and the results of the M/A model simulations of these experiments. 11 refs., 7 figs., 1 tab.

  6. Allergy evaluation after emergency treatment: anaphylaxis to the over‐the‐counter medication clobutinol

    PubMed Central

    Seitz, Cornelia S; Bröcker, Eva‐B; Trautmann, Axel

    2007-01-01

    Anaphylaxis is traditionally diagnosed and treated as an acute emergency but should be always followed by a search for specific triggers, resulting in avoidance strategies. This case report highlights the relevance of a detailed evaluation after anaphylaxis for diagnosis of a rare but potentially life‐threatening allergy. Considering the high frequency of clobutinol application, IgE‐mediated allergic hypersensitivity seems extremely rare and has to be distinguished from infection‐associated urticaria and angioedema as well as non‐specific summation effects. Accidental re‐exposure has to be strictly avoided and therefore after identification of clobutinol as the anaphylaxis trigger, the patient received detailed allergy documents including international non‐proprietary and trade names of the culprit drug. PMID:17351213

  7. Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States

    PubMed Central

    Baumbach, Joan; Cieslak, Paul R.

    2015-01-01

    Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis. PMID:26291475

  8. Headache in Pregnancy: An Approach to Emergency Department Evaluation and Management

    PubMed Central

    Schoen, Jessica C.; Campbell, Ronna L.; Sadosty, Annie T.

    2015-01-01

    Headache is a common presenting complaint in the emergency department. The differential diagnosis is broad and includes benign primary causes as well as ominous secondary causes. The diagnosis and management of headache in the pregnant patient presents several challenges. There are important unique considerations regarding the differential diagnosis, imaging options, and medical management. Physiologic changes induced by pregnancy increase the risk of cerebral venous thrombosis, dissection, and pituitary apoplexy. Preeclampsia, a serious condition unique to pregnancy, must also be considered. A high index of suspicion for carbon monoxide toxicity should be maintained. Primary headaches should be a diagnosis of exclusion. When advanced imaging is indicated, magnetic resonance imaging (MRI) should be used, if available, to reduce radiation exposure. Contrast agents should be avoided unless absolutely necessary. Medical therapy should be selected with careful consideration of adverse fetal effects. Herein, we present a review of the literature and discuss an approach to the evaluation and management of headache in pregnancy PMID:25834672

  9. Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States.

    PubMed

    Skoff, Tami H; Baumbach, Joan; Cieslak, Paul R

    2015-09-01

    Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in understanding the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis.

  10. Flight Simulator Evaluation of Enhanced Propulsion Control Modes for Emergency Operation

    NASA Technical Reports Server (NTRS)

    Litt, Jonathan, S; Sowers, T.; Owen, A., Karl; Fulton, Christopher, E.; Chicatelli, Amy, K.

    2012-01-01

    This paper describes piloted evaluation of enhanced propulsion control modes for emergency operation of aircraft. Fast Response and Overthrust modes were implemented to assess their ability to help avoid or mitigate potentially catastrophic situations, both on the ground and in flight. Tests were conducted to determine the reduction in takeoff distance achievable using the Overthrust mode. Also, improvements in Dutch roll damping, enabled by using yaw rate feedback to the engines to replace the function of a stuck rudder, were investigated. Finally, pilot workload and ability to handle the impaired aircraft on approach and landing were studied. The results showed that improvement in all aspects is possible with these enhanced propulsion control modes, but the way in which they are initiated and incorporated is important for pilot comfort and perceived benefit.

  11. Differences in Self-expression Reflect Formal Evaluation in a Fourth-year Emergency Medicine Clerkship

    PubMed Central

    Chary, Michael; Leuthauser, Amy; Hu, Kevin; Hexom, Braden

    2017-01-01

    Introduction Medical schools have begun to incorporate self-reflection exercises into their curricula, with the belief that these exercises help students master the material more deeply and perform better. Reflection may be a potential learning tool for emergency medicine (EM), but there are few data supporting this hypothesis. The authors evaluated the relationship between a linguistic marker of the degree of reflection after a student’s shift in an emergency department and that student’s clerkship performance. Methods The authors conducted a retrospective case series by analyzing the performance and reflective statements of 116 students from a single medical school who participated in a required EM clerkship at one or two of four clinical sites from 2013–14. After each shift, an attending emergency physician evaluated the student according to the RIME (Reporter-Interpreter-Manager-Educator) scheme. The authors developed software to extract the text from those comments, remove uninformative words and standardize the remaining words. The authors determined the most common words and two-word phrases that students used to describe their shift. The correlation between students’ final clerkship grades and the fraction of student comments with at least one content word was analyzed. Results Of the 145 possible students, 116 were included for analysis. The other 29 were excluded as they were visiting students who did not receive a final numeric grade. The correlation between final grade and the number of completed self-reflections was 0.32. The correlation between final grade and the average number of words in each self-reflection was 0.21. The first correlation is significantly greater than 0 (p=0.03, t-test), but the second correlation is not (p=0.16, t-test). The median final grade of those who wrote reflections on more than half of their shifts was significantly greater than those who wrote reflections half of the time, 83.675 versus 79.23 (p=0.05, 2-sample

  12. Comparison of emergency nurses association Emergency Severity Triage and Australian emergency mental health triage systems for the evaluation of psychiatric patients.

    PubMed

    Downey, La Vonne A; Zun, Leslie S; Burke, Trena

    2014-01-01

    The use of a triage system in the emergency department allows for the ability to reliably assign patients for treatment within a short amount of time in order to prioritize and treat on the basis of patients injury and illness. A 5 point triage system has been shown to have the highest correlation with effective resource utilizations, lower time to be seen and treatment times, and admission or release outcomes for patients. The problem is, however, that these triage scales were developed on the basis of physical illness and not on the ever-increasing number of patients who present with mental illness. This article compares one physical and one specific mental illness-based triage system to measure the differences in times to be seen by a physician. It found that the specialized psychiatric triage system decreased wait times and allowed symptoms to be addressed sooner for patients presenting with psychiatric complaints.

  13. Evaluation of emerging factors blocking filtration of high-adjunct-ratio wort.

    PubMed

    Ma, Ting; Zhu, Linjiang; Zheng, Feiyun; Li, Yongxian; Li, Qi

    2014-08-20

    Corn starch has become a common adjunct for beer brewing in Chinese breweries. However, with increasing ratio of corn starch, problems like poor wort filtration performance arise, which will decrease production capacity of breweries. To solve this problem, factors affecting wort filtration were evaluated, such as the size of corn starch particle, special yellow floats formed during liquefaction of corn starch, and residual substance after liquefaction. The effects of different enzyme preparations including β-amylase and β-glucanase on filtration rate were also evaluated. The results indicate that the emerging yellow floats do not severely block filtration, while the fine and uniform-shape corn starch particle and its incompletely hydrolyzed residue after liquefaction are responsible for filtration blocking. Application of β-amylase preparation increased the filtration rate of liquefied corn starch. This study is useful for our insight into the filtration blocking problem arising in the process of high-adjunct-ratio beer brewing and also provides a feasible solution using enzyme preparations.

  14. Evaluation of field triage decision scheme educational resources: audience research with emergency medical service personnel.

    PubMed

    Sarmiento, Kelly; Eckstein, Daniel; Zambon, Allison

    2013-03-01

    In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons-Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC's first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme's intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community.

  15. Emergent Expertise?

    ERIC Educational Resources Information Center

    McGivern, Patrick

    2014-01-01

    The concept of emergence appears in various places within the literature on expertise and expert practice. Here, I examine some of these applications of emergence in the light of two prominent accounts of emergence from the philosophy of science and philosophy of mind. I evaluate these accounts with respect to several specific contexts in which…

  16. Do health checks for adults with intellectual disability reduce emergency hospital admissions? Evaluation of a natural experiment

    PubMed Central

    Hosking, Fay J; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Shah, Sunil M; Cook, Derek G

    2017-01-01

    Background Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. Methods An evaluation of a ‘natural experiment’, incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009–2010 and 2011–2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. Results Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. Conclusions Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. PMID:27312249

  17. Modeling Computer Communication Networks in a Realistic 3D Environment

    DTIC Science & Technology

    2010-03-01

    visualization in OPNET . . . . . . . . . . . . 13 6. Sample NetViz visualization . . . . . . . . . . . . . . . . . . . 15 7. Realistic 3D terrains...scenario in OPNET . . . 19 10. OPNET 3DNV only displays connectivity . . . . . . . . . . . . 29 11. The digitally connected battlefield...confirmation tool 12 OPNET Optimized Network Evaluation Tool . . . . . . . . . . . . 13 NetViz Network Visualization

  18. The Use of More Realistic Utility Functions in Educational Applications.

    ERIC Educational Resources Information Center

    Novick, Melvin R.; Lindley, Dennis V.

    1978-01-01

    The use of some very simple loss or utility functions in educational evaluation has recently been advocated by Gross and Su, Petersen and Novick, and Petersen. This paper demonstrates that more realistic utility functions can easily be used and may be preferable in some applications. (Author/CTM)

  19. Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

    NASA Technical Reports Server (NTRS)

    Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis

    2006-01-01

    International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task

  20. Bosonic condensates in realistic supersymmetric GUT cosmic strings

    SciTech Connect

    Allys, Erwan

    2016-04-01

    We study the realistic structure of F-term Nambu-Goto cosmic strings forming in a general supersymmetric Grand Unified Theory implementation, assuming standard hybrid inflation. Examining the symmetry breaking of the unification gauge group down to the Standard Model, we discuss the minimal field content necessary to describe abelian cosmic strings appearing at the end of inflation. We find that several fields will condense in most theories, questioning the plausible occurrence of associated currents (bosonic and fermionic). We perturbatively evaluate the modification of their energy per unit length due to the condensates. We provide a criterion for comparing the usual abelian Higgs approximation used in cosmology to realistic situations.

  1. Protective Action Evaluator for Chemical Emergencies: A user's manual (MS-DOS reg sign Version 1. 0)

    SciTech Connect

    Rogers, G.O.; Sharp, R.D.

    1990-10-01

    The protective action evaluator for chemical emergencies (PAECE) is a package of computer programs developed to simulate an emergency response to airborne release of chemical agents. This user's manual documents the use of PAECE in the evaluation of chemical agent emergencies in areas potentially affected by the Chemical Stockpile Emergency Planning Program (CSEPP). This research documents the development and use of a method for the evaluation of protective action alternatives in conjunction with potential chemical agent emergencies. The user's manual highlights the development of the PAECE model, the selection of appropriate parameters to represent various scenarios, generate results and interpret them in the analysis of protective action alternatives during the planning and preparedness phases of the CSEPP. The PAECE model is designed to evaluate protective actions in the context of potential accidents, the emergency management systems required to implement protective actions, and the anticipated consequences for human receptors. The implications and uncertainties of the model are discussed to provide potential users with insight into the use, limitations, and uncertainties associated with evaluating the effectiveness of protective action alternatives. While PAECE represents a unique and powerful tool to evaluate protective actions, the user must exercise caution when interpreting the results to avoid misrepresentation. The expected value interpretation of the PAECE results biases the results toward extreme values. Hence, the PAECE results have to be interpreted in the context exposures similar to those represented by the unprotected exposure and the protection capacity that tend to be associated with people completing the implementation of the required actions later than and earlier than average, respectively. 16 refs., 24 figs., 1 tab. (JF)

  2. An Independent Human Factors Analysis and Evaluation of the Emergency Medical Protocol Checklist for the International Space Station

    NASA Technical Reports Server (NTRS)

    Marshburn, Thomas; Whitmore, Mihriban; Ortiz, Rosie; Segal, Michele; Smart, Kieran; Hughes, Catherine

    2003-01-01

    Emergency medical capabilities aboard the ISS include a Crew Medical Officer (CMO) (not necessarily a physician), and back-up, resuscitation equipment, and a medical checklist. It is essential that CMOs have reliable, usable and informative medical protocols that can be carried out independently in flight. The study evaluates the existing ISS Medical Checklist layout against a checklist updated to reflect a human factors approach to structure and organization. Method: The ISS Medical checklist was divided into non-emergency and emergency sections, and re-organized based on alphabetical and a body systems approach. A desk-top evaluation examined the ability of subjects to navigate to specific medical problems identified as representative of likely non-emergency events. A second evaluation aims to focus on the emergency section of the Medical Checklist, based on the preliminary findings of the first. The final evaluation will use Astronaut CMOs as subjects comparing the original checklist against the updated layout in the task of caring for a "downed crewmember" using a Human Patient Simulator [Medical Education Technologies, Inc.]. Results: Initial results have demonstrated a clear improvement of the re-organized sections to determine the solution to the medical problems. There was no distinct advantage for either alternative, although subjects stated having a preference for the body systems approach. In the second evaluation, subjects will be asked to identify emergency medical conditions, with measures including correct diagnosis, time to completion and solution strategy. The third evaluation will compare the original and fully updated checklists in clinical situations. Conclusions: Initial findings indicate that the ISS Medical Checklist will benefit from a reorganization. The present structure of the checklist has evolved over recent years without systematic testing of crewmember ability to diagnose medical problems. The improvements are expected to enable ISS

  3. Survey of Approaches to Generate Realistic Synthetic Graphs

    SciTech Connect

    Lim, Seung-Hwan; Lee, Sangkeun; Powers, Sarah S; Shankar, Mallikarjun; Imam, Neena

    2016-10-01

    A graph is a flexible data structure that can represent relationships between entities. As with other data analysis tasks, the use of realistic graphs is critical to obtaining valid research results. Unfortunately, using the actual ("real-world") graphs for research and new algorithm development is difficult due to the presence of sensitive information in the data or due to the scale of data. This results in practitioners developing algorithms and systems that employ synthetic graphs instead of real-world graphs. Generating realistic synthetic graphs that provide reliable statistical confidence to algorithmic analysis and system evaluation involves addressing technical hurdles in a broad set of areas. This report surveys the state of the art in approaches to generate realistic graphs that are derived from fitted graph models on real-world graphs.

  4. Realistic modeling of the biological channel for the design of implantable wireless UWB communication systems.

    PubMed

    Bahrami, Hadi; Gosselin, Benoit; Rusch, Leslie A

    2012-01-01

    Several emerging medical applications require that a miniature data acquisition device be implanted into the head to extract and wirelessly communicate brain activity to other devices. Designing a reliable communication link for such an application requires a realistic model of the surrounding biological tissues. This paper exploits a realistic model of the biological channel to design a suitable wireless ultra wideband communication link in a brain monitoring application. Two scenarios for positioning the implanted transmitting antenna are considered. The 1(st) scenario places the antenna under the skull, whereas the 2(nd) scenario places the antenna under the skin, above the skull. The propagation characteristics of the signal through the tissues of the human head have been determined with full-wave electromagnetic simulation based on Finite Element Method. The implantable antenna and the external antenna are key components to establish an electromagnetic link between an implanted transmitter and an external receiver. The average specific absorption rate (ASAR) of the implantable antennas are evaluated and compared for the two proposed scenarios. Moreover, the maximum available power from the implanted antenna is evaluated to characterize the performance of the communication link established between the implantable antenna and the external antenna, with respect to spectrum and safety regulations. We show how sensitive the receiver must be in order to implement a reliable telemetry link based on the proposed model of the channel.

  5. Developing and evaluating an automated appendicitis risk stratification algorithm for pediatric patients in the emergency department

    PubMed Central

    Deleger, Louise; Brodzinski, Holly; Zhai, Haijun; Li, Qi; Lingren, Todd; Kirkendall, Eric S; Alessandrini, Evaline; Solti, Imre

    2013-01-01

    Objective To evaluate a proposed natural language processing (NLP) and machine-learning based automated method to risk stratify abdominal pain patients by analyzing the content of the electronic health record (EHR). Methods We analyzed the EHRs of a random sample of 2100 pediatric emergency department (ED) patients with abdominal pain, including all with a final diagnosis of appendicitis. We developed an automated system to extract relevant elements from ED physician notes and lab values and to automatically assign a risk category for acute appendicitis (high, equivocal, or low), based on the Pediatric Appendicitis Score. We evaluated the performance of the system against a manually created gold standard (chart reviews by ED physicians) for recall, specificity, and precision. Results The system achieved an average F-measure of 0.867 (0.869 recall and 0.863 precision) for risk classification, which was comparable to physician experts. Recall/precision were 0.897/0.952 in the low-risk category, 0.855/0.886 in the high-risk category, and 0.854/0.766 in the equivocal-risk category. The information that the system required as input to achieve high F-measure was available within the first 4 h of the ED visit. Conclusions Automated appendicitis risk categorization based on EHR content, including information from clinical notes, shows comparable performance to physician chart reviewers as measured by their inter-annotator agreement and represents a promising new approach for computerized decision support to promote application of evidence-based medicine at the point of care. PMID:24130231

  6. Evaluation of emerging contaminants in a drinking water treatment plant using electrodialysis reversal technology.

    PubMed

    Gabarrón, S; Gernjak, W; Valero, F; Barceló, A; Petrovic, M; Rodríguez-Roda, I

    2016-05-15

    Emerging contaminants (EC) have gained much attention with globally increasing consumption and detection in aquatic ecosystems during the last two decades from ng/L to lower ug/L. The aim of this study was to evaluate the occurrence and removal of pharmaceutically active compounds (PhACs), endocrine disrupting chemicals (EDCs) and related compounds in a Drinking Water Treatment Plant (DWTP) treating raw water from the Mediterranean Llobregat River. The DWTP combined conventional treatment steps with the world's largest electrodialysis reversal (EDR) facility. 49 different PhACs, EDCs and related compounds were found above their limit of quantification in the influent of the DWTP, summing up to a total concentration of ECs between 1600-4200 ng/L. As expected, oxidation using chlorine dioxide and granular activated carbon filters were the most efficient technologies for EC removal. However, despite the low concentration detected in the influent of the EDR process, it was also possible to demonstrate that this process partially removed ionized compounds, thereby constituting an additional barrier against EC pollution in the product. In the product of the EDR system, only 18 out of 49 compounds were quantifiable in at least one of the four experimental campaigns, showing in all cases removals higher than 65% and often beyond 90% for the overall DWTP process.

  7. Development and Psychometric Evaluation of the Treatment-Emergent Activation and Suicidality Assessment Profile

    PubMed Central

    Storch, Eric A.; Murphy, Tanya K.; Bodzin, Danielle; Mutch, P. Jane; Lehmkuhl, Heather; Aman, Michael; Goodman, Wayne K.

    2010-01-01

    Although effective in treating a range of childhood psychiatric conditions, selective serotonin reuptake inhibitors (SSRI) have been implicated in the induction of an “activation syndrome” (characterized by symptoms of irritability, restlessness, emotional labiality, etc.) that may represent an intermediary state change that fosters suicidality. SSRI-induced activation syndrome is well-accepted by many clinicians and thought to be relatively common, particularly in children and teens. However, gaps exist in empirical data on phenomenology and tools for early detection. With this in mind, we report on a recently funded National Institutes of Health grant to develop a measure of behavioral activation to be completed in a clinical setting. We discuss the development of this measure—the Treatment-Emergent Activation and Suicidality Assessment Profile (TE-ASAP)—as well as psychometric results from a sample of youth with internalizing disorders who were at varying stages of SSRI treatment. Overall, psychometric data were quite promising, with the TE-ASAP demonstrating excellent reliability (i.e., internal consistency, inter-rater, short-term test–retest stability) and strong validity properties. Through further evaluation of the TE-ASAP in the context of a controlled multimodal trial in youth with obsessive–compulsive disorder, we hope to augment understanding of activation syndrome and, in turn, mitigate risks through early detection of this potentially lifethreatening adverse effect. PMID:20473344

  8. Development and Psychometric Evaluation of the Treatment-Emergent Activation and Suicidality Assessment Profile.

    PubMed

    Reid, Jeannette M; Storch, Eric A; Murphy, Tanya K; Bodzin, Danielle; Mutch, P Jane; Lehmkuhl, Heather; Aman, Michael; Goodman, Wayne K

    2010-02-04

    Although effective in treating a range of childhood psychiatric conditions, selective serotonin reuptake inhibitors (SSRI) have been implicated in the induction of an "activation syndrome" (characterized by symptoms of irritability, restlessness, emotional labiality, etc.) that may represent an intermediary state change that fosters suicidality. SSRI-induced activation syndrome is well-accepted by many clinicians and thought to be relatively common, particularly in children and teens. However, gaps exist in empirical data on phenomenology and tools for early detection. With this in mind, we report on a recently funded National Institutes of Health grant to develop a measure of behavioral activation to be completed in a clinical setting. We discuss the development of this measure-the Treatment-Emergent Activation and Suicidality Assessment Profile (TE-ASAP)-as well as psychometric results from a sample of youth with internalizing disorders who were at varying stages of SSRI treatment. Overall, psychometric data were quite promising, with the TE-ASAP demonstrating excellent reliability (i.e., internal consistency, inter-rater, short-term test-retest stability) and strong validity properties. Through further evaluation of the TE-ASAP in the context of a controlled multimodal trial in youth with obsessive-compulsive disorder, we hope to augment understanding of activation syndrome and, in turn, mitigate risks through early detection of this potentially lifethreatening adverse effect.

  9. Realistic control of network dynamics.

    PubMed

    Cornelius, Sean P; Kath, William L; Motter, Adilson E

    2013-01-01

    The control of complex networks is of paramount importance in areas as diverse as ecosystem management, emergency response and cell reprogramming. A fundamental property of networks is that perturbations to one node can affect other nodes, potentially causing the entire system to change behaviour or fail. Here we show that it is possible to exploit the same principle to control network behaviour. Our approach accounts for the nonlinear dynamics inherent to real systems, and allows bringing the system to a desired target state even when this state is not directly accessible due to constraints that limit the allowed interventions. Applications show that this framework permits reprogramming a network to a desired task, as well as rescuing networks from the brink of failure-which we illustrate through the mitigation of cascading failures in a power-grid network and the identification of potential drug targets in a signalling network of human cancer.

  10. Realistic Control of Network Dynamics

    PubMed Central

    Cornelius, Sean P.; Kath, William L.; Motter, Adilson E.

    2014-01-01

    The control of complex networks is of paramount importance in areas as diverse as ecosystem management, emergency response, and cell reprogramming. A fundamental property of networks is that perturbations to one node can affect other nodes, potentially causing the entire system to change behavior or fail. Here, we show that it is possible to exploit the same principle to control network behavior. Our approach accounts for the nonlinear dynamics inherent to real systems, and allows bringing the system to a desired target state even when this state is not directly accessible due to constraints that limit the allowed interventions. Applications show that this framework permits reprogramming a network to a desired task as well as rescuing networks from the brink of failure—which we illustrate through the mitigation of cascading failures in a power-grid network and the identification of potential drug targets in a signaling network of human cancer. PMID:23803966

  11. Medical Team Evaluation: Effect on Emergency Department Waiting Time and Length of Stay

    PubMed Central

    Lauks, Juliane; Mramor, Blaz; Baumgartl, Klaus; Maier, Heinrich; Nickel, Christian H.; Bingisser, Roland

    2016-01-01

    Emergency Departments (ED) are trying to alleviate crowding using various interventions. We assessed the effect of an alternative model of care, the Medical Team Evaluation (MTE) concept, encompassing team triage, quick registration, redesign of triage rooms and electronic medical records (EMR) on door-to-doctor (waiting) time and ED length of stay (LOS). We conducted an observational, before-and-after study at an urban academic tertiary care centre. On July 17th 2014, MTE was initiated from 9:00 a.m. to 10 p.m., 7 days a week. A registered triage nurse was teamed with an additional senior ED physician. Data of the 5-month pre-MTE and the 5-month MTE period were analysed. A matched comparison of waiting times and ED LOS of discharged and admitted patients pertaining to various Emergency Severity Index (ESI) triage categories was performed based on propensity scores. With MTE, the median waiting times improved from 41.2 (24.8–66.6) to 10.2 (5.7–18.1) minutes (min; P < 0.01). Though being beneficial for all strata, the improvement was somewhat greater for discharged, than for admitted patients. With a reduction from 54.3 (34.2–84.7) to 10.5 (5.9–18.4) min (P < 0.01), in terms of waiting times, MTE was most advantageous for ESI4 patients. The overall median ED LOS increased for about 15 min (P < 0.01), increasing from 3.4 (2.1–5.3) to 3.7 (2.3–5.6) hours. A significant increase was observed for all the strata, except for ESI5 patients. Their median ED LOS dropped by 73% from 1.2 (0.8–1.8) to 0.3 (0.2–0.5) hours (P < 0.01). In the same period the total orders for diagnostic radiology increased by 1,178 (11%) from 10,924 to 12,102 orders, with more imaging tests being ordered for ESI 2, 3 and 4 patients. Despite improved waiting times a decrease of ED LOS was only seen in ESI level 5 patients, whereas in all the other strata ED LOS increased. We speculate that this was brought about by the tendency of triage physicians to order more diagnostic radiology

  12. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in Great Lakes areas of concern

    EPA Science Inventory

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, we have been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). Over three field seaso...

  13. Novel effects-based monitoring approaches to evaluate chemicals of emerging concern in the St. Louis River estuary

    EPA Science Inventory

    As part of an on-going program of research in support of the Great Lakes Restoration Initiative, the US EPA MED laboratory has been developing effects-based biomonitoring tools to evaluate the occurrence and potential hazards associated with Chemicals of Emerging Concern (CECs). ...

  14. Content, Conciousness, and Colleagues: Emerging Themes from a Program Evaluation of Graduate Student Progress toward Multidisciplinary Science.

    ERIC Educational Resources Information Center

    Kusmierek, Kristin N.; Piontek, Mary

    Multidisciplinary education attempts to produce individuals with new capacities to address the problems of an increasingly interconnected world. Although these programs are often exciting, descriptions of optimal design and measures of success are few. Emerging evaluation results from one multidisciplinary graduate training program provide…

  15. Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from within

    ERIC Educational Resources Information Center

    Dion, Jacinthe; Kennedy, Allison; Cloutier, Paula; Gray, Clare

    2010-01-01

    An innovative crisis intervention programme was created at the Children's Hospital of Eastern Ontario in Canada in order to provide emergency assessments for youth presenting with mental health crises. The current investigation presents an overview of the programme and examines the emergency staff's perception and satisfaction with it.…

  16. Evaluating an Alternative to the Emergency Department for Adults in Mental Health Crisis.

    PubMed

    Heyland, Michelle; Johnson, Mary

    2017-04-07

    Adults with mental health issues lack clinically indicated options when in crisis. Historically, the emergency department (ED) has been the primary source of intervention largely due to funding cuts and decreased community resources in the USA. The literature highlights drastic mental health funding cuts alongside an increased prevalence of mental illness. A community-based alternative for adults in mental health crises was subsequently developed as a model of crisis care. The program has demonstrated impressive short-term outcomes, typically avoiding ED admissions in over 95% of the clients. This number benefits both the consumers who otherwise rely on the ED and the State of Illinois in terms of cost savings for avoidable ED visits. The current deflection rate only reflects ED admissions deflected on the day of the visit to the crisis respite program. To establish the long-term outcomes for this model, follow-up phone calls were conducted to determine whether or not the individual required an ED visit for a psychiatric reason within 30 days of utilization of the program. The follow-up phone calls began in May and continued for eight weeks. At this time, the data collected were analyzed and the outcomes of the program were further evaluated. Based on the follow-up survey results, the positive long-term outcomes validate this model as a cost-saving and clinically indicated alternative to the ED. Establishing such outcomes was necessary to ensure continued funding and to support establishment of similar models of crisis care.

  17. Evaluating Contaminants of Emerging Concern as tracers of wastewater from septic systems.

    PubMed

    James, C Andrew; Miller-Schulze, Justin P; Ultican, Shawn; Gipe, Alex D; Baker, Joel E

    2016-09-15

    Bacterial and nutrient contamination from anthropogenic sources impacts fresh and marine waters, reducing water quality and restricting recreational and commercial activities. In many cases the source of this contamination is ambiguous, and a tracer or set of tracers linking contamination to source would be valuable. In this work, the effectiveness of utilizing a suite of Contaminants of Emerging Concern (CECs) as tracers of bacteria from human septic system effluent is investigated. Field sampling was performed at more than 20 locations over approximately 18 months and analyzed for a suite of CECs and fecal coliform bacteria. The sampling locations included seeps and small freshwater discharges to the shoreline. Sites were selected and grouped according to level of impact by septic systems as determined by previous field sampling programs. A subset of selected locations had been positively identified as being impacted by effluent from failing septic systems through dye testing. The CECs were selected based on their predominant use, their frequency of use, and putative fate and transport properties. In addition, two rounds of focused sampling were performed at selected sites to characterize short-term variations in CEC and fecal coliform concentrations, and to evaluate environmental persistence following source correction activities. The results indicate that a suite of common use compounds are suitable as generalized tracers of bacterial contamination from septic systems and that fate and transport properties are important in tracer selection. Highly recalcitrant or highly labile compounds likely follow different loss profiles in the subsurface compared to fecal bacteria and are not suitable tracers. The use of more than one tracer compound is recommended due to source variability of septic systems and to account for variations in the subsurface condition. In addition, concentrations of some CECs were measured in receiving waters at levels which suggested the

  18. [Evaluation of emergency services of the hospitals from the QualiSUS program].

    PubMed

    O'Dwyer, Gisele Oliveira; de Oliveira, Sergio Pacheco; de Seta, Marismary Horsth

    2009-01-01

    The aid lent by the emergency services is the object of this paper, which aims to assess the emergency service of the QualiSUS program. The study is descriptive with the application of a questionnaire to the responsible of the emergency services in eight hospitals. The emergency services were always overcrowded, and the causes pointed were the low resolutivity of basic attention and the precariousness of the hospital network. Contributing to this there is the primary care decreased resolutivity and the precariousness of the hospital network. Six hospitals do not manage the emergency service. The entrance system is not organized and only three hospitals work with risk classification. All of them refer difficulties with internal and external services. The hardest pathologies to refer to other services are the chronicles, neurological and social. The professionals do not have specific qualification and the precariousness job contracts do not contribute neither for the professional's fixation nor for his qualification. Clinical protocols are used by one service. It was noticed the influence of the QualiSUS in the hospitals. The failure of the health services network interferes with the emergency patient's profile. The investment of the QualiSUS cannot be restrained to the hospital. Emergency should be more integrated to the system and hospital. The qualification of human resources is indispensable as well as the bed's regulation.

  19. Improving the health and safety of 911 emergency call centre agents: an evaluability assessment of a knowledge transfer strategy.

    PubMed

    Dagenais, Christian; Plouffe, Laurence; Gagné, Charles; Toulouse, Georges; Breault, Andrée-Anne; Dupont, Didier

    2017-03-01

    A knowledge transfer (KT) strategy was implemented by the IRSST, an occupational health and safety research institute established in Québec (Canada), to improve the prevention of psychological and musculoskeletal problems among 911 emergency call centre agents. An evaluability assessment was conducted in which each aspect of the KT approach was documented systematically to determine whether the strategy had the potential to be evaluated in terms of its impact on the targeted population. A review of the literature on KT in occupational health and safety and on the evaluation of such KT programmes, along with the development of a logic model based on documentary analysis and semi-structured interviews with key stakeholders, indicated that the KT strategy was likely to have had a positive impact in the 911 emergency call centre sector. Implications for future research are discussed.

  20. Evaluating the Pediatric Early Warning Score (PEWS) System for Admitted Patients in the Pediatric Emergency Department

    PubMed Central

    Gold, Delia L.; Mihalov, Leslie K.; Cohen, Daniel M.

    2015-01-01

    Objectives The Pediatric Early Warning Score (PEWS) systems were developed to provide a reproducible assessment of a child’s clinical status while hospitalized. Most studies investigating the PEWS evaluate its usefulness in the inpatient setting. Limited studies evaluate the effectiveness and integration of PEWS in the pediatric emergency department (ED). The goal of this study was to explore the test characteristics of an ED-assigned PEWS score for intensive care unit (ICU) admission or clinical deterioration in admitted patients. Methods This was a prospective 12-month observational study of patients, aged 0 to 21 years, admitted from the ED of an urban, tertiary care children’s hospital. ED nurses were instructed in PEWS assignment and electronic medical record (EMR) documentation. Interrater reliability between nurses was evaluated. PEWS scores were measured at initial assessment (P0) and time of admission (P1). Patients were stratified into outcome groups: those admitted to the ICU either from the ED or as transfers from the floor and those admitted to the floor only. Clinical deterioration was defined as transfer to the ICU within 6 hours or within 6 to 24 hours of admission. PEWS scores and receiver operating characteristic (ROC) curves were compared for patients admitted to the floor, ICU, and with clinical deterioration. Results The authors evaluated 12,306 consecutively admitted patients, with 99% having a PEWS documented in the EMR. Interrater reliability was excellent (intraclass coefficient 0.91). A total of 1,300 (10.6%) patients were admitted to the ICU and 11,066 (89.4%) were admitted to the floor. PEWS scores were higher for patients in the ICU group (P0 = 2.8, SD ± 2.4; P1 = 3.2, SD ± 2.4; p < 0.0001) versus floor patients (P0 = 0.7, SD ± 1.2; P1 = 0.5, SD ± 0.9; p < 0.0001). To predict the need for ICU admission, the optimal cutoff points on the ROC are P0 = 1 and P1 = 2, with areas under the ROC curve (AUCs) of 0.79 and 0

  1. Marine Corps Recruit Training Attrition: The Effect of Realistic Job Preview and Stress-Coping Films.

    ERIC Educational Resources Information Center

    Githens, William H.; Zalinski, James

    Two films were evaluated to determine their effectiveness in reducing attrition among Marine Corps recruits. The films were a realistic job preview of military training and a stress-coping film. Platoons of Marine recruits were randomly assigned to four treatment groups: viewing the realistic job preview film, viewing the stress-coping film,…

  2. Vibration signaling in mobile devices for emergency alerting: a study with deaf evaluators.

    PubMed

    Harkins, Judith; Tucker, Paula E; Williams, Norman; Sauro, Jeff

    2010-01-01

    In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify that the incoming message pertains to an emergency. Ratings of vibration signals of varying lengths and patterns were obtained from 44 deaf users of mobile devices for the perceived effectiveness of the signal in getting their attention in an emergency situation. Longer signals received higher ratings than shorter ones, and three signals with temporal on-off patterns were rated significantly better than a constant vibration. The U.S. government's recommended vibration signal for the CMAS, an important feature for access to emergency alerts by deaf persons, is supported by the results of the study.

  3. Identifying preschool children at risk of later reading difficulties: evaluation of two emergent literacy screening tools.

    PubMed

    Wilson, Shauna B; Lonigan, Christopher J

    2010-01-01

    Emergent literacy skills are predictive of children's early reading success, and literacy achievement in early schooling declines more rapidly for children who are below-average readers. It is therefore important for teachers to identify accurately children at risk for later reading difficulty so children can be exposed to effective emergent literacy interventions. In this study, 176 preschoolers were administered two screening tools, the Revised Get Ready to Read! (GRTR-R) and the Individual Growth and Development Indicators (IGDIs), and a diagnostic measure at two time points. Receiver operating characteristic curve analyses revealed that, at optimal cut scores, GRTR-R provided more accurate classification of children's overall emergent literacy skills than did IGDIs. However, neither measure was particularly good at classifying specific emergent literacy skills.

  4. Systems approach to detect and evaluate contaminants of emerging concern in the Great Lakes

    EPA Science Inventory

    The release of chemicals of emerging concern threatens near shore health in the Great Lakes, particularly in regions already suffering from degradation of water and environmental quality due to past and present anthropogenic activities. Critical issues remain in delisting Areas ...

  5. Toward a Direct Realist Account of Observation.

    ERIC Educational Resources Information Center

    Sievers, K. H.

    1999-01-01

    Criticizes the account of observation given by Alan Chalmers in "What Is This Thing Called Science?" and provides an alternative based on direct realist approaches to perception. Contains 15 references. (Author/WRM)

  6. Temporal Coding in Realistic Neural Networks

    NASA Astrophysics Data System (ADS)

    Gerasyuta, S. M.; Ivanov, D. V.

    1995-10-01

    The modification of realistic neural network model have been proposed. The model differs from the Hopfield model because of the two characteristic contributions to synaptic efficacious: the short-time contribution which is determined by the chemical reactions in the synapses and the long-time contribution corresponding to the structural changes of synaptic contacts. The approximation solution of the realistic neural network model equations is obtained. This solution allows us to calculate the postsynaptic potential as function of input. Using the approximate solution of realistic neural network model equations the behaviour of postsynaptic potential of realistic neural network as function of time for the different temporal sequences of stimuli is described. The various outputs are obtained for the different temporal sequences of the given stimuli. These properties of the temporal coding can be exploited as a recognition element capable of being selectively tuned to different inputs.

  7. Evaluating the Linkage Between Emergency Medical Services and the Provision of Scarce Resources Through Simulation

    PubMed Central

    Klafehn, Keith A.; Owens, Deborah L.; Felter, Robert A.; Vonneman, Nancy; McKinnon, Carla J.

    1989-01-01

    A simulation model of the flow of patients in the emergency room of a pediatric hospital was used to investigate the linkage between the emergency medical services provided and the efficient mix of scarce resources. Specific attention was given to the results of the patient flows as they were affected by whether there was one or two triage nurses, the nurse complement for non-urgent patients, and the number of orthopedic groups available for diagnosis and prescription.

  8. An evidence-based approach to the evaluation and treatment of low back pain in the emergency department.

    PubMed

    Borczuk, Pierre

    2013-07-01

    Low back pain is the most common musculoskeletal complaint that results in a visit to the emergency department, and it is 1 of the top 5 most common complaints in emergency medicine. Estimates of annual healthcare expenditures for low back pain in the United States exceed $90 billion annually, not even taking lost productivity and business costs into account. This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department. Published guidelines from the American College of Physicians and American Pain Society are reviewed, with emphasis on best evidence for pharmacologic treatments, self-care interventions, and more invasive procedures and surgery in management of low back pain. Utilizing effective and proven strategies will avoid medical errors, provide better care for patients, and help manage healthcare resources and costs.

  9. Thallium myocardial scanning in the emergency department evaluation of chest pain

    SciTech Connect

    Mace, S.E.

    1989-05-01

    Chest pain is a common complaint of patients seen in the emergency department. The causes are legion, and range from the non-life threatening to the potentially catastrophic. Thallium heart scanning was done prospectively in 20 patients with a ''classic'' history for myocardial infarction (eight patients) or atypical chest pain and/or associated symptoms plus an abnormal ECG (12 patients) to discern a subset of patients from whom thallium scintography may be indicated in the emergency department. Although further investigation is needed, our preliminary study suggests that myocardial scanning with thallium can be a safe, fairly rapid, and useful objective parameter in the emergency department detection of suspected myocardial infarction, and in differential diagnosis of chest pain when other data such as the history, physical examination, ECG, or enzymes are inconclusive.

  10. Blend Shape Interpolation and FACS for Realistic Avatar

    NASA Astrophysics Data System (ADS)

    Alkawaz, Mohammed Hazim; Mohamad, Dzulkifli; Basori, Ahmad Hoirul; Saba, Tanzila

    2015-03-01

    The quest of developing realistic facial animation is ever-growing. The emergence of sophisticated algorithms, new graphical user interfaces, laser scans and advanced 3D tools imparted further impetus towards the rapid advancement of complex virtual human facial model. Face-to-face communication being the most natural way of human interaction, the facial animation systems became more attractive in the information technology era for sundry applications. The production of computer-animated movies using synthetic actors are still challenging issues. Proposed facial expression carries the signature of happiness, sadness, angry or cheerful, etc. The mood of a particular person in the midst of a large group can immediately be identified via very subtle changes in facial expressions. Facial expressions being very complex as well as important nonverbal communication channel are tricky to synthesize realistically using computer graphics. Computer synthesis of practical facial expressions must deal with the geometric representation of the human face and the control of the facial animation. We developed a new approach by integrating blend shape interpolation (BSI) and facial action coding system (FACS) to create a realistic and expressive computer facial animation design. The BSI is used to generate the natural face while the FACS is employed to reflect the exact facial muscle movements for four basic natural emotional expressions such as angry, happy, sad and fear with high fidelity. The results in perceiving the realistic facial expression for virtual human emotions based on facial skin color and texture may contribute towards the development of virtual reality and game environment of computer aided graphics animation systems.

  11. Evaluating instruments for quality: testing convergent validity of the consumer emergency care satisfaction scale.

    PubMed

    Davis, Barbara A; Kiesel, Cynthia K; McFarland, Julie; Collard, Adressa; Coston, Kyle; Keeton, Ada

    2005-01-01

    Having reliable and valid instruments is a necessity for nurses and others measuring concepts such as patient satisfaction. The purpose of this article is to describe the use of convergence to test the construct validity of the Davis Consumer Emergency Care Satisfaction Scale (CECSS). Results indicate convergence of the CECSS with the Risser Patient Satisfaction Scale and 2 single-item visual analogue scales, therefore supporting construct validity. Persons measuring patient satisfaction with nurse behaviors in the emergency department can confidently use the CECSS.

  12. Building Leadership Capacity: An Evaluation of the University of Cape Town's Emerging Student Leaders Programme

    ERIC Educational Resources Information Center

    Mukoza, Stella Kyobula; Goodman, Suki

    2013-01-01

    Universities worldwide are becoming increasingly interested in the importance of emerging co-curricula that focus on developing graduate attributes beyond specific academic disciplines. This is being influenced by industry demands for graduates with behavioural and cognitive skills aligned to the work they will do in their early careers. This…

  13. Evaluation of the Cooperative Emergency Substance Abuse Prevention Training Program, 1991-1992. OER Report.

    ERIC Educational Resources Information Center

    Weich, Leah; Philip, Radhika

    The 1991-1992 Cooperative Emergency Substance Abuse Prevention Program was the first year of a two-year program in Community School District 3 in New York City. The overall objectives of the program were to provide staff training in the knowledge and skills necessary to carry out substance abuse prevention education, to make available to students…

  14. A pilot study to evaluate learning style–tailored information prescriptions for hypertensive emergency department patients*

    PubMed Central

    Giuse, Nunzia B; Storrow, Alan B

    2011-01-01

    Objective: This pilot study explored whether learning style–tailored education materials, “information prescriptions,” are effective in increasing hypertension knowledge in emergency room patients. Methods: In a randomized trial, hypertensive emergency medicine patients received either standard care discharge instructions or discharge instructions in combination with an information prescription individualized to each patient's learning-style preference. Two weeks post-visit, the study team assessed changes in hypertension knowledge via a survey. Results: No significant difference was observed for changes in quiz scores on the hypertension knowledge assessment, though patients receiving the tailored information prescriptions reported higher levels of satisfaction with intervention materials. Conclusion: The study demonstrated the workflow feasibility of implementing a learning-style approach to patient education in the emergency department setting. Further research is needed to develop more robust measures of high blood pressure knowledge among the emergency department patient population. This work will contribute to establishing a framework for developing customized information prescriptions that can be broadly adapted for use in varied settings and with varied health care conditions. PMID:22022222

  15. An Evaluation of Two Stimulus Equivalence Training Sequences on the Emergence of Novel Intraverbals

    ERIC Educational Resources Information Center

    Zaring-Hinkle, Brittany; Carp, Charlotte Lynn; Lepper, Tracy L.

    2016-01-01

    Researchers have begun to investigate the emergence of novel intraverbals using equivalence-based instruction (EBI) in typically developing children (Carp & Petursdottir, 2012; Pérez-González, Herszlikowicz, & Williams, 2008). We sought to replicate and extend the previous research by investigating two stimulus equivalence training…

  16. 76 FR 72431 - Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... Plans and Preparedness in Support of Nuclear Power Plants, NUREG-0654/FEMA-REP-1, Supplement 4 and FEMA... Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants,'' NUREG-0654/FEMA... Program Manual). Supplement 4 is a joint document issued by FEMA and the Nuclear Regulatory...

  17. Vibration Signaling in Mobile Devices for Emergency Alerting: A Study with Deaf Evaluators

    ERIC Educational Resources Information Center

    Harkins, Judith; Tucker, Paula E.; Williams, Norman; Sauro, Jeff

    2010-01-01

    In the United States, a nationwide Commercial Mobile Alert Service (CMAS) is being planned to alert cellular mobile device subscribers to emergencies occurring near the location of the mobile device. The plan specifies a unique audio attention signal as well as a unique vibration attention signal (for mobile devices set to vibrate) to identify…

  18. Emergency Contraception Education for Health and Human Service Professionals: An Evaluation of Knowledge and Attitudes

    ERIC Educational Resources Information Center

    Colarossi, Lisa; Billowitz, Marissa; Breitbart, Vicki

    2010-01-01

    Objective: To assess the knowledge and attitudes of health care providers, health educators, and social service providers before and after a training session on emergency contraceptive pills. Design: A survey study using pre-post training measurements. Setting: Two hundred and twenty-three medical, social service, and health education providers in…

  19. Evaluation and correlation of sensory attributes and chemical compositions of emerging fresh produce: Microgreens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Microgreens are an emerging healthy food product with vivid colors and diverse flavors. However, information pertaining to their sensory attributes is scarce. In this study, six microgreen varieties were specifically selected from 25 varieties to represent five distinct flavor groups: 1) mustard (Di...

  20. Evaluating the Components of an Emergent Literacy Intervention for Preschool Children at Risk for Reading Difficulties

    ERIC Educational Resources Information Center

    Lonigan, Christopher J.; Purpura, David J.; Wilson, Shauna B.; Walker, Patricia M.; Clancy-Menchetti, Jeanine

    2013-01-01

    Many preschool children are at risk for reading problems because of inadequate emergent literacy skills. Evidence supports the effectiveness of interventions to promote these skills, but questions remain about which intervention components work and whether combining intervention components will result in larger gains. In this study, 324…

  1. Investigating Attitudes towards an Emerging Standard of English: Evaluations of Newscasters' Accents in Trinidad

    ERIC Educational Resources Information Center

    Deuber, Dagmar; Leung, Glenda-Alicia

    2013-01-01

    This paper addresses the issue of the emergence of new standards of English in the postcolonial world by means of a language attitude study conducted in the Caribbean island of Trinidad that involved rating the accents of newscasters. Accents represented in the clips played to respondents comprised various local as well as non-local ones. The…

  2. [Evaluation of a Legionella outbreak emerged in a recently opening hotel].

    PubMed

    Erdoğan, Haluk; Arslan, Hande

    2013-04-01

    Legionnaires' disease (LD) is a systemic infection caused by Legionella species especially colonized in the water systems. Hotels are common locations in which waterwork-associated sporadic or epidemic legionellosis can be detected. The aim of this study was to evaluate a small Legionella outbreak emerged in a recently opened 600-bed hotel in Alanya, a touristic county in Mediterranean part of Turkey. A 66 years old male patient who stayed in this hotel opened on May 15th, 2009, was admitted to our hospital on May 21st, 2009 with the complaints of high fever, headache and diarrhea lasting for three days. Since chest X-ray revealed non-homogenous density increase in left middle and inferior zone, the patient was diagnosed as atypical pneumoniae and LD was confirmed by positive urinary Legionella antigen test (Card test, BinaxNOW®Legionella Urinary Antigen Test; Alere Co, USA) result. Following the identification of the index case, the records of our hospital were reviewed and revealed another case being treated with the diagnosis of community acquired pneumonia who was also the guest of the same hotel. This patient was then diagnosed as LD by positive urinary antigen test. Since new cases were identified during the following days (May 22, 25 and 26) the Antalya County Health Department and hotel management were informed about a cluster of LD. In addition subsequent investigation for environmental surveillance and water sampling were conducted. The LD diagnosis and environmental inspections were performed according to the procedure described in the guideline from "Turkish Ministry of Health Travel-Associated Legionnaires' Disease Control Programme". Five definitive cases and one presumptive case of LD were identified during the outbreak period (May 20-26, 2009). All of the cases were successfully treated (intravenous ciprofloxacin or levofloxacin or clarithromycin), however one patient died due to sudden death during sleep after being discharged. Since sputum

  3. Role of dissipation in realistic Majorana nanowires

    NASA Astrophysics Data System (ADS)

    Liu, Chun-Xiao; Sau, Jay D.; Das Sarma, S.

    2017-02-01

    We carry out a realistic simulation of Majorana nanowires in order to understand the latest high-quality experimental data [H. Zhang et al., arXiv:1603.04069 (2016)] and, in the process, develop a comprehensive picture for what physical mechanisms may be operational in realistic nanowires leading to discrepancies between minimal theory and experimental observations (e.g., weakness and broadening of the zero-bias peak and breaking of particle-hole symmetry). Our focus is on understanding specific intriguing features in the data, and our goal is to establish matters of principle controlling the physics of the best possible nanowires available in current experiments. We identify dissipation, finite temperature, multi-sub-band effects, and the finite tunnel barrier as the four most important physical mechanisms controlling the zero-bias conductance peak. Our theoretical results including these realistic effects agree well with the best available experimental data in ballistic nanowires.

  4. Realistic losses of rare species disproportionately impact higher trophic levels.

    PubMed

    Bracken, Matthew E S; Low, Natalie H N

    2012-05-01

    Predicting the consequences of changes in biodiversity requires understanding both species' susceptibility to extirpation and their functional roles in ecosystems. However, few studies have evaluated the effects of realistic, non-random biodiversity losses, severely limiting the applicability of biodiversity research to conservation. Here, we removed sessile species from a rocky shore community in a way that deliberately mimicked natural patterns of species loss. We found that the rarest species in the system act from the bottom up to disproportionately impact the diversity and abundance of consumers. Realistic losses of rare species in a diverse assemblage of seaweeds and sessile invertebrates, collectively comprising <10% of sessile biomass, resulted in a 42-47% decline in consumer biomass. In contrast, removal of an equivalent biomass of dominant sessile species had no effect on consumers. Our results highlight the 'cornerstone' role that rare species can play in shaping the structure of the community they support.

  5. A Virtual Emergency Telemedicine Serious Game in Medical Training: A Quantitative, Professional Feedback-Informed Evaluation Study

    PubMed Central

    Constantinou, Riana; Marangos, Charis; Kyriacou, Efthyvoulos; Bamidis, Panagiotis; Dafli, Eleni; Pattichis, Constantinos S

    2015-01-01

    Background Serious games involving virtual patients in medical education can provide a controlled setting within which players can learn in an engaging way, while avoiding the risks associated with real patients. Moreover, serious games align with medical students’ preferred learning styles. The Virtual Emergency TeleMedicine (VETM) game is a simulation-based game that was developed in collaboration with the mEducator Best Practice network in response to calls to integrate serious games in medical education and training. The VETM game makes use of data from an electrocardiogram to train practicing doctors, nurses, or medical students for problem-solving in real-life clinical scenarios through a telemedicine system and virtual patients. The study responds to two gaps: the limited number of games in emergency cardiology and the lack of evaluations by professionals. Objective The objective of this study is a quantitative, professional feedback-informed evaluation of one scenario of VETM, involving cardiovascular complications. The study has the following research question: “What are professionals’ perceptions of the potential of the Virtual Emergency Telemedicine game for training people involved in the assessment and management of emergency cases?” Methods The evaluation of the VETM game was conducted with 90 professional ambulance crew nursing personnel specializing in the assessment and management of emergency cases. After collaboratively trying out one VETM scenario, participants individually completed an evaluation of the game (36 questions on a 5-point Likert scale) and provided written and verbal comments. The instrument assessed six dimensions of the game: (1) user interface, (2) difficulty level, (3) feedback, (4) educational value, (5) user engagement, and (6) terminology. Data sources of the study were 90 questionnaires, including written comments from 51 participants, 24 interviews with 55 participants, and 379 log files of their interaction with

  6. Evaluating the Reliability of Emergency Response Systems for Large-Scale Incident Operations

    DTIC Science & Technology

    2010-01-01

    a hospital can accept after an incident). Effectiveness-reduction failures may cause a reduction in system performance either directly or via their...information on where food aid was needed couldn’t be transmitted from the affected area because communications links were severed. Or agency disputes about...incident.9 For example, if a mass casualty plan includes a surge in hospital beds and staff and emergency supplies to temporarily 7 This framing is

  7. Evaluation of Emergency-Locator-Transmitter performance in real and simulated crash tests

    NASA Technical Reports Server (NTRS)

    Carden, H. D.

    1981-01-01

    Emergency locator transmitter (ELT) activation problems were investigated by testing a sampling of ELT units in actual crashes and in a special test apparatus which simulated longitudinal crash pulses with superimposed local structural resonances. The probable causes of excessive false alarms and nonactivation of ELT's during crash situations were determined. Solutions to operational and technical problems were also examined as well as the sensitivity of ELT impact switches to orientation and to local structural vibrations.

  8. Keeping It Real: How Realistic Does Realistic Fiction for Children Need to Be?

    ERIC Educational Resources Information Center

    O'Connor, Barbara

    2010-01-01

    O'Connor, an author of realistic fiction for children, shares her attempts to strike a balance between carefree, uncensored, authentic, realistic writing and age-appropriate writing. Of course, complicating that balancing act is the fact that what seems age-appropriate to her might not seem so to everyone. O'Connor suggests that while it may be…

  9. Emergency evacuation/transportation plan update: Traffic model development and evaluation of early closure procedures. Final report

    SciTech Connect

    1993-10-28

    Prolonged delays in traffic experienced by Laboratory personnel during a recent early dismissal in inclement weather, coupled with reconstruction efforts along NM 502 east of the White Rock Wye for the next 1 to 2 years, has prompted Los Alamos National Laboratory (LANL) to re-evaluate and improve the present transportation plan and its integration with contingency plans maintained in other organizations. Facilities planners and emergency operations staff need to evaluate the transportation system`s capability to inefficiently and safely evacuate LANL under different low-level emergency conditions. A variety of potential procedures governing the release of employees from the different technical areas (TAs) requires evaluation, perhaps with regard to multiple emergency-condition scenarios, with one or more optimal procedures ultimately presented for adoption by Lab Management. The work undertaken in this project will hopefully lay a foundation for an on-going, progressive transportation system analysis capability. It utilizes microscale simulation techniques to affirm, reassess and validate the Laboratory`s Early Dismissal/Closure/Delayed Opening Plan. The Laboratory is required by Federal guidelines, and compelled by prudent practice and conscientious regard for the welfare of employees and nearby residents, to maintain plans and operating procedures for evacuation if the need arises. The tools developed during this process can be used outside of contingency planning. It is anticipated that the traffic models developed will allow site planners to evaluate changes to the traffic network which could better serve the normal traffic levels. Changes in roadway configuration, control strategies (signalization and signing), response strategies to traffic accidents, and patterns of demand can be modelled using the analysis tools developed during this project. Such scenarios typically are important considerations in master planning and facilities programming.

  10. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. Setting Community pharmacies across the North East of England accredited to provide this service. Participants Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. Intervention Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. Primary outcomes Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. Results A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. Conclusions Community pharmacists were able to manage patients’ OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when

  11. A Look at Young Children's Realistic Fiction.

    ERIC Educational Resources Information Center

    Madsen, Jane M.; Wickersham, Elaine B.

    1980-01-01

    Analyzes recent realistic fiction for children produced in the United States in terms of ethnicity, stereotyped behavior, and themes. Concludes that the sample did not reflect equivalent treatment of males and females nor the culturally pluralistic makeup of U.S. society. Provides an annotated bibliography of the books analyzed. (Author/FL)

  12. Making a Literature Methods Course "Realistic."

    ERIC Educational Resources Information Center

    Lewis, William J.

    Recognizing that it can be a challenge to make an undergraduate literature methods course realistic, a methods instructor at a Michigan university has developed three major and several minor activities that have proven effective in preparing pre-student teachers for the "real world" of teaching and, at the same time, have been challenging and…

  13. Satellite Maps Deliver More Realistic Gaming

    NASA Technical Reports Server (NTRS)

    2013-01-01

    When Redwood City, California-based Electronic Arts (EA) decided to make SSX, its latest snowboarding video game, it faced challenges in creating realistic-looking mountains. The solution was NASA's ASTER Global Digital Elevation Map, made available by the Jet Propulsion Laboratory, which EA used to create 28 real-life mountains from 9 different ranges for its award-winning game.

  14. Spatial Visualization by Realistic 3D Views

    ERIC Educational Resources Information Center

    Yue, Jianping

    2008-01-01

    In this study, the popular Purdue Spatial Visualization Test-Visualization by Rotations (PSVT-R) in isometric drawings was recreated with CAD software that allows 3D solid modeling and rendering to provide more realistic pictorial views. Both the original and the modified PSVT-R tests were given to students and their scores on the two tests were…

  15. Improving Intuition Skills with Realistic Mathematics Education

    ERIC Educational Resources Information Center

    Hirza, Bonita; Kusumah, Yaya S.; Darhim; Zulkardi

    2014-01-01

    The intention of the present study was to see the improvement of students' intuitive skills. This improvement was seen by comparing the Realistic Mathematics Education (RME)-based instruction with the conventional mathematics instruction. The subject of this study was 164 fifth graders of elementary school in Palembang. The design of this study…

  16. Evaluation of emerging parallel optical link technology for high energy physics

    SciTech Connect

    Chramowicz, J.; Kwan, S.; Prosser, A.; Winchell, M.; /Fermilab

    2012-01-01

    Modern particle detectors utilize optical fiber links to deliver event data to upstream trigger and data processing systems. Future detector systems can benefit from the development of dense arrangements of high speed optical links emerging from industry advancements in transceiver technology. Supporting data transfers of up to 120 Gbps in each direction, optical engines permit assembly of the optical transceivers in close proximity to ASICs and FPGAs. Test results of some of these parallel components will be presented including the development of pluggable FPGA Mezzanine Cards equipped with optical engines to provide to collaborators on the Versatile Link Common Project for the HI-LHC at CERN.

  17. Evaluation and management of traumatic knee injuries in the emergency department.

    PubMed

    Knutson, Tristan; Bothwell, Jason; Durbin, Ricky

    2015-05-01

    Posttraumatic knee pain is a common presentation in the emergency department (ED). The use of clinical decision rules can rule out reliably fractures of the knee and reduce the unnecessary cost and radiation exposure associated with plain radiographs. If ligamentous or meniscal injury to the knee is suspected, the ED physician should arrange for expedited follow- up with the patient's primary care physician or an orthopedic specialist for consideration of an MRI and further management. Patients presenting after high-energy mechanisms are at risk for occult fracture and vascular injuries. ED providers must consider these injuries in the proper clinical setting.

  18. An anatomically realistic temperature phantom for radiofrequency heating measurements

    PubMed Central

    Graedel, Nadine N.; Polimeni, Jonathan R.; Guerin, Bastien; Gagoski, Borjan; Wald, Lawrence L.

    2014-01-01

    Purpose An anthropomorphic phantom with realistic electrical properties allows for a more accurate reproduction of tissue current patterns during excitation. A temperature map can then probe the worst-case heating expected in the un-perfused case. We describe an anatomically realistic human head phantom that allows rapid 3D temperature mapping at 7 T. Methods The phantom was based on hand-labeled anatomical imaging data and consists of four compartments matching the corresponding human tissues in geometry and electrical properties. The increases in temperature resulting from radiofrequency excitation were measured with MR thermometry using a temperature sensitive contrast agent (TmDOTMA−) validated by direct fiber optic temperature measurements. Results Acquisition of 3D temperature maps of the full phantom with a temperature accuracy better than 0.1°C was achieved with an isotropic resolution of 5 mm and acquisition times of 2–4 minutes. Conclusion Our results demonstrate the feasibility of constructing anatomically realistic phantoms with complex geometries incorporating the ability to measure accurate temperature maps in the phantom. The anthropomorphic temperature phantom is expected to provide a useful tool for the evaluation of the heating effects of both conventional and parallel transmit pulses and help validate electromagnetic and temperature simulations. PMID:24549755

  19. Comparison between realistic and spherical approaches in EEG forward modelling.

    PubMed

    Meneghini, Fabio; Vatta, Federica; Esposito, Fabrizio; Mininel, Stefano; Di Salle, Francesco

    2010-06-01

    In electroencephalography (EEG) a valid conductor model of the head (forward model) is necessary for predicting measurable scalp voltages from intra-cranial current distributions. All inverse models, capable of inferring the spatial distribution of the neural sources generating measurable electrical and magnetic signals outside the brain are normally formulated in terms of a pre-estimated forward model, which implies considering one (or more) current dipole(s) inside the head and computing the electrical potentials generated at the electrode sites on the scalp surface. Therefore, the accuracy of the forward model strongly affects the reliability of the source reconstruction process independently of the specific inverse model. So far, it is as yet unclear which brain regions are more sensitive to the choice of different model geometry, from both quantitative and qualitative points of view. In this paper, we compare the finite difference method-based realistic model with the four-layers sensor-fitted spherical model using simulated cortical sources in the MNI152 standard space. We focused on the investigation of the spatial variation of the lead fields produced by simulated cortical sources which were placed on the reconstructed mesh of the neocortex along the surface electrodes of a 62-channel configuration. This comparison is carried out by evaluating a point spread function all over the brain cortex, with the aim of finding the lead fields mismatch between realistic and spherical geometry. Realistic geometry turns out to be a relevant factor of improvement which is particularly important when considering sources placed in the temporal or in the occipital cortex. In these situations, using a realistic head model will allow a better spatial discrimination of neural sources when compared to the spherical model.

  20. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

    PubMed Central

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-01

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

  1. Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

    PubMed

    Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

    2017-01-21

    This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

  2. Evaluation of the certificate in emerging infectious disease research and the certificate in one health training programs, University of Florida.

    PubMed

    Valentine, Marissa A; Perdue, Christopher L; Cummings, James F; Smith, Jacqueline C; Gray, Gregory C

    2015-03-01

    In developing countries, public health professionals and scientists need targeted training and practical skills to respond to global emerging infectious disease threats. The Certificate in Emerging Infectious Disease Research was developed in 2008 to aid such professionals to respond to complex emerging disease problems. The short-course was modified slightly in 2013 and renamed the Certificate in One Health. To evaluate the immediate impact of the short-course, an online survey of 176 past participants from both the courses was conducted. The survey tool assessed the program's process, impact, and outcome measures respectively via assessing the courses' perceived strengths and weaknesses, perceived skills gained, and the participants' current position, publication status, funding status, and educational attainment; 85 (48.3%) participants completed the survey. Reported program strengths included the curriculum, expertise of lecturers, and diversity of the training cohort. The principal reported weakness was the compressed academic schedule. The most frequently reported benefits included: epidemiological and biostatistical skills, followed by One-Health knowledge, and research skills. Twenty-eight percent of the survey respondents reported publishing one or more manuscripts since completing the course and 21% reported receiving research funding. The course appears to have had a positive, immediate impact on the students' self-perceived knowledge and capabilities.

  3. Evaluation of emerging parallel optical link technology for high energy physics

    NASA Astrophysics Data System (ADS)

    Chramowicz, J.; Kwan, S.; Prosser, A.; Winchell, M.

    2012-01-01

    Modern particle detectors utilize optical fiber links to deliver event data to upstream trigger and data processing systems. Future detector systems can benefit from the development of dense arrangements of high speed optical links emerging from industry advancements in transceiver technology. Supporting data transfers of up to 120 Gbps in each direction, optical engines permit assembly of the optical transceivers in close proximity to ASICs and FPGAs. Test results of some of these parallel components will be presented including the development of pluggable FPGA Mezzanine Cards equipped with optical engines to provide to collaborators on the Versatile Link Common Project for the HI-LHC at CERN. This work was supported by the U.S. Department of Energy, operated by Fermi Research Alliance, LLC under contract No. DE-AC02-07CH11359 with the United States Department of Energy.

  4. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem

    SciTech Connect

    Duberstein, Corey A.; Downs, Janelle L.

    2008-11-06

    Emergent sandbar habitat (ESH) in the Missouri River Mainstem System is a critical habitat element for several federally listed bird species: the endangered interior least tern (Sterna antillarum) and the threatened Northern Great Plains piping plover (Charadrius melodus). The Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River and is responsible under the Endangered Species Act (ESA) to take actions within its authorities to conserve listed species. To comply with the 2000 USFWS BiOp and the 2003 amended USFWS BiOp, the Corps has created habitats below Gavins Point Dam using mechanical means. Initial monitoring indicates that constructed sandbars provide suitable habitat features for nesting and foraging least terns and piping plovers. Terns and plovers are using constructed sandbars and successfully reproducing at or above levels stipulated in the BiOp. However, whether such positive impacts will persist cannot yet be adequately assessed at this time.

  5. Nine-year evaluation of emergency department personnel exposure to ionizing radiation

    SciTech Connect

    Grazer, R.E.; Meislin, H.W.; Westerman, B.R.; Criss, E.A.

    1987-03-01

    Emergency department personnel experience potential occupational hazards from exposure to ionizing radiation (x-rays). To assess this risk, ionizing radiation exposure was analyzed during a nine-year period for 128 ED personnel. The group consisted of 21 physicians, 92 nurses, and 15 ancillary personnel. Exposure was measured for both penetrating and nonpenetrating radiation using standard film dosimeter badges. Film badge use compliance was 66.7% for physicians, 86.2% for nurses, and 86.7% for ancillary personnel. Penetrating radiation exposure averaged 0.12 mrem/month for physicians, 0.70 mrem/month for nurses, and 0 mrem/month for ancillary personnel, all less than the average natural background exposure. We concluded that if standard radiation precautions are taken, the occupational risk from ionizing radiation exposure to personnel in the ED is minimal, and that routine monitoring of radiation exposure of ED personnel is unnecessary.

  6. Evaluation of Stress Experienced by Emergency Telecommunications Personnel Employed in a Large Metropolitan Police Department.

    PubMed

    Ramey, Sandra L; Perkhounkova, Yelena; Hein, Maria; Chung, Sophia J; Anderson, Amanda A

    2016-12-09

    Emergency telecommunications personnel (ETCP) form the hub of police agencies and persistently deal with distressing situations on a daily basis, making them highly susceptible to psychological and physiological ailments. To date, few studies have examined the necessity or feasibility of implementing a resilience training intervention for ETCP. In this study, the authors assessed baseline psychological data from the ETCP of a large police department to determine the differences in baseline measures for ETCP and police officers. Participants included ETCP ages 29 to 64 years (n = 19). Results showed that ETCP self-reported greater levels of psychological stress compared with police officers (p < .05) for the majority of measures; ETCP experience excessive levels of stress and greater prevalence of chronic disease. Consideration should be given to piloting resilience interventions within this group to manage stress; improve health, performance, and decision making; and decrease the prevalence of chronic disease.

  7. Evaluation of preventable trauma death in emergency department of Imam Reza hospital

    PubMed Central

    Gholipour, Changiz; Rad, Bahram Samadi; Vahdati, Samad Shams; Ghaffarzad, Amir; Masoud, Armita

    2016-01-01

    BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS: In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Forty-three patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries. PMID:27313809

  8. Evaluation of the clinical effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency

    PubMed Central

    Zhao, Gang; Wu, Wei; Feng, Qi-ming; Sun, Jian

    2017-01-01

    Objective The objective of the present study was to explore the resuscitative effect of small-volume resuscitation on uncontrolled hemorrhagic shock in emergency. Methods In this study, the resuscitative effects in 200 trauma patients with uncontrolled hemorrhagic shock in emergency were studied. Half of these patients were infused with hypertonic/hyperoncotic fluid (small-volume resuscitation group, n=100), whereas the rest were infused with Hespan and lactated Ringer’s solution (conventional fluid resuscitation group, n=100). The changes in hemodynamics, coagulation function, blood biochemistry, blood hematology, and the average infusion volume in both the groups were comparatively studied. Results It was found that the hemodynamics were improved in both the groups after resuscitation. Interestingly, compared with trauma patients infused with Hespan and lactated Ringer’s solution, the growth rate, range, and time duration of the mean arterial pressure of the patients in small-volume resuscitation group increased significantly, and the shock index decreased progressively; in the 60th min after the resuscitation, blood index including hemoglobin, hematocrit, red blood cells, white blood cells, and platelet declined, whereas prothrombin time and activated partial thromboplastin time were prolonged in both the groups, but these changes were less obvious in the small-volume group. In addition, the average infusion volume of patients in the small-volume group was less than that of patients in conventional fluid resuscitation group. Conclusion Featured with small infusion volume and less influence to coagulation function and homeostasis of human body, small-volume resuscitation possesses a significantly higher resuscitative effect. Therefore, trauma patients may have a better chance to maintain the hemodynamic stability and the survival rate, or recovery speed will be increased when traditional aggressive fluid resuscitation is replaced by small-volume resuscitation

  9. Logic model use in developing a survey instrument for program evaluation: emergency preparedness summits for schools of nursing in Georgia.

    PubMed

    Torghele, Karen; Buyum, Arielle; Dubruiel, Nicole; Augustine, Jill; Houlihan, Catherine; Alperin, Melissa; Miner, Kathleen R

    2007-01-01

    The objective of this paper is to describe a method for using a logic model to guide program evaluation by detailing the steps used, providing diagrams that visually depict the process, and giving an example based on the evaluation of emergency preparedness nursing summits in Georgia. Developing a logic model is an ideal way to visually depict the inputs, activities, outputs, and outcomes of a program, thus providing a clear framework of the workings and functions of the program. In planning a comprehensive evaluation, being able to view all the elements in a program and how they interrelate makes it easier to determine the areas that should be addressed. When a survey is part of a program evaluation, determining that the goals, objectives, research questions, logic model, and survey questions maintain consistency in the way they relate and lead to each other can help document the completeness and symmetry of the assessment. By showing these linkages, the utility of the logic model is maximized and the stakeholders in the assessment of the program have clear evidence that their expectations and needs have been met for a valuable, useful evaluation product.

  10. Development and Flight Evaluation of an Emergency Digital Flight Control System Using Only Engine Thrust on an F-15 Airplane

    NASA Technical Reports Server (NTRS)

    Burcham, Frank W., Jr.; Maine, Trindel A.; Fullerton, C. Gordon; Webb, Lannie Dean

    1996-01-01

    A propulsion-controlled aircraft (PCA) system for emergency flight control of aircraft with no flight controls was developed and flight tested on an F-15 aircraft at the NASA Dryden Flight Research Center. The airplane has been flown in a throttles-only manual mode and with an augmented system called PCA in which pilot thumbwheel commands and aircraft feedback parameters were used to drive the throttles. Results from a 36-flight evaluation showed that the PCA system can be used to safety land an airplane that has suffered a major flight control system failure. The PCA system was used to recover from a severe upset condition, descend, and land. Guest pilots have also evaluated the PCA system. This paper describes the principles of throttles-only flight control; a history of loss-of-control accidents; a description of the F-15 aircraft; the PCA system operation, simulation, and flight testing; and the pilot comments.

  11. Design and evaluation of a patient website to reduce crowding in emergency departments: a preliminary study.

    PubMed

    Schiro, Jessica; Marcilly, Romaric; Leroy, Nicolas; Wawrzyniak, Clément; Martinot, Alain; Pelayo, Sylvia

    2015-01-01

    The study aims to identify the information useful to support a patients' EDs' choice in order to design a patient Web-based system. For that purpose, a focus group and a formative user test have been performed. The results show that five types of information can be relevant. The spontaneous favored information is the "distance" to EDs. The "Wait time", that is sanctified in literature, is only used in a second time. A larger summative evaluation should be planned to evaluate and validate the befits of this kind of tool.

  12. Realistic molecular model of kerogen's nanostructure

    NASA Astrophysics Data System (ADS)

    Bousige, Colin; Ghimbeu, Camélia Matei; Vix-Guterl, Cathie; Pomerantz, Andrew E.; Suleimenova, Assiya; Vaughan, Gavin; Garbarino, Gaston; Feygenson, Mikhail; Wildgruber, Christoph; Ulm, Franz-Josef; Pellenq, Roland J.-M.; Coasne, Benoit

    2016-05-01

    Despite kerogen's importance as the organic backbone for hydrocarbon production from source rocks such as gas shale, the interplay between kerogen's chemistry, morphology and mechanics remains unexplored. As the environmental impact of shale gas rises, identifying functional relations between its geochemical, transport, elastic and fracture properties from realistic molecular models of kerogens becomes all the more important. Here, by using a hybrid experimental-simulation method, we propose a panel of realistic molecular models of mature and immature kerogens that provide a detailed picture of kerogen's nanostructure without considering the presence of clays and other minerals in shales. We probe the models' strengths and limitations, and show that they predict essential features amenable to experimental validation, including pore distribution, vibrational density of states and stiffness. We also show that kerogen's maturation, which manifests itself as an increase in the sp2/sp3 hybridization ratio, entails a crossover from plastic-to-brittle rupture mechanisms.

  13. Realistic molecular model of kerogen's nanostructure.

    PubMed

    Bousige, Colin; Ghimbeu, Camélia Matei; Vix-Guterl, Cathie; Pomerantz, Andrew E; Suleimenova, Assiya; Vaughan, Gavin; Garbarino, Gaston; Feygenson, Mikhail; Wildgruber, Christoph; Ulm, Franz-Josef; Pellenq, Roland J-M; Coasne, Benoit

    2016-05-01

    Despite kerogen's importance as the organic backbone for hydrocarbon production from source rocks such as gas shale, the interplay between kerogen's chemistry, morphology and mechanics remains unexplored. As the environmental impact of shale gas rises, identifying functional relations between its geochemical, transport, elastic and fracture properties from realistic molecular models of kerogens becomes all the more important. Here, by using a hybrid experimental-simulation method, we propose a panel of realistic molecular models of mature and immature kerogens that provide a detailed picture of kerogen's nanostructure without considering the presence of clays and other minerals in shales. We probe the models' strengths and limitations, and show that they predict essential features amenable to experimental validation, including pore distribution, vibrational density of states and stiffness. We also show that kerogen's maturation, which manifests itself as an increase in the sp(2)/sp(3) hybridization ratio, entails a crossover from plastic-to-brittle rupture mechanisms.

  14. Spectral tunability of realistic plasmonic nanoantennas

    SciTech Connect

    Portela, Alejandro; Matsui, Hiroaki; Tabata, Hitoshi; Yano, Takaaki; Hayashi, Tomohiro; Hara, Masahiko; Santschi, Christian; Martin, Olivier J. F.

    2014-09-01

    Single nanoantenna spectroscopy was carried out on realistic dipole nanoantennas with various arm lengths and gap sizes fabricated by electron-beam lithography. A significant difference in resonance wavelength between realistic and ideal nanoantennas was found by comparing their spectral response. Consequently, the spectral tunability (96 nm) of the structures was significantly lower than that of simulated ideal nanoantennas. These observations, attributed to the nanofabrication process, are related to imperfections in the geometry, added metal adhesion layer, and shape modifications, which are analyzed in this work. Our results provide important information for the design of dipole nanoantennas clarifying the role of the structural modifications on the resonance spectra, as supported by calculations.

  15. Regularization techniques in realistic Laplacian computation.

    PubMed

    Bortel, Radoslav; Sovka, Pavel

    2007-11-01

    This paper explores regularization options for the ill-posed spline coefficient equations in the realistic Laplacian computation. We investigate the use of the Tikhonov regularization, truncated singular value decomposition, and the so-called lambda-correction with the regularization parameter chosen by the L-curve, generalized cross-validation, quasi-optimality, and the discrepancy principle criteria. The provided range of regularization techniques is much wider than in the previous works. The improvement of the realistic Laplacian is investigated by simulations on the three-shell spherical head model. The conclusion is that the best performance is provided by the combination of the Tikhonov regularization and the generalized cross-validation criterion-a combination that has never been suggested for this task before.

  16. Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes. Traumatic aortic rupture, aortic aneurysm, aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer.

    PubMed

    Ledbetter, S; Stuk, J L; Kaufman, J A

    1999-05-01

    For the near future, CT will play the critical and dominant role in the evaluation of patients presenting with emergent aortic syndromes. Its convenience, accuracy, and utility in the rapid evaluation of not just the aorta, but the entire thorax, make it ideally suited for use in emergency settings. Further benefits are likely to be realized in speed and resolution with multislice CT, although it is as yet not widely available.

  17. Identification and evaluation of competencies of health professionals in the hospital emergency management of the radiation accident victim

    SciTech Connect

    Berger, M.E.

    1982-01-01

    A preliminary list of ten competency and forty-six sub-competency statements derived from literature and consultation with experts and based on the general areas of clinical performance defined by the National Board of Medical Examiners were the concern of Phase I of this study. Forty-eight experts in nuclear medicine, radiology, radiotherapy, health physics, medical physics, radiation biology, public and occupational health, surgery, and emergency medicine and nursing considered this preliminary list of competencies and sub-competencies to determine which were essential for health professionals who may be caring for radiation accident victims in hospital emergency departments. Eight competencies and thirty-three sub-competencies were rated as Essential competencies. Competencies dealing with establishing priorities in patient care and initiating treatment, assessment, contamination control, and decontamination were highly rated. In the second part of this study, the Essential competencies were utilized in the development of an original evaluation instrument designed to identify deficiencies and continuing education needs during radiation accident drills or exercises. The instrument was designed for use in sixteen possible patient care situations in which the radiation accident victims have varying medical and radiological conditions. Development of the evaluation instrument was described.

  18. Comparative Analysis of the Effectiveness of Three Immunization Strategies in Controlling Disease Outbreaks in Realistic Social Networks

    PubMed Central

    Xu, Zhijing; Zu, Zhenghu; Zheng, Tao; Zhang, Wendou; Xu, Qing; Liu, Jinjie

    2014-01-01

    The high incidence of emerging infectious diseases has highlighted the importance of effective immunization strategies, especially the stochastic algorithms based on local available network information. Present stochastic strategies are mainly evaluated based on classical network models, such as scale-free networks and small-world networks, and thus are insufficient. Three frequently referred stochastic immunization strategies—acquaintance immunization, community-bridge immunization, and ring vaccination—were analyzed in this work. The optimal immunization ratios for acquaintance immunization and community-bridge immunization strategies were investigated, and the effectiveness of these three strategies in controlling the spreading of epidemics were analyzed based on realistic social contact networks. The results show all the strategies have decreased the coverage of the epidemics compared to baseline scenario (no control measures). However the effectiveness of acquaintance immunization and community-bridge immunization are very limited, with acquaintance immunization slightly outperforming community-bridge immunization. Ring vaccination significantly outperforms acquaintance immunization and community-bridge immunization, and the sensitivity analysis shows it could be applied to controlling the epidemics with a wide infectivity spectrum. The effectiveness of several classical stochastic immunization strategies was evaluated based on realistic contact networks for the first time in this study. These results could have important significance for epidemic control research and practice. PMID:24787718

  19. Maintaining Realistic Uncertainty in Model and Forecast

    DTIC Science & Technology

    1999-09-30

    Maintaining Realistic Uncertainty in Model and Forecast Leonard Smith Pembroke College Oxford University St Aldates Oxford OX1 3LB England phone... Oxford University ,Pembroke College,St Aldates,Oxford OX1 3LB England, 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S...in my group. REFERENCES Clarke, L. (1999) Rogue Thermocouple Detection. MSc Thesis, Mathematical Institute, Oxford University . Hansen J. and L. A

  20. Evaluation of sensor types and environmental controls on mapping biomass of coastal marsh emergent vegetation

    USGS Publications Warehouse

    Byrd, Kristin B.; O'Connell, Jessica L.; Di Tommaso, Stefania; Kelly, Maggi

    2014-01-01

    There is a need to quantify large-scale plant productivity in coastal marshes to understand marsh resilience to sea level rise, to help define eligibility for carbon offset credits, and to monitor impacts from land use, eutrophication and contamination. Remote monitoring of aboveground biomass of emergent wetland vegetation will help address this need. Differences in sensor spatial resolution, bandwidth, temporal frequency and cost constrain the accuracy of biomass maps produced for management applications. In addition the use of vegetation indices to map biomass may not be effective in wetlands due to confounding effects of water inundation on spectral reflectance. To address these challenges, we used partial least squares regression to select optimal spectral features in situ and with satellite reflectance data to develop predictive models of aboveground biomass for common emergent freshwater marsh species, Typha spp. and Schoenoplectus acutus, at two restored marshes in the Sacramento–San Joaquin River Delta, California, USA. We used field spectrometer data to test model errors associated with hyperspectral narrowbands and multispectral broadbands, the influence of water inundation on prediction accuracy, and the ability to develop species specific models. We used Hyperion data, Digital Globe World View-2 (WV-2) data, and Landsat 7 data to scale up the best statistical models of biomass. Field spectrometer-based models of the full dataset showed that narrowband reflectance data predicted biomass somewhat, though not significantly better than broadband reflectance data [R2 = 0.46 and percent normalized RMSE (%RMSE) = 16% for narrowband models]. However hyperspectral first derivative reflectance spectra best predicted biomass for plots where water levels were less than 15 cm (R2 = 0.69, %RMSE = 12.6%). In species-specific models, error rates differed by species (Typha spp.: %RMSE = 18.5%; S. acutus: %RMSE = 24.9%), likely due to the more vertical structure and

  1. Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain.

    PubMed

    Vora, Amit N; Bonaca, Marc P; Ruff, Christian T; Jarolim, Petr; Murphy, Sabina; Croce, Kevin; Sabatine, Marc S; Simon, Daniel I; Morrow, David A

    2012-08-01

    Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (<0.4, 1.15) with only moderate correlation between serum and plasma (ρ = 0.40). A final diagnosis of MI was made in 106 (26%). Peak serum MRP-8/14 was higher in patients presenting with MI (p < 0.001). However, the overall diagnostic performance of MRP-8/14 was poor: sensitivity 28% (95% CI 20-38), specificity 82% (78-86), positive predictive value 36% (26-47), and negative predictive value 77% (72-81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51-0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

  2. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

    PubMed Central

    Pearson, David; Bond, Michael C.; Kegg, Jason; Pillow, Tyson; Hopson, Laura; Cooney, Robert; Garg, Manish; Khadpe, Jay; Runyon, Michael; Patterson, Leigh

    2015-01-01

    Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p

  3. Evaluating the components of an emergent literacy intervention for preschool children at risk for reading difficulties.

    PubMed

    Lonigan, Christopher J; Purpura, David J; Wilson, Shauna B; Walker, Patricia M; Clancy-Menchetti, Jeanine

    2013-01-01

    Many preschool children are at risk for reading problems because of inadequate emergent literacy skills. Evidence supports the effectiveness of interventions to promote these skills, but questions remain about which intervention components work and whether combining intervention components will result in larger gains. In this study, 324 preschoolers (mean age=54.32 months, SD=5.88) from low-income backgrounds (46% girls and 54% boys; 82% African American, 14% White, and 4% other) were randomized to combinations of meaning-focused (dialogic reading or shared reading) and code-focused (phonological awareness, letter knowledge, or both) interventions or a control group. Interventions had statistically significant positive impacts only on measures of their respective skill domains. Combinations of interventions did not enhance outcomes across domains, indicating instructional needs in all areas of weakness for young children at risk for later reading difficulties. Less time for each intervention in the combined phonological awareness and letter knowledge intervention conditions, however, did not result in reduced effects relative to nearly twice as much time for each intervention when children received either only the phonological awareness intervention or only the letter knowledge intervention. This finding suggests that a relatively compact code-focused intervention can address the needs of children with weaknesses in both domains.

  4. A guide for clinicians in the evaluation of emerging molecular diagnostics for newly diagnosed prostate cancer.

    PubMed

    Canfield, Steven E; Kibel, Adam S; Kemeter, Michael J; Febbo, Phillip G; Lawrence, H Jeffrey; Moul, Judd W

    2014-01-01

    Prostate-specific antigen (PSA) screening is associated with a decline in prostate cancer-related mortality. However, screening has also led to overdiagnosis and overtreatment of clinically insignificant tumors. Recently, certain national guidelines (eg, US Preventive Services Task Force) have recommended against PSA screening, which may lead to a reverse-stage migration. Although many prostate tumors are indolent at presentation, others are aggressive and are appropriate targets for treatment interventions. Utilization of molecular markers may improve our ability to measure tumor biology and allow better discrimination of indolent and aggressive tumors at diagnosis. Many emerging commercial molecular diagnostic assays have been designed to provide more accurate risk stratification for newly diagnosed prostate cancer. Unfamiliarity with molecular diagnostics may make it challenging for some clinicians to navigate and interpret the medical literature to ascertain whether particular assays are appropriately developed and validated for clinical use. Herein, the authors provide a framework for practitioners to use when assessing new tissue-based molecular assays. This review outlines aspects of assay development, clinical and analytic validation and clinical utility studies, and regulatory issues, which collectively determine whether tests (1) are actionable for specific clinical indications, (2) measurably influence treatment decisions, and (3) are sufficiently validated to warrant incorporation into clinical practice.

  5. Overview and Evaluation of Bluetooth Low Energy: An Emerging Low-Power Wireless Technology

    PubMed Central

    Gomez, Carles; Oller, Joaquim; Paradells, Josep

    2012-01-01

    Bluetooth Low Energy (BLE) is an emerging low-power wireless technology developed for short-range control and monitoring applications that is expected to be incorporated into billions of devices in the next few years. This paper describes the main features of BLE, explores its potential applications, and investigates the impact of various critical parameters on its performance. BLE represents a trade-off between energy consumption, latency, piconet size, and throughput that mainly depends on parameters such as connInterval and connSlaveLatency. According to theoretical results, the lifetime of a BLE device powered by a coin cell battery ranges between 2.0 days and 14.1 years. The number of simultaneous slaves per master ranges between 2 and 5,917. The minimum latency for a master to obtain a sensor reading is 676 μs, although simulation results show that, under high bit error rate, average latency increases by up to three orders of magnitude. The paper provides experimental results that complement the theoretical and simulation findings, and indicates implementation constraints that may reduce BLE performance.

  6. [Complex evaluation of the impact of emerging mining industries in Northern regions on public health].

    PubMed

    Mitrofanov, I M; Nikolaev, Iu A; Keĭl', V R; Kuznetsova, I Iu; Shurgaia, A M; Seliatitskaia, V G

    2001-01-01

    The studies covered public health state in vicinity of concentration enterprise being built in Far North, with selecting a cohort of workers extracting diamonds in Yakutia, conducting a primary standardized health screening in accordance with WHO program. The public health state is characterized in connection with ecologic, social and economic circumstances. The authors necessitate complex evaluation of influence caused by industrial enterprises on health of workers and general population.

  7. Advanced biosensing methodologies developed for evaluating performance quality and safety of emerging biophotonics technologies and medical devices (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Ilev, Ilko K.; Walker, Bennett; Calhoun, William; Hassan, Moinuddin

    2016-03-01

    Biophotonics is an emerging field in modern biomedical technology that has opened up new horizons for transfer of state-of-the-art techniques from the areas of lasers, fiber optics and biomedical optics to the life sciences and medicine. This field continues to vastly expand with advanced developments across the entire spectrum of biomedical applications ranging from fundamental "bench" laboratory studies to clinical patient "bedside" diagnostics and therapeutics. However, in order to translate these technologies to clinical device applications, the scientific and industrial community, and FDA are facing the requirement for a thorough evaluation and review of laser radiation safety and efficacy concerns. In many cases, however, the review process is complicated due the lack of effective means and standard test methods to precisely analyze safety and effectiveness of some of the newly developed biophotonics techniques and devices. There is, therefore, an immediate public health need for new test protocols, guidance documents and standard test methods to precisely evaluate fundamental characteristics, performance quality and safety of these technologies and devices. Here, we will overview our recent developments of novel test methodologies for safety and efficacy evaluation of some emerging biophotonics technologies and medical devices. These methodologies are based on integrating the advanced features of state-of-the-art optical sensor technologies and approaches such as high-resolution fiber-optic sensing, confocal and optical coherence tomography imaging, and infrared spectroscopy. The presentation will also illustrate some methodologies developed and implemented for testing intraocular lens implants, biochemical contaminations of medical devices, ultrahigh-resolution nanoscopy, and femtosecond laser therapeutics.

  8. Large-System Transformation in Health Care: A Realist Review

    PubMed Central

    Best, Allan; Greenhalgh, Trisha; Lewis, Steven; Saul, Jessie E; Carroll, Simon; Bitz, Jennifer

    2012-01-01

    Context An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy development and strategy initiatives focused on patient- and family-centered care, primary health care renewal, quality improvement, and surgical wait lists. The aims of the review were to analyze examples of successful and less successful transformation initiatives, to synthesize knowledge of the underlying mechanisms, to clarify the role of government, and to outline options for evaluation. Methods We used realist review, whose working assumption is that a particular intervention triggers particular mechanisms of change. Mechanisms may be more or less effective in producing their intended outcomes, depending on their interaction with various contextual factors. We explain the variations in outcome as the interplay between context and mechanisms. We nested this analytic approach in a macro framing of complex adaptive systems (CAS). Findings Our rapid realist review identified five “simple rules” of LST that were likely to enhance the success of the target initiatives: (1) blend designated leadership with distributed leadership; (2) establish feedback loops; (3) attend to history; (4) engage physicians; and (5) include patients and families. These principles play out differently in different contexts affecting human behavior (and thereby contributing to change) through a wide range of different mechanisms. Conclusions Realist review methodology can be applied in combination with a complex system lens on published literature to produce a knowledge synthesis that informs a prospective change effort in large-system transformation. A collaborative process engaging both research producers and research users contributes to local

  9. Evaluation and improvement of doctor–patient communication competence for emergency neurosurgeons: a standardized family model

    PubMed Central

    Wu, Xi; Wang, Zhinong; Hong, Bo; Shen, Shengjuan; Guo, Yan; Huang, Qinghai; Liu, Jianmin

    2014-01-01

    Disease treatments have been significantly influenced by the communications between patients, their families, and doctors the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors communication and interpersonal skills, are as important as clinical skills and medical knowledge. In this study we intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate their integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects PMID:25018623

  10. Identification and Evaluation of Human Factors Issues Associated with Emerging Nuclear Plant Technology

    SciTech Connect

    O'Hara,J.M.; Higgins,J.; Brown, William S.

    2009-04-01

    This study has identified human performance research issues associated with the implementation of new technology in nuclear power plants (NPPs). To identify the research issues, current industry developments and trends were evaluated in the areas of reactor technology, instrumentation and control technology, human-system integration technology, and human factors engineering (HFE) methods and tools. The issues were prioritized into four categories based on evaluations provided by 14 independent subject matter experts representing vendors, utilities, research organizations and regulators. Twenty issues were categorized into the top priority category. The study also identifies the priority of each issue and the rationale for those in the top priority category. The top priority issues were then organized into research program areas of: New Concepts of Operation using Multi-agent Teams, Human-system Interface Design, Complexity Issues in Advanced Systems, Operating Experience of New and Modernized Plants, and HFE Methods and Tools. The results can serve as input to the development of a long-term strategy and plan for addressing human performance in these areas to support the safe operation of new NPPs.

  11. Evaluation of emergence traps for monitoring blueberry gall midge (Diptera: Cecidomyiidae) adults and within field distribution of midge infestation.

    PubMed

    Roubos, Craig R; Liburd, Oscar E

    2010-08-01

    The blueberry gall midge, Dasineura oxycoccana (Johnson) (Diptera: Cecidomyiidae), is a key pest of rabbiteye blueberry, Vaccinium virgatum Aiton, in the southeastern United States, but it has not been studied extensively and little is known about its ecology and management. Studies were conducted to develop an improved method for monitoring D. oxycoccana adults and to determine the within-field distribution of infestation. Four emergence traps were evaluated in an organic rabbiteye blueberry planting for their effectiveness in capturing D. oxycoccana adults early in the season. These traps included a jar trap, wheat blossom midge trap, petri dish trap, and bucket trap. The petri dish and bucket traps captured the highest numbers of adults in 2007 and 2008, respectively. Both traps had a clear plastic panel coated with adhesive. Adult midges emerging from the soil beneath the traps were caught in the adhesive as they flew up toward the light. Emergence traps are useful for detecting the presence of adults early in the season before larval infestation is apparent in the flower buds. To determine the pattern of midge infestation, flower buds were collected weekly from January to March in 2006 from rabbiteye blueberry plants located in a plot at the southwest border of an existing blueberry planting. There were no differences found in the number of larvae collected from various distances within blueberry rows. However, when flower buds were collected from an isolated rabbiteye plot in 2007 and 2008, D. oxycoccana infestation was not uniform. In both years, the southern border row had a significantly higher number of midge larvae per bud compared with the other rows.

  12. The consumer quality index (CQ-index) in an accident and emergency department: development and first evaluation

    PubMed Central

    2012-01-01

    Background Assessment of patients’ views are essential to provide a patient-centred health service and to evaluating quality of care. As no standardized and validated system for measuring patients’ experiences in accident and emergency departments existed, we have developed the Consumer Quality index for the accident and emergency department (CQI A&E). Methods Qualitative research has been undertaken to determine the content validity of the CQI A&E. In order to assess psychometric characteristics an 84-item questionnaire was sent to 653 patients who had attended a large A&E in the Netherlands. Also, fifty importance questions were added to determine relevance of the questions and for future calculations of improvement scores. Exploratory factor analysis was applied to detect the domains of the questionnaire. Results Survey data of 304 (47%) patients were used for the analysis. The first exploratory factor analysis resulted in three domains based on 13 items: ‘Attitude of the healthcare professionals’, ‘Environment and impression of the A&E’ and ‘Respect for and explanation to the patient’. The first two had an acceptable internal consistency. The second analysis, included 24 items grouped into 5 domains: ‘Attitude of the healthcare professionals’, ‘Information and explanation’, ‘Environment of the A&E’,’Leaving the A&E’ and ‘General information and rapidity of care’. All factors were internal consistent. According to the patients, the three most important aspects in healthcare performance in the A&E were: trust in the competence of the healthcare professionals, hygiene in the A&E and patients’ health care expectations. In general, the highest improvement scores concerned patient information. Conclusions The Consumer Quality index for the accident and emergency department measures patients’ experiences of A&E healthcare performance. Preliminary psychometric characteristics are sufficient to justify further research into

  13. Tertiary Evaluation of the Committed Effective Dose of Emergency Workers That Responded to the Fukushima Daiichi NPP Accident.

    PubMed

    Yasui, Shojiro

    2017-02-06

    In January 2014, Tokyo Electric Power Company (TEPCO) learned that the committed effective dose (CED) for nine emergency workers at the Fukushima Daiichi Nuclear Power Plant accident had been assessed by a method other than the standard assessment methods, established by the Ministry of Health, Labour and Welfare (MHLW) in a secondary evaluation conducted in July 2013. The MHLW requested that the TEPCO and primary contractors review all CED data for 6,245 workers who engaged in emergency work in March and April 2011 except those previously reviewed in the 2013 secondary evaluation. This tertiary evaluation revealed that the recorded CED for 1,536 workers had more than 0.1 mSv discrepancy with the CED evaluated previously. The MHLW requested that TEPCO and primary contractors revise CED data for 142 workers whose CED was 2 mSv or greater that required a CED revision of 1 mSv or greater. The average CED revision was 5.86 mSv. The revised effective dose ranged from 2.17 mSv to 180.10 mSv. In addition, the number of workers whose CED exceeded 100 mSv increased by one. New issues addressed during the tertiary evaluation included the following: a) setting of calibration coefficients to convert the CED value from whole body counters equipped with NaI scintillator (WBC(NaI)) to a CED value from WBCs with Ge semiconductor detector (WBC (Ge); b) estimation methods for the cases where (131)I was not detectable by WBC (NaI) and where (137)Cs was not detectable but (134)Cs was detected; c) effects of stable iodine (KI) tablets to block the uptake of (131)I by thyroid gland; and d) complications in determining additional doses during stand-by in the seismically isolated building. To prevent the future use of non-uniform CED assessment methods in the dose assessment for workers, the MHLW issued administrative guidance documents to TEPCO and primary contractors on March 25, 2014.

  14. Anderson localization for chemically realistic systems

    NASA Astrophysics Data System (ADS)

    Terletska, Hanna

    2015-03-01

    Disorder which is ubiquitous for most materials can strongly effect their properties. It may change their electronic structures or even cause their localization, known as Anderson localization. Although, substantial progress has been achieved in the description of the Anderson localization, a proper mean-field theory of this phenomenon for more realistic systems remains elusive. Commonly used theoretical methods such as the coherent potential approximation and its cluster extensions fail to describe the Anderson transition, as the average density of states (DOS) employed in such theories is not critical at the transition. However, near the transition, due to the spatial confinement of carriers, the local DOS becomes highly skewed with a log-normal distribution, for which the most probable and the typical values differ noticeably from the average value. Dobrosavljevic et.al., incorporated such ideas in their typical medium theory (TMT), and showed that the typical (not average) DOS is critical at the transition. While the TMT is able to capture the localized states, as a local single site theory it still has several drawbacks. For the disorder Anderson model in three dimension it underestimates the critical disorder strength, and fails to capture the re-entrance behavior of the mobility edge. We have recently developed a cluster extension of the TMT, which addresses these drawbacks by systematically incorporating non-local corrections. This approach converges quickly with cluster size and allows us to incorporate the effect of interactions and realistic electronic structure. As the first steps towards realistic material modeling, we extended our TMDCA formalisms to systems with the off diagonal disorder and multiple bands structures. We also applied our TMDCA scheme to systems with both disorder and interactions and found that correlations effects tend to stabilize the metallic behavior even in two dimensions. This work was supported by DOE SciDAC Grant No. DE-FC02

  15. Realistic inflation models and primordial gravity waves

    NASA Astrophysics Data System (ADS)

    Rehman, Mansoor Ur

    We investigate both supersymmetric and non-supersymmetric realistic models of inflation. In non-supersymmetric models, inflation is successfully realized by employing both Coleman Weinberg and Higgs potentials in GUTs such as SU(5) and SO(10). The quantum smearing of tree level predictions is discussed in the Higgs inflation. These quantum corrections can arise from the inflaton couplings to other particles such as GUT scalars. As a result of including these corrections, a reduction in the tensor-to-scalar ratio r, a canonical measure of gravity waves produced during inflation, is observed. In a simple phi4 chaotic model, we reconsider a non-minimal (xi > 0) gravitationalcoupling of inflaton φ arising from the interaction xi R phi2, where R is the Ricci scalar. In estimating bounds on various inflationaryparameters we also include quantum corrections. We emphasize that while working with high precision observations such as the current Planck satellite experiment we cannot ignore these radiative and gravitational corrections in analyzing the predictions of various inflationary models. In supersymmetric hybrid inflation with minimal Kahler potential, the soft SUSY breaking terms are shown to play an important role in realizing inflation consistent with the latest WMAP data. The SUSY hybrid models which we consider here predict exceedingly small values of r. However, to obtain observable gravity waves the non-minimal Kahler potential turns out to be a necessary ingredient. A realistic model of flipped SU(5) model, which benefits from the absence of topological defects, is considered in the standard SUSY hybrid inflation. We also present a discussion of shifted hybrid inflation in a realistic model of SUSY SU(5) GUT.

  16. Realistic and efficient 2D crack simulation

    NASA Astrophysics Data System (ADS)

    Yadegar, Jacob; Liu, Xiaoqing; Singh, Abhishek

    2010-04-01

    Although numerical algorithms for 2D crack simulation have been studied in Modeling and Simulation (M&S) and computer graphics for decades, realism and computational efficiency are still major challenges. In this paper, we introduce a high-fidelity, scalable, adaptive and efficient/runtime 2D crack/fracture simulation system by applying the mathematically elegant Peano-Cesaro triangular meshing/remeshing technique to model the generation of shards/fragments. The recursive fractal sweep associated with the Peano-Cesaro triangulation provides efficient local multi-resolution refinement to any level-of-detail. The generated binary decomposition tree also provides efficient neighbor retrieval mechanism used for mesh element splitting and merging with minimal memory requirements essential for realistic 2D fragment formation. Upon load impact/contact/penetration, a number of factors including impact angle, impact energy, and material properties are all taken into account to produce the criteria of crack initialization, propagation, and termination leading to realistic fractal-like rubble/fragments formation. The aforementioned parameters are used as variables of probabilistic models of cracks/shards formation, making the proposed solution highly adaptive by allowing machine learning mechanisms learn the optimal values for the variables/parameters based on prior benchmark data generated by off-line physics based simulation solutions that produce accurate fractures/shards though at highly non-real time paste. Crack/fracture simulation has been conducted on various load impacts with different initial locations at various impulse scales. The simulation results demonstrate that the proposed system has the capability to realistically and efficiently simulate 2D crack phenomena (such as window shattering and shards generation) with diverse potentials in military and civil M&S applications such as training and mission planning.

  17. Model Selection and Evaluation Based on Emerging Infectious Disease Data Sets including A/H1N1 and Ebola

    PubMed Central

    Liu, Wendi; Tang, Sanyi; Xiao, Yanni

    2015-01-01

    The aim of the present study is to apply simple ODE models in the area of modeling the spread of emerging infectious diseases and show the importance of model selection in estimating parameters, the basic reproduction number, turning point, and final size. To quantify the plausibility of each model, given the data and the set of four models including Logistic, Gompertz, Rosenzweg, and Richards models, the Bayes factors are calculated and the precise estimates of the best fitted model parameters and key epidemic characteristics have been obtained. In particular, for Ebola the basic reproduction numbers are 1.3522 (95% CI (1.3506, 1.3537)), 1.2101 (95% CI (1.2084, 1.2119)), 3.0234 (95% CI (2.6063, 3.4881)), and 1.9018 (95% CI (1.8565, 1.9478)), the turning points are November 7,November 17, October 2, and November 3, 2014, and the final sizes until December 2015 are 25794 (95% CI (25630, 25958)), 3916 (95% CI (3865, 3967)), 9886 (95% CI (9740, 10031)), and 12633 (95% CI (12515, 12750)) for West Africa, Guinea, Liberia, and Sierra Leone, respectively. The main results confirm that model selection is crucial in evaluating and predicting the important quantities describing the emerging infectious diseases, and arbitrarily picking a model without any consideration of alternatives is problematic. PMID:26451161

  18. A realistic renormalizable supersymmetric E₆ model

    SciTech Connect

    Bajc, Borut; Susič, Vasja

    2014-01-01

    A complete realistic model based on the supersymmetric version of E₆ is presented. It consists of three copies of matter 27, and a Higgs sector made of 2×(27+27⁻)+351´+351´⁻ representations. An analytic solution to the equations of motion is found which spontaneously breaks the gauge group into the Standard Model. The light fermion mass matrices are written down explicitly as non-linear functions of three Yukawa matrices. This contribution is based on Ref. [1].

  19. Adiabatic Hyperspherical Analysis of Realistic Nuclear Potentials

    NASA Astrophysics Data System (ADS)

    Daily, K. M.; Kievsky, Alejandro; Greene, Chris H.

    2015-12-01

    Using the hyperspherical adiabatic method with the realistic nuclear potentials Argonne V14, Argonne V18, and Argonne V18 with the Urbana IX three-body potential, we calculate the adiabatic potentials and the triton bound state energies. We find that a discrete variable representation with the slow variable discretization method along the hyperradial degree of freedom results in energies consistent with the literature. However, using a Laguerre basis results in missing energy, even when extrapolated to an infinite number of basis functions and channels. We do not include the isospin T = 3/2 contribution in our analysis.

  20. Evaluation of cardiac troponin I in dogs presenting to the emergency room using a point-of-care assay

    PubMed Central

    Porter, Adam; Rozanski, Elizabeth; Price, Lori Lyn; Shaw, Scott

    2016-01-01

    We used a point-of-care assay to evaluate cardiac troponin I (cTnI) in clinically normal dogs and a heterogeneous population of dogs presenting to the emergency room (ER) and to determine whether cTnI has prognostic capabilities in an ER population. Fourteen clinically normal dogs and 129 dogs presented to the ER were evaluated. Of the study group, 88 dogs had normal cTnI (< 0.1 ng/mL), 29 had elevated cTnI (0.1 to 1.0 ng/mL), and 12 had high cTnI (> 1.0 ng/mL). Dogs with elevated cTnI had 8 times the odds of mortality compared to dogs with normal cTnI [odds ratio (OR): 8.2, 95% confidence interval (CI): 3.0, 22.3]. Dogs with high cTnI had 17 times higher odds of mortality compared to dogs with normal cTnI (OR: 17.6, 95% CI: 4.4, 70.1). We conclude that cTnI shows promise as a prognostic indicator for dogs presenting to the ER and can be easily evaluated using a point-of-care assay. PMID:27247465

  1. Evaluation of cardiac troponin I in dogs presenting to the emergency room using a point-of-care assay.

    PubMed

    Porter, Adam; Rozanski, Elizabeth; Price, Lori Lyn; Shaw, Scott

    2016-06-01

    We used a point-of-care assay to evaluate cardiac troponin I (cTnI) in clinically normal dogs and a heterogeneous population of dogs presenting to the emergency room (ER) and to determine whether cTnI has prognostic capabilities in an ER population. Fourteen clinically normal dogs and 129 dogs presented to the ER were evaluated. Of the study group, 88 dogs had normal cTnI (< 0.1 ng/mL), 29 had elevated cTnI (0.1 to 1.0 ng/mL), and 12 had high cTnI (> 1.0 ng/mL). Dogs with elevated cTnI had 8 times the odds of mortality compared to dogs with normal cTnI [odds ratio (OR): 8.2, 95% confidence interval (CI): 3.0, 22.3]. Dogs with high cTnI had 17 times higher odds of mortality compared to dogs with normal cTnI (OR: 17.6, 95% CI: 4.4, 70.1). We conclude that cTnI shows promise as a prognostic indicator for dogs presenting to the ER and can be easily evaluated using a point-of-care assay.

  2. Epidemiological evaluation of cats rescued at a secondary emergency animal shelter in Miharu, Fukushima, after the Great East Japan Earthquakes.

    PubMed

    Tanaka, Aki; Martinez-Lopez, Beatriz; Kass, Philip

    2017-03-01

    The aims of this research were to report characteristics of rescued cats at a secondary emergency animal shelter in Fukushima prefecture, Japan, and evaluate how adoptability, stress level, upper respiratory infection (URI) syndrome incidence, and URI pathogen prevalence were associated with the cat's shelter intake source and shelter characteristics. All cats admitted to the Miharu shelter, Fukushima Prefecture from 2012 to 2014 were included in the study. The results demonstrate that in situ corticosteroid and antibiotic use were associated with cats subsequently developing upper respiratory infections (URI). Disease and cat behavior were unassociated with adoption. Cats in group housing had lower stress metrics than cats individually housed. Prevalences of URI pathogens exceeded 80%, but symptomatic cats were uncommon. Environmental enrichment and stress reduction strategies are important in controlling URI and reducing the need for corticosteroids and antibiotics in shelters. Preemptive protocols are important in preventing shelter admission of cats during disasters.

  3. Scaling up complex interventions: insights from a realist synthesis.

    PubMed

    Willis, Cameron D; Riley, Barbara L; Stockton, Lisa; Abramowicz, Aneta; Zummach, Dana; Wong, Geoff; Robinson, Kerry L; Best, Allan

    2016-12-19

    Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations.A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research.Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant

  4. Computer Simulation in Mass Emergency and Disaster Response: An Evaluation of Its Effectiveness as a Tool for Demonstrating Strategic Competency in Emergency Department Medical Responders

    ERIC Educational Resources Information Center

    O'Reilly, Daniel J.

    2011-01-01

    This study examined the capability of computer simulation as a tool for assessing the strategic competency of emergency department nurses as they responded to authentically computer simulated biohazard-exposed patient case studies. Thirty registered nurses from a large, urban hospital completed a series of computer-simulated case studies of…

  5. Lung Emergencies

    MedlinePlus

    ... Emergencies Cardiac Emergencies Eye Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at ... should be considered an emergency. Symptoms of sudden lung collapse (pneumothorax) Symptoms of a sudden lung collapse ...

  6. The Emerging Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Metabolic Cardiomyopathies.

    PubMed

    Mavrogeni, S; Markousis-Mavrogenis, G; Markussis, V; Kolovou, G

    2015-08-01

    The aim of this review is to discuss the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis, risk stratification, and follow-up of metabolic cardiomyopathies. The classification of myocardial diseases, proposed by WHO/ISFC task force, distinguished specific cardiomyopathies, caused by metabolic disorders, into 4 types: 1) endocrine disorders, 2) storage or infiltration disorders (amyloidosis, hemochromatosis and familial storage disorders), 3) nutritional disorders (Kwashiorkor, beri-beri, obesity, and alcohol), and 4) diabetic heart. Thyroid disease, pheochromocytoma, and growth hormone excess or deficiency may contribute to usually reversible dilated cardiomyopathy. Glucogen storage diseases can be presented with myopathy, liver, and heart failure. Lysosomal storage diseases can provoke cardiac hypertrophy, mimicking hypertrophic cardiomyopathy and arrhythmias. Hereditary hemochromatosis, an inherited disorder of iron metabolism, leads to tissue iron overload in different organs, including the heart. Cardiac amyloidosis is the result of amyloid deposition in the heart, formed from breakdown of normal or abnormal proteins that leads to increased heart stiffness, restrictive cardiomyopathy, and heart failure. Finally, nutritional disturbances and metabolic diseases, such as Kwashiorkor, beri-beri, obesity, alcohol consumption, and diabetes mellitus may also lead to severe cardiac dysfunction. CMR, through its capability to reliably assess anatomy, function, inflammation, rest-stress myocardial perfusion, myocardial fibrosis, aortic distensibility, iron and/or fat deposition can serve as an excellent tool for early diagnosis of heart involvement, risk stratification, treatment evaluation, and long term follow-up of patients with metabolic cardiomyopathies.

  7. Neurogenic orthostatic hypotension in Parkinson’s disease: evaluation, management, and emerging role of droxidopa

    PubMed Central

    Isaacson, Stuart H; Skettini, Julia

    2014-01-01

    Neurogenic orthostatic hypotension (nOH) is due to failure of the autonomic nervous system to regulate blood pressure in response to postural changes due to an inadequate release of norepinephrine, leading to orthostatic hypotension and supine hypertension. nOH is common in Parkinson’s disease (PD). Prevalence varies throughout the course of PD, ranging from 40% to 60%, and resulting in symptomatic nOH in approximately half. Symptomatic nOH, including lightheadedness, can limit daily activities and lead to falls. Symptomatic nOH can also limit therapeutic options for treating PD motor symptoms. Clinical evaluation should routinely include symptom assessment and blood pressure measurement of supine, sitting, and 3-minute standing; 24-hour ambulatory blood pressure monitoring can also be helpful. Non-pharmacological management of symptomatic nOH involves education, physical maneuvers, and adequate hydration. Current pharmacological treatment of symptomatic nOH includes salt supplement, fludrocortisone, midodrine, pyridostigmine, and other empiric medications. Despite these options, treatment of symptomatic nOH remains suboptimal, often limited by severe increases in supine blood pressure. Droxidopa, an oral prodrug converted by decarboxylation to norepinephrine, is a promising therapeutic option for symptomatic nOH in PD, improving symptoms of nOH, daily activities, falls, and standing systolic blood pressure in several recent trials. These trials demonstrated short-term efficacy and tolerability, with comparable increases in standing and supine blood pressures. Longer-term studies are ongoing to confirm durability of treatment effect. PMID:24729712

  8. Epidemiology and causation: a realist view.

    PubMed Central

    Renton, A

    1994-01-01

    In this paper the controversy over how to decide whether associations between factors and diseases are causal is placed within a description of the public health and scientific relevance of epidemiology. It is argued that the rise in popularity of the Popperian view of science, together with a perception of the aims of epidemiology as being to identify appropriate public health interventions, have focussed this debate on unresolved questions of inferential logic, leaving largely unanalysed the notions of causation and of disease at the ontological level. A realist ontology of causation of disease and pathogenesis is constructed within the framework of "scientific materialism", and is shown to provide a coherent basis from which to decide causes and to deal with problems of confounding and interaction in epidemiological research. It is argued that a realist analysis identifies a richer role for epidemiology as an integral part of an ontologically unified medical science. It is this unified medical science as a whole rather than epidemiological observation or experiment which decides causes and, in turn, provides a key element to the foundations of rational public health decision making. PMID:8138775

  9. Realistic Mobility Modeling for Vehicular Ad Hoc Networks

    NASA Astrophysics Data System (ADS)

    Akay, Hilal; Tugcu, Tuna

    2009-08-01

    Simulations used for evaluating the performance of routing protocols for Vehicular Ad Hoc Networks (VANET) are mostly based on random mobility and fail to consider individual behaviors of the vehicles. Unrealistic assumptions about mobility produce misleading results about the behavior of routing protocols in real deployments. In this paper, a realistic mobility modeling tool, Mobility for Vehicles (MOVE), which considers the basic mobility behaviors of vehicles, is proposed for a more accurate evaluation. The proposed model is tested against the Random Waypoint (RWP) model using AODV and OLSR protocols. The results show that the mobility model significantly affects the number of nodes within the transmission range of a node, the volume of control traffic, and the number of collisions. It is shown that number of intersections, grid size, and node density are important parameters when dealing with VANET performance.

  10. Emergency department evaluation and 30-day readmission after craniotomy for primary brain tumor resection in New York State.

    PubMed

    Missios, Symeon; Bekelis, Kimon

    2017-01-06

    OBJECTIVE Fragmentation of care has been recognized as a major contributor to 30-day readmissions after surgical procedures. The authors investigated the association of evaluation in the hospital where the original procedure was performed with the rate of 30-day readmissions for patients presenting to the emergency department (ED) after craniotomy for primary brain tumor resection. METHODS A cohort study was conducted, involving patients who were evaluated in the ED within 30 days after discharge following a craniotomy for primary brain tumor resection between 2009 and 2013, and who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. A propensity score-adjusted model was used to control for confounding, whereas a mixed-effects model accounted for clustering at the hospital level. RESULTS Of the 610 patients presenting to the ED, 422 (69.2%) were evaluated in a hospital different from the one where the original procedure was performed (28.9% were readmitted), and 188 (30.8%) were evaluated at the original hospital (20.3% were readmitted). In a multivariable analysis, the authors demonstrated that being evaluated in the ED of the original hospital was associated with a decreased rate of 30-day readmission (OR 0.64, 95% CI 0.41-0.98). Similar associations were found in a mixed-effects logistic regression model (OR 0.63, 95% CI 0.40-0.96) and a propensity score-adjusted model (OR 0.64, 95% CI 0.41-0.98). This corresponds to one less readmission per 12 patients evaluated in the hospital where the original procedure was performed. CONCLUSIONS Using a comprehensive all-payer cohort of patients in New York State who were evaluated in the ED after craniotomy for primary brain tumor resection, the authors identified an association of assessment in the hospital where the original procedure was performed with a lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in

  11. Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department

    PubMed Central

    Sawyer, Kelly N.; Shah, Payal; Qu, Lihua; Kurz, Michael C.; Clark, Carol L.; Swor, Robert A.

    2015-01-01

    Introduction Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods. Methods This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events. Results A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6mSv). No patient in either group had a related 30-day revisit. Conclusion Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation. PMID:26587090

  12. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    PubMed

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the

  13. Modeling and Analysis of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

    Brooker, J. E.; Dietrich, D. L.; Gokoglu, S. A.; Urban, D. L.; Ruff, G. A.

    2015-01-01

    An accidental fire inside a spacecraft is an unlikely, but very real emergency situation that can easily have dire consequences. While much has been learned over the past 25+ years of dedicated research on flame behavior in microgravity, a quantitative understanding of the initiation, spread, detection and extinguishment of a realistic fire aboard a spacecraft is lacking. Virtually all combustion experiments in microgravity have been small-scale, by necessity (hardware limitations in ground-based facilities and safety concerns in space-based facilities). Large-scale, realistic fire experiments are unlikely for the foreseeable future (unlike in terrestrial situations). Therefore, NASA will have to rely on scale modeling, extrapolation of small-scale experiments and detailed numerical modeling to provide the data necessary for vehicle and safety system design. This paper presents the results of parallel efforts to better model the initiation, spread, detection and extinguishment of fires aboard spacecraft. The first is a detailed numerical model using the freely available Fire Dynamics Simulator (FDS). FDS is a CFD code that numerically solves a large eddy simulation form of the Navier-Stokes equations. FDS provides a detailed treatment of the smoke and energy transport from a fire. The simulations provide a wealth of information, but are computationally intensive and not suitable for parametric studies where the detailed treatment of the mass and energy transport are unnecessary. The second path extends a model previously documented at ICES meetings that attempted to predict maximum survivable fires aboard space-craft. This one-dimensional model implies the heat and mass transfer as well as toxic species production from a fire. These simplifications result in a code that is faster and more suitable for parametric studies (having already been used to help in the hatch design of the Multi-Purpose Crew Vehicle, MPCV).

  14. UAV based distributed ATR under realistic simulated environmental effects

    NASA Astrophysics Data System (ADS)

    Chen, Xiaohan; Gong, Shanshan; Schmid, Natalia A.; Valenti, Matthew C.

    2007-04-01

    Over the past several years, the military has grown increasingly reliant upon the use of unattended aerial vehicles (UAVs) for surveillance missions. There is an increasing trend towards fielding swarms of UAVs operating as large-scale sensor networks in the air. Such systems tend to be used primarily for the purpose of acquiring sensory data with the goal of automatic detection, identification, and tracking objects of interest. These trends have been paralleled by advances in both distributed detection, image/signal processing and data fusion techniques. Furthermore, swarmed UAV systems must operate under severe constraints on environmental conditions and sensor limitations. In this work, we investigate the effects of environmental conditions on target detection and recognition performance in a UAV network. We assume that each UAV is equipped with an optical camera, and use a realistic computer simulation to generate synthetic images. The detection algorithm relies on Haar-based features while the automatic target recognition (ATR) algorithm relies on Bessel K features. The performance of both algorithms is evaluated using simulated images that closely mimic data acquired in a UAV network under realistic environmental conditions. We design several fusion techniques and analyze both the case of a single observation and the case of multiple observations of the same target.

  15. Electron percolation in realistic models of carbon nanotube networks

    SciTech Connect

    Simoneau, Louis-Philippe Villeneuve, Jérémie Rochefort, Alain

    2015-09-28

    The influence of penetrable and curved carbon nanotubes (CNT) on the charge percolation in three-dimensional disordered CNT networks have been studied with Monte-Carlo simulations. By considering carbon nanotubes as solid objects but where the overlap between their electron cloud can be controlled, we observed that the structural characteristics of networks containing lower aspect ratio CNT are highly sensitive to the degree of penetration between crossed nanotubes. Following our efficient strategy to displace CNT to different positions to create more realistic statistical models, we conclude that the connectivity between objects increases with the hard-core/soft-shell radii ratio. In contrast, the presence of curved CNT in the random networks leads to an increasing percolation threshold and to a decreasing electrical conductivity at saturation. The waviness of CNT decreases the effective distance between the nanotube extremities, hence reducing their connectivity and degrading their electrical properties. We present the results of our simulation in terms of thickness of the CNT network from which simple structural parameters such as the volume fraction or the carbon nanotube density can be accurately evaluated with our more realistic models.

  16. Electron percolation in realistic models of carbon nanotube networks

    NASA Astrophysics Data System (ADS)

    Simoneau, Louis-Philippe; Villeneuve, Jérémie; Rochefort, Alain

    2015-09-01

    The influence of penetrable and curved carbon nanotubes (CNT) on the charge percolation in three-dimensional disordered CNT networks have been studied with Monte-Carlo simulations. By considering carbon nanotubes as solid objects but where the overlap between their electron cloud can be controlled, we observed that the structural characteristics of networks containing lower aspect ratio CNT are highly sensitive to the degree of penetration between crossed nanotubes. Following our efficient strategy to displace CNT to different positions to create more realistic statistical models, we conclude that the connectivity between objects increases with the hard-core/soft-shell radii ratio. In contrast, the presence of curved CNT in the random networks leads to an increasing percolation threshold and to a decreasing electrical conductivity at saturation. The waviness of CNT decreases the effective distance between the nanotube extremities, hence reducing their connectivity and degrading their electrical properties. We present the results of our simulation in terms of thickness of the CNT network from which simple structural parameters such as the volume fraction or the carbon nanotube density can be accurately evaluated with our more realistic models.

  17. Functional consequences of realistic biodiversity changes in a marine ecosystem.

    PubMed

    Bracken, Matthew E S; Friberg, Sara E; Gonzalez-Dorantes, Cirse A; Williams, Susan L

    2008-01-22

    Declines in biodiversity have prompted concern over the consequences of species loss for the goods and services provided by natural ecosystems. However, relatively few studies have evaluated the functional consequences of realistic, nonrandom changes in biodiversity. Instead, most designs have used randomly selected assemblages from a local species pool to construct diversity gradients. It is therefore difficult, based on current evidence, to predict the functional consequences of realistic declines in biodiversity. In this study, we used tide pool microcosms to demonstrate that the effects of real-world changes in biodiversity may be very different from those of random diversity changes. Specifically, we measured the relationship between the diversity of a seaweed assemblage and its ability to use nitrogen, a key limiting nutrient in nearshore marine systems. We quantified nitrogen uptake using both experimental and model seaweed assemblages and found that natural increases in diversity resulted in enhanced rates of nitrogen use, whereas random diversity changes had no effect on nitrogen uptake. Our results suggest that understanding the real-world consequences of declining biodiversity will require addressing changes in species performance along natural diversity gradients and understanding the relationships between species' susceptibility to loss and their contributions to ecosystem functioning.

  18. Simulating realistic predator signatures in quantitative fatty acid signature analysis

    USGS Publications Warehouse

    Bromaghin, Jeffrey F.

    2015-01-01

    Diet estimation is an important field within quantitative ecology, providing critical insights into many aspects of ecology and community dynamics. Quantitative fatty acid signature analysis (QFASA) is a prominent method of diet estimation, particularly for marine mammal and bird species. Investigators using QFASA commonly use computer simulation to evaluate statistical characteristics of diet estimators for the populations they study. Similar computer simulations have been used to explore and compare the performance of different variations of the original QFASA diet estimator. In both cases, computer simulations involve bootstrap sampling prey signature data to construct pseudo-predator signatures with known properties. However, bootstrap sample sizes have been selected arbitrarily and pseudo-predator signatures therefore may not have realistic properties. I develop an algorithm to objectively establish bootstrap sample sizes that generates pseudo-predator signatures with realistic properties, thereby enhancing the utility of computer simulation for assessing QFASA estimator performance. The algorithm also appears to be computationally efficient, resulting in bootstrap sample sizes that are smaller than those commonly used. I illustrate the algorithm with an example using data from Chukchi Sea polar bears (Ursus maritimus) and their marine mammal prey. The concepts underlying the approach may have value in other areas of quantitative ecology in which bootstrap samples are post-processed prior to their use.

  19. Evaluating legacy contaminants and emerging chemicals in marine environments using adverse outcome pathways and biological effects-directed analysis.

    PubMed

    Hutchinson, Thomas H; Lyons, Brett P; Thain, John E; Law, Robin J

    2013-09-30

    Natural and synthetic chemicals are essential to our daily lives, food supplies, health care, industries and safe sanitation. At the same time protecting marine ecosystems and seafood resources from the adverse effects of chemical contaminants remains an important issue. Since the 1970s, monitoring of persistent, bioaccumulative and toxic (PBT) chemicals using analytical chemistry has provided important spatial and temporal trend data in three important contexts; relating to human health protection from seafood contamination, addressing threats to marine top predators and finally providing essential evidence to better protect the biodiversity of commercial and non-commercial marine species. A number of regional conventions have led to controls on certain PBT chemicals over several years (termed 'legacy contaminants'; e.g. cadmium, lindane, polycyclic aromatic hydrocarbons [PAHs] and polychlorinated biphenyls [PCBs]). Analytical chemistry plays a key role in evaluating to what extent such regulatory steps have been effective in leading to reduced emissions of these legacy contaminants into marine environments. In parallel, the application of biomarkers (e.g. DNA adducts, CYP1A-EROD, vitellogenin) and bioassays integrated with analytical chemistry has strengthened the evidence base to support an ecosystem approach to manage marine pollution problems. In recent years, however,the increased sensitivity of analytical chemistry, toxicity alerts and wider environmental awareness has led to a focus on emerging chemical contaminants (defined as chemicals that have been detected in the environment, but which are currently not included in regulatory monitoring programmes and whose fate and biological impacts are poorly understood). It is also known that natural chemicals (e.g. algal biotoxins) may also pose a threat to marine species and seafood quality. Hence complex mixtures of legacy contaminants, emerging chemicals and natural biotoxins in marine ecosystems represent

  20. Helioseismology of a Realistic Magnetoconvective Sunspot Simulation

    NASA Technical Reports Server (NTRS)

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L., Jr.

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  1. HELIOSEISMOLOGY OF A REALISTIC MAGNETOCONVECTIVE SUNSPOT SIMULATION

    SciTech Connect

    Braun, D. C.; Birch, A. C.; Rempel, M.; Duvall, T. L. Jr. E-mail: aaronb@cora.nwra.com E-mail: Thomas.L.Duvall@nasa.gov

    2012-01-01

    We compare helioseismic travel-time shifts measured from a realistic magnetoconvective sunspot simulation using both helioseismic holography and time-distance helioseismology, and measured from real sunspots observed with the Helioseismic and Magnetic Imager instrument on board the Solar Dynamics Observatory and the Michelson Doppler Imager instrument on board the Solar and Heliospheric Observatory. We find remarkable similarities in the travel-time shifts measured between the methodologies applied and between the simulated and real sunspots. Forward modeling of the travel-time shifts using either Born or ray approximation kernels and the sound-speed perturbations present in the simulation indicates major disagreements with the measured travel-time shifts. These findings do not substantially change with the application of a correction for the reduction of wave amplitudes in the simulated and real sunspots. Overall, our findings demonstrate the need for new methods for inferring the subsurface structure of sunspots through helioseismic inversions.

  2. Presupernova neutrinos: realistic emissivities from stellar evolution

    NASA Astrophysics Data System (ADS)

    Patton, Kelly; Lunardini, Cecilia; Farmer, Rob; Timmes, Frank

    2017-01-01

    We present a calculation of neutrino emissivities and energy spectra from a presupernova, a massive star going through the advanced stages of nuclear burning before becoming a supernova. Neutrinos produced from beta decay and electron capture, as well as pair annihilation, plasmon decay, and the photoneutrino process are included. We use the state of the art stellar evolution code MESA to obtain realistic conditions for temperature, density, electron fraction, and nuclear isotopic composition. We have found that beta processes contribute significantly to the neutrino flux at potentially detectable energies of a few MeV. Estimates for the number of events at several current and future detectors are presented for the last few hours before collapse.

  3. Realistic page-turning of electronic books

    NASA Astrophysics Data System (ADS)

    Fan, Chaoran; Li, Haisheng; Bai, Yannan

    2014-01-01

    The booming electronic books (e-books), as an extension to the paper book, are popular with readers. Recently, many efforts are put into the realistic page-turning simulation o f e-book to improve its reading experience. This paper presents a new 3D page-turning simulation approach, which employs piecewise time-dependent cylindrical surfaces to describe the turning page and constructs smooth transition method between time-dependent cylinders. The page-turning animation is produced by sequentially mapping the turning page into the cylinders with different radii and positions. Compared to the previous approaches, our method is able to imitate various effects efficiently and obtains more natural animation of turning page.

  4. Demonstrating a Realistic IP Mission Prototype

    NASA Technical Reports Server (NTRS)

    Rash, James; Ferrer, Arturo B.; Goodman, Nancy; Ghazi-Tehrani, Samira; Polk, Joe; Johnson, Lorin; Menke, Greg; Miller, Bill; Criscuolo, Ed; Hogie, Keith

    2003-01-01

    Flight software and hardware and realistic space communications environments were elements of recent demonstrations of the Internet Protocol (IP) mission concept in the lab. The Operating Missions as Nodes on the Internet (OMNI) Project and the Flight Software Branch at NASA/GSFC collaborated to build the prototype of a representative space mission that employed unmodified off-the-shelf Internet protocols and technologies for end-to-end communications between the spacecraft/instruments and the ground system/users. The realistic elements used in the prototype included an RF communications link simulator and components of the TRIANA mission flight software and ground support system. A web-enabled camera connected to the spacecraft computer via an Ethernet LAN represented an on-board instrument creating image data. In addition to the protocols at the link layer (HDLC), transport layer (UDP, TCP), and network (IP) layer, a reliable file delivery protocol (MDP) at the application layer enabled reliable data delivery both to and from the spacecraft. The standard Network Time Protocol (NTP) performed on-board clock synchronization with a ground time standard. The demonstrations of the prototype mission illustrated some of the advantages of using Internet standards and technologies for space missions, but also helped identify issues that must be addressed. These issues include applicability to embedded real-time systems on flight-qualified hardware, range of applicability of TCP, and liability for and maintenance of commercial off-the-shelf (COTS) products. The NASA Earth Science Technology Office (ESTO) funded the collaboration to build and demonstrate the prototype IP mission.

  5. Breast imaging after dark: patient outcomes following evaluation for breast abscess in the emergency department after hours.

    PubMed

    Bosma, Melissa S; Morden, Kasey L; Klein, Katherine A; Neal, Colleen H; Knoepp, Ursula S; Patterson, Stephanie K

    2016-02-01

    In our study, we sought to report the management, clinical outcomes, and follow-up rates of patients who presented for evaluation of breast abscess in the Emergency Department (ED) after hours. A retrospective search of ultrasound reports at our institution identified all patients from January 1, 2009 to June 30, 2013 who were scanned in the ED after hours to evaluate for breast abscess. Patient demographics, clinical information, imaging findings, follow-up rates, and outcomes were reviewed. One hundred eighty-five patients were included in the study. Forty-four percent (86/185) of the patients were diagnosed with abscess based on ultrasound findings in the ED. Twenty-seven percent (23/86) were recently post-operative, and 12 % (10/86) were postpartum/breastfeeding. Mastitis was the diagnosis in the remaining 54 % (99/185). Only 1/86 cases were associated with breast cancer. Seventy-seven percent (66/86) of patients were treated with an invasive procedure; 39 % (26/66) had surgical evacuation, 30 % (20/66) image-guided drainage, 23 % (15/66) bedside or clinic incision and drainage, and 8 % (5/66) palpation-guided fine needle aspiration (FNA). Seventy-seven percent (143/185) of patients had clinical and/or imaging follow-up. Forty-four percent (63/143) had long-term follow-up (≥ 3 months). Almost 50 % of the patients who presented to the ED for evaluation of abscess were diagnosed with abscess while the remaining patients were diagnosed with mastitis. Appropriate clinical and/or imaging follow-up occurred in 77 %. Long-term follow-up (≥ 3 months) occurred more frequently in patients older than 30 years of age. Appropriate follow-up does not occur in approximately one fourth of cases, suggesting that additional clinician and patient education is warranted.

  6. Implementation and evaluation of a novel research education rotation for Royal College of Physicians and Surgeons emergency medicine residents.

    PubMed

    Abu-Laban, Riyad B; Jarvis-Selinger, Sandra; Newton, Lana; Chung, Brian

    2013-07-01

    Royal College of Physicians and Surgeons (RCPS) emergency medicine (EM) residents must complete a scholarly project; however, significant variation exists in Canadian EM resident research education and facilitation. We developed and implemented a novel mandatory research education rotation for RCPS EM residents intended to increase knowledge, faculty/resident collaborations, and, ultimately, scholarly output. This 4-week rotation took place in the fall of 2011 and consisted of 37 faculty-led didactic, critical appraisal, and workshop seminars. Exposure to faculty research and resulting opportunities and the development of resident research projects were integrated into the rotation. Twelve participating residents completed daily evaluations and took part in an exit focus group analyzed using a constant comparative method. Knowledge acquisition was assessed with a pre/post comprehensive examination instrument evaluated by a paired t-test. Evaluations indicated generally high satisfaction throughout the rotation. Focus group analysis indicated that residents felt two important but competing goals existed: developing a research project and developing critical appraisal skills. The research knowledge of all participants improved significantly (mean/SD examination change +35.4%/+10.4%, range +20.0% to +53.6%, p < 0.001), and several new resident/faculty research collaborations arose from the rotation. A rotation of this nature is an efficient and effective means to increase research and critical appraisal knowledge and faculty/resident collaborations. As a result of our positive experience, the rotation will continue annually and has been expanded to include pediatric EM fellows. Longitudinal tracking of the participating trainee cohort will remain ongoing to assess the scholarly output impact of the rotation.

  7. Optimizing performance of hybrid FSO/RF networks in realistic dynamic scenarios

    NASA Astrophysics Data System (ADS)

    Llorca, Jaime; Desai, Aniket; Baskaran, Eswaran; Milner, Stuart; Davis, Christopher

    2005-08-01

    Hybrid Free Space Optical (FSO) and Radio Frequency (RF) networks promise highly available wireless broadband connectivity and quality of service (QoS), particularly suitable for emerging network applications involving extremely high data rate transmissions such as high quality video-on-demand and real-time surveillance. FSO links are prone to atmospheric obscuration (fog, clouds, snow, etc) and are difficult to align over long distances due the use of narrow laser beams and the effect of atmospheric turbulence. These problems can be mitigated by using adjunct directional RF links, which provide backup connectivity. In this paper, methodologies for modeling and simulation of hybrid FSO/RF networks are described. Individual link propagation models are derived using scattering theory, as well as experimental measurements. MATLAB is used to generate realistic atmospheric obscuration scenarios, including moving cloud layers at different altitudes. These scenarios are then imported into a network simulator (OPNET) to emulate mobile hybrid FSO/RF networks. This framework allows accurate analysis of the effects of node mobility, atmospheric obscuration and traffic demands on network performance, and precise evaluation of topology reconfiguration algorithms as they react to dynamic changes in the network. Results show how topology reconfiguration algorithms, together with enhancements to TCP/IP protocols which reduce the network response time, enable the network to rapidly detect and act upon link state changes in highly dynamic environments, ensuring optimized network performance and availability.

  8. Evaluation of Highly Realistic Training for Independent Duty Corpsmen Students

    DTIC Science & Technology

    2015-05-21

    confidence), readiness, and career intentions. We expected that participants would generally express a high level of satisfaction with the...was significantly higher after the training than before (p < 0.001). This was consistent with our expectations . On the career intentions item, there...and career intentions. Corpsmen participants expressed high levels of satisfaction with the training overall and with specific elements of the

  9. Universal influenza vaccines: a realistic option?

    PubMed

    de Vries, R D; Altenburg, A F; Rimmelzwaan, G F

    2016-12-01

    The extensive antigenic drift displayed by seasonal influenza viruses and the risk of pandemics caused by newly emerging antigenically distinct influenza A viruses of novel subtypes has raised considerable interest in the development of so-called universal influenza vaccines. We review options for the development of universal flu vaccines and discuss progress that has been made recently.

  10. Evaluation of emergency department performance – a systematic review on recommended performance and quality-in-care measures

    PubMed Central

    2013-01-01

    Background Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability. Aim To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. Methods Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level. Results A number of articles addresses this study’s objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, “patients left without being seen” (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles. Conclusions A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study’s results allow for advancement

  11. Impact evaluation of green-grey infrastructure interaction on built-space integrity: an emerging perspective to urban ecosystem service.

    PubMed

    Tiwary, Abhishek; Kumar, Prashant

    2014-07-15

    This paper evaluates the role of urban green infrastructure (GI) in maintaining integrity of built-space. The latter is considered as a lateral ecosystem function, worth including in future assessments of integrated ecosystem services. The basic tenet is that integrated green-grey infrastructures (GGIs) would have three influences on built-spaces: (i) reduced wind withering from flow deviation; (ii) reduced material corrosion/degeneration from pollution removal; and (iii) act as a biophysical buffer in altering the micro-climate. A case study is presented, combining the features of computational fluid dynamics (CFD) in micro-environmental modelling with the emerging science on interactions of GGIs. The coupled seasonal dynamics of the above three effects are assessed for two building materials (limestone and steel) using the following three scenarios: (i) business as usual (BAU), (ii) summer (REGEN-S), and (iii) winter (REGEN-W). Apparently, integrated ecosystem service from green-grey interaction, as scoped in this paper, has strong seasonal dependence. Compared to BAU our results suggest that REGEN-S leads to slight increment in limestone recession (<10%), mainly from exacerbation in ozone damage, while large reduction in steel recession (up to 37%) is observed. The selection of vegetation species, especially their bVOC emission potential and seasonal foliage profile, appears to play a vital role in determining the impact GI has on the integrity of the neighbouring built-up environment.

  12. Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

    PubMed Central

    IMANI NASAB, Mohammad Hasan; MOHAGHEGH, Bahram; KHALESI, Nader; JAAFARIPOOYAN, Ebrahim

    2013-01-01

    Background European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs. Conclusion: The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable. PMID:23967429

  13. Comparative evaluation of differential laser-induced perturbation spectroscopy as a technique to discriminate emerging skin pathology

    NASA Astrophysics Data System (ADS)

    Kozikowski, Raymond T.; Smith, Sarah E.; Lee, Jennifer A.; Castleman, William L.; Sorg, Brian S.; Hahn, David W.

    2012-06-01

    Fluorescence spectroscopy has been widely investigated as a technique for identifying pathological tissue; however, unrelated subject-to-subject variations in spectra complicate data analysis and interpretation. We describe and evaluate a new biosensing technique, differential laser-induced perturbation spectroscopy (DLIPS), based on deep ultraviolet (UV) photochemical perturbation in combination with difference spectroscopy. This technique combines sequential fluorescence probing (pre- and post-perturbation) with sub-ablative UV perturbation and difference spectroscopy to provide a new spectral dimension, facilitating two improvements over fluorescence spectroscopy. First, the differential technique eliminates significant variations in absolute fluorescence response within subject populations. Second, UV perturbations alter the extracellular matrix (ECM), directly coupling the DLIPS response to the biological structure. Improved biosensing with DLIPS is demonstrated in vivo in a murine model of chemically induced skin lesion development. Component loading analysis of the data indicates that the DLIPS technique couples to structural proteins in the ECM. Analysis of variance shows that DLIPS has a significant response to emerging pathology as opposed to other population differences. An optimal likelihood ratio classifier for the DLIPS dataset shows that this technique holds promise for improved diagnosis of epithelial pathology. Results further indicate that DLIPS may improve diagnosis of tissue by augmenting fluorescence spectra (i.e. orthogonal sensing).

  14. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study.

    PubMed

    Wang, Hao; Robinson, Richard D; Garrett, John S; Bunch, Kellie; Huggins, Charles A; Watson, Katherine; Daniels, Joni; Banks, Brett; D'Etienne, James P; Zenarosa, Nestor R

    2015-01-01

    Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery.

  15. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study

    PubMed Central

    Wang, Hao; Robinson, Richard D.; Garrett, John S.; Bunch, Kellie; Huggins, Charles A.; Watson, Katherine; Daniels, Joni; Banks, Brett; D'Etienne, James P.; Zenarosa, Nestor R.

    2015-01-01

    Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery. PMID:26167302

  16. Comparative evaluation of differential laser-induced perturbation spectroscopy as a technique to discriminate emerging skin pathology.

    PubMed

    Kozikowski, Raymond T; Smith, Sarah E; Lee, Jennifer A; Castleman, William L; Sorg, Brian S; Hahn, David W

    2012-06-01

    Fluorescence spectroscopy has been widely investigated as a technique for identifying pathological tissue; however, unrelated subject-to-subject variations in spectra complicate data analysis and interpretation. We describe and evaluate a new biosensing technique, differential laser-induced perturbation spectroscopy (DLIPS), based on deep ultraviolet (UV) photochemical perturbation in combination with difference spectroscopy. This technique combines sequential fluorescence probing (pre- and post-perturbation) with sub-ablative UV perturbation and difference spectroscopy to provide a new spectral dimension, facilitating two improvements over fluorescence spectroscopy. First, the differential technique eliminates significant variations in absolute fluorescence response within subject populations. Second, UV perturbations alter the extracellular matrix (ECM), directly coupling the DLIPS response to the biological structure. Improved biosensing with DLIPS is demonstrated in vivo in a murine model of chemically induced skin lesion development. Component loading analysis of the data indicates that the DLIPS technique couples to structural proteins in the ECM. Analysis of variance shows that DLIPS has a significant response to emerging pathology as opposed to other population differences. An optimal likelihood ratio classifier for the DLIPS dataset shows that this technique holds promise for improved diagnosis of epithelial pathology. Results further indicate that DLIPS may improve diagnosis of tissue by augmenting fluorescence spectra (i.e. orthogonal sensing).

  17. What makes Health Demand-Side Financing Schemes Work in Low-and Middle-Income Countries? A Realist Review

    PubMed Central

    Gopalan, Saji S.; Das, Ashis; Mutasa, Ronald

    2014-01-01

    This realist review explored causal pathways of the possible consumer effects of health sector demand-side financial (DSF) incentives, their contextual factors and mechanisms in low-and-middle-income countries. We searched six electronic data bases and identified 659 abstracts with different evaluation designs. Based on methodological rigor and content relevance, only 24 studies published up to April 2013 were selected for the final review. A conceptual framework consisting of various program theories on potential context-mechanism-outcome (C-M-O) configuration of DSF initiative was designed, tested and adapted during the review. Synthesized results were presented as a C-M-O configuration for each of the consumer –side effect. DSF was effective to improve health seeking behaviour considerably and health status to some extent. The causal pathway of DSF’s functioning and effectiveness was not linear. Key demand-side contextual factors which affected DSF’s consumer-side effects were background characteristics of the beneficiaries including their socio-cultural beliefs, motivations, and level of health awareness. At the supply-side, service availability status and provider incentives were contextual determinants. The mechanisms which enabled the interaction of contextual influence were consumer and provider accountability and consumer trust on providers. In order to enhance DSF programs’ effectiveness, their design and implementation should carefully consider the potential contextual elements that may influence the causal pathways. Significance for public health This article focuses on a rare topic i.e. Realist Review, which is an emerging concept to explore causal factors behind every intervention that make it effective or ineffective. This manuscript is a first attempt on a Realist Review of health sector demand-side financing (DSF) in a number of low-and middle-income countries. DSF is a widely employed health promotion strategy in many countries to improve

  18. [The expertise evaluation of organization of rendering of acute, emergency and urgent medical care in rural regions of Novosibirsk oblast'].

    PubMed

    Ivaninskiĭ, O I; Sharapov, I V; Sadovoĭ, M A

    2013-01-01

    The most problematic spheres in the resource support of emergency medical care to rural residents are the completeness of staff of physicians in rural medical surgeries, community hospitals and departments of emergency medical care in central district hospitals. The provision of feldsher obstetrics posts with sanitary motor transport and medical equipment is yet another problematic sphere. The main troubles during provision of emergency medical care at feldsher obstetrics posts are related to surgery treatment. The organization of emergency and urgent medical care suffers of many unresolved problems related to informational program support at feldsher obstetrics posts, polyclinics of central district hospitals.

  19. Determination of Realistic Fire Scenarios in Spacecraft

    NASA Technical Reports Server (NTRS)

    Dietrich, Daniel L.; Ruff, Gary A.; Urban, David

    2013-01-01

    This paper expands on previous work that examined how large a fire a crew member could successfully survive and extinguish in the confines of a spacecraft. The hazards to the crew and equipment during an accidental fire include excessive pressure rise resulting in a catastrophic rupture of the vehicle skin, excessive temperatures that burn or incapacitate the crew (due to hyperthermia), carbon dioxide build-up or accumulation of other combustion products (e.g. carbon monoxide). The previous work introduced a simplified model that treated the fire primarily as a source of heat and combustion products and sink for oxygen prescribed (input to the model) based on terrestrial standards. The model further treated the spacecraft as a closed system with no capability to vent to the vacuum of space. The model in the present work extends this analysis to more realistically treat the pressure relief system(s) of the spacecraft, include more combustion products (e.g. HF) in the analysis and attempt to predict the fire spread and limiting fire size (based on knowledge of terrestrial fires and the known characteristics of microgravity fires) rather than prescribe them in the analysis. Including the characteristics of vehicle pressure relief systems has a dramatic mitigating effect by eliminating vehicle overpressure for all but very large fires and reducing average gas-phase temperatures.

  20. Challenges and solutions for realistic room simulation

    NASA Astrophysics Data System (ADS)

    Begault, Durand R.

    2002-05-01

    Virtual room acoustic simulation (auralization) techniques have traditionally focused on answering questions related to speech intelligibility or musical quality, typically in large volumetric spaces. More recently, auralization techniques have been found to be important for the externalization of headphone-reproduced virtual acoustic images. Although externalization can be accomplished using a minimal simulation, data indicate that realistic auralizations need to be responsive to head motion cues for accurate localization. Computational demands increase when providing for the simulation of coupled spaces, small rooms lacking meaningful reverberant decays, or reflective surfaces in outdoor environments. Auditory threshold data for both early reflections and late reverberant energy levels indicate that much of the information captured in acoustical measurements is inaudible, minimizing the intensive computational requirements of real-time auralization systems. Results are presented for early reflection thresholds as a function of azimuth angle, arrival time, and sound-source type, and reverberation thresholds as a function of reverberation time and level within 250-Hz-2-kHz octave bands. Good agreement is found between data obtained in virtual room simulations and those obtained in real rooms, allowing a strategy for minimizing computational requirements of real-time auralization systems.

  1. Mechanical stabilization of the Levitron's realistic model

    NASA Astrophysics Data System (ADS)

    Olvera, Arturo; De la Rosa, Abraham; Giordano, Claudia M.

    2016-11-01

    The stability of the magnetic levitation showed by the Levitron was studied by M.V. Berry as a six degrees of freedom Hamiltonian system using an adiabatic approximation. Further, H.R. Dullin found critical spin rate bounds where the levitation persists and R.F. Gans et al. offered numerical results regarding the initial conditions' manifold where this occurs. In the line of this series of works, first, we extend the equations of motion to include dissipation for a more realistic model, and then introduce a mechanical forcing to inject energy into the system in order to prevent the Levitron from falling. A systematic study of the flying time as a function of the forcing parameters is carried out which yields detailed bifurcation diagrams showing an Arnold's tongues structure. The stability of these solutions were studied with the help of a novel method to compute the maximum Lyapunov exponent called MEGNO. The bifurcation diagrams for MEGNO reproduce the same Arnold's tongue structure.

  2. Differentiability of correlations in realistic quantum mechanics

    SciTech Connect

    Cabrera, Alejandro; Faria, Edson de; Pujals, Enrique; Tresser, Charles

    2015-09-15

    We prove a version of Bell’s theorem in which the locality assumption is weakened. We start by assuming theoretical quantum mechanics and weak forms of relativistic causality and of realism (essentially the fact that observable values are well defined independently of whether or not they are measured). Under these hypotheses, we show that only one of the correlation functions that can be formulated in the framework of the usual Bell theorem is unknown. We prove that this unknown function must be differentiable at certain angular configuration points that include the origin. We also prove that, if this correlation is assumed to be twice differentiable at the origin, then we arrive at a version of Bell’s theorem. On the one hand, we are showing that any realistic theory of quantum mechanics which incorporates the kinematic aspects of relativity must lead to this type of rough correlation function that is once but not twice differentiable. On the other hand, this study brings us a single degree of differentiability away from a relativistic von Neumann no hidden variables theorem.

  3. Comparing Realistic Subthalamic Nucleus Neuron Models

    NASA Astrophysics Data System (ADS)

    Njap, Felix; Claussen, Jens C.; Moser, Andreas; Hofmann, Ulrich G.

    2011-06-01

    The mechanism of action of clinically effective electrical high frequency stimulation is still under debate. However, recent evidence points at the specific activation of GABA-ergic ion channels. Using a computational approach, we analyze temporal properties of the spike trains emitted by biologically realistic neurons of the subthalamic nucleus (STN) as a function of GABA-ergic synaptic input conductances. Our contribution is based on a model proposed by Rubin and Terman and exhibits a wide variety of different firing patterns, silent, low spiking, moderate spiking and intense spiking activity. We observed that most of the cells in our network turn to silent mode when we increase the GABAA input conductance above the threshold of 3.75 mS/cm2. On the other hand, insignificant changes in firing activity are observed when the input conductance is low or close to zero. We thus reproduce Rubin's model with vanishing synaptic conductances. To quantitatively compare spike trains from the original model with the modified model at different conductance levels, we apply four different (dis)similarity measures between them. We observe that Mahalanobis distance, Victor-Purpura metric, and Interspike Interval distribution are sensitive to different firing regimes, whereas Mutual Information seems undiscriminative for these functional changes.

  4. Sialendoscopy Training: Presentation of a Realistic Model.

    PubMed

    Pascoto, Gabriela Robaskewicz; Stamm, Aldo Cassol; Lyra, Marcos

    2017-01-01

    Introduction Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments. Objective The aim of this study is to present a novel simulator for training sialendoscopy. Method This realistic simulator was built with a synthetic thermo-retractile, thermo-sensible rubber which, when combined with different polymers, produces more than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues. Results The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser. Conclusion This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors.

  5. Sialendoscopy Training: Presentation of a Realistic Model

    PubMed Central

    Pascoto, Gabriela Robaskewicz; Stamm, Aldo Cassol; Lyra, Marcos

    2016-01-01

    Introduction Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments. Objective The aim of this study is to present a novel simulator for training sialendoscopy. Method This realistic simulator was built with a synthetic thermo-retractile, thermo-sensible rubber which, when combined with different polymers, produces more than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues. Results The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser. Conclusion This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors. PMID:28050202

  6. EVALUATION OF DEMONSTRATED AND EMERGING TECHNOLOGIES FOR THE TREATMENT OF CONTAMINATED LAND AND GROUNDWATER (PHASE III) - 1999 SPECIAL SESSION ON MONITORED NATURAL ATTENUATION

    EPA Science Inventory

    This report includes the papers presented at the NATO/CCMS Pilot Study Meeting in Angers, France, May 9-14, 1999, for the special session on Monitored Natural Attenuation (MNA). This is the Phase III of the Evaluation of Demonstrated and Emerging Technologies for the Treatment a...

  7. Evaluating and Measuring the Return on Investment of an Emergency Center Health Care Professional Picture Archiving and Communication Systems Training Program

    ERIC Educational Resources Information Center

    Roelandt, James P.

    2012-01-01

    Picture archiving and communication system (PACS) workflow directly affects the quality of emergency patient care through radiology exam turn-around times and the speed of delivery of diagnostic radiology results. This study was a mixed methods training and performance improvement study that evaluated the effectiveness and value of a hospital…

  8. Evaluation of seed coating formulations of Trichoderma harzianum on cucumber seeds against pre- and post-emergence damping-off caused by Pythium ultimum

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Seed coating formulations of Trichoderma harzianum were evaluated on cucumber seeds to control pre- and post-emergence damping-off caused by Pythium ultimum in greenhouse studies. Results showed that coating formulation H reduced the disease incidence significantly, and had the potential for commer...

  9. Development and Evaluation of Senior High School Courses on Emerging Technology: A Case Study of a Course on Virtual Reality

    ERIC Educational Resources Information Center

    Chen, Chi-Tung

    2012-01-01

    In Taiwan, the National Science Council has implemented the High Scope Program (HSP) since 2006. The purpose of this study was to analyze the development and effectiveness of senior high school HSP courses on emerging technology. This study used a course on virtual reality as an example, to investigate the influence of emerging technology courses…

  10. The standing wave FEL/TBA: Realistic cavity geometry and energy extraction

    SciTech Connect

    Kim, Jin-Soo, Henke, H.; Sessler, A.M.; Sharp, W.M.

    1993-05-01

    A set of parameters for standing wave free electron laser two beam accelerators (SWFEL/TBA) is evaluated for realistic cavity geometry taking into account beam-break-up and the sensitivity of output power to imperfections. Also given is a power extraction system using cavity coupled wave guides.

  11. A realistic molecular model of cement hydrates

    PubMed Central

    Pellenq, Roland J.-M.; Kushima, Akihiro; Shahsavari, Rouzbeh; Van Vliet, Krystyn J.; Buehler, Markus J.; Yip, Sidney; Ulm, Franz-Josef

    2009-01-01

    Despite decades of studies of calcium-silicate-hydrate (C-S-H), the structurally complex binder phase of concrete, the interplay between chemical composition and density remains essentially unexplored. Together these characteristics of C-S-H define and modulate the physical and mechanical properties of this “liquid stone” gel phase. With the recent determination of the calcium/silicon (C/S = 1.7) ratio and the density of the C-S-H particle (2.6 g/cm3) by neutron scattering measurements, there is new urgency to the challenge of explaining these essential properties. Here we propose a molecular model of C-S-H based on a bottom-up atomistic simulation approach that considers only the chemical specificity of the system as the overriding constraint. By allowing for short silica chains distributed as monomers, dimers, and pentamers, this C-S-H archetype of a molecular description of interacting CaO, SiO2, and H2O units provides not only realistic values of the C/S ratio and the density computed by grand canonical Monte Carlo simulation of water adsorption at 300 K. The model, with a chemical composition of (CaO)1.65(SiO2)(H2O)1.75, also predicts other essential structural features and fundamental physical properties amenable to experimental validation, which suggest that the C-S-H gel structure includes both glass-like short-range order and crystalline features of the mineral tobermorite. Additionally, we probe the mechanical stiffness, strength, and hydrolytic shear response of our molecular model, as compared to experimentally measured properties of C-S-H. The latter results illustrate the prospect of treating cement on equal footing with metals and ceramics in the current application of mechanism-based models and multiscale simulations to study inelastic deformation and cracking. PMID:19805265

  12. A realistic molecular model of cement hydrates.

    PubMed

    Pellenq, Roland J-M; Kushima, Akihiro; Shahsavari, Rouzbeh; Van Vliet, Krystyn J; Buehler, Markus J; Yip, Sidney; Ulm, Franz-Josef

    2009-09-22

    Despite decades of studies of calcium-silicate-hydrate (C-S-H), the structurally complex binder phase of concrete, the interplay between chemical composition and density remains essentially unexplored. Together these characteristics of C-S-H define and modulate the physical and mechanical properties of this "liquid stone" gel phase. With the recent determination of the calcium/silicon (C/S = 1.7) ratio and the density of the C-S-H particle (2.6 g/cm(3)) by neutron scattering measurements, there is new urgency to the challenge of explaining these essential properties. Here we propose a molecular model of C-S-H based on a bottom-up atomistic simulation approach that considers only the chemical specificity of the system as the overriding constraint. By allowing for short silica chains distributed as monomers, dimers, and pentamers, this C-S-H archetype of a molecular description of interacting CaO, SiO2, and H2O units provides not only realistic values of the C/S ratio and the density computed by grand canonical Monte Carlo simulation of water adsorption at 300 K. The model, with a chemical composition of (CaO)(1.65)(SiO2)(H2O)(1.75), also predicts other essential structural features and fundamental physical properties amenable to experimental validation, which suggest that the C-S-H gel structure includes both glass-like short-range order and crystalline features of the mineral tobermorite. Additionally, we probe the mechanical stiffness, strength, and hydrolytic shear response of our molecular model, as compared to experimentally measured properties of C-S-H. The latter results illustrate the prospect of treating cement on equal footing with metals and ceramics in the current application of mechanism-based models and multiscale simulations to study inelastic deformation and cracking.

  13. Realistic Detectability of Close Interstellar Comets

    NASA Astrophysics Data System (ADS)

    Cook, Nathaniel V.; Ragozzine, Darin; Granvik, Mikael; Stephens, Denise C.

    2016-07-01

    During the planet formation process, billions of comets are created and ejected into interstellar space. The detection and characterization of such interstellar comets (ICs) (also known as extra-solar planetesimals or extra-solar comets) would give us in situ information about the efficiency and properties of planet formation throughout the galaxy. However, no ICs have ever been detected, despite the fact that their hyperbolic orbits would make them readily identifiable as unrelated to the solar system. Moro-Martín et al. have made a detailed and reasonable estimate of the properties of the IC population. We extend their estimates of detectability with a numerical model that allows us to consider “close” ICs, e.g., those that come within the orbit of Jupiter. We include several constraints on a “detectable” object that allow for realistic estimates of the frequency of detections expected from the Large Synoptic Survey Telescope (LSST) and other surveys. The influence of several of the assumed model parameters on the frequency of detections is explored in detail. Based on the expectation from Moro-Martín et al., we expect that LSST will detect 0.001-10 ICs during its nominal 10 year lifetime, with most of the uncertainty from the unknown number density of small (nuclei of ˜0.1-1 km) ICs. Both asteroid and comet cases are considered, where the latter includes various empirical prescriptions of brightening. Using simulated LSST-like astrometric data, we study the problem of orbit determination for these bodies, finding that LSST could identify their orbits as hyperbolic and determine an ephemeris sufficiently accurate for follow-up in about 4-7 days. We give the hyperbolic orbital parameters of the most detectable ICs. Taking the results into consideration, we give recommendations to future searches for ICs.

  14. Are Bogs Reservoirs for Emerging Disease Vectors? Evaluation of Culicoides Populations in the Hautes Fagnes Nature Reserve (Belgium)

    PubMed Central

    Zimmer, Jean-Yves; Smeets, François; Simonon, Grégory; Fagot, Jean; Haubruge, Eric; Francis, Frédéric; Losson, Bertrand

    2013-01-01

    Several species of Culicoides (Diptera: Ceratopogonidae) biting midges serve as biological vectors for the bluetongue virus (BTV) and the recently described Schmallenberg virus (SBV) in northern Europe. Since their recent emergence in this part of the continent, these diseases have caused considerable economic losses to the sheep and cattle industries. Much data is now available that describe the distribution, population dynamics, and feeding habits of these insects. However, little is known regarding the presence of Culicoides in unusual habitats such as peaty marshes, nor their potential vector capacity. This study evaluated Culicoides biting midges present in the bogs of a Belgian nature reserve compared to those residing at a nearby cattle farm. Culicoides were trapped in 2011 at four different sites (broadleaved and coniferous forested areas, open environments, and at a scientific station) located in the Hautes Fagnes Nature Reserve (Belgium). An additional light trap was operated on a nearby cattle farm. Very high numbers of biting midges were captured in the marshy area and most of them (70 to 95%) were Culicoides impunctatus, a potential vector of BTV and other pathogens. In addition, fewer numbers of C. obsoletus/C. scoticus species, C. chiopterus, and C. dewulfi were observed in the bogs compared to the farm. The wet environment and oligotrophic nature of the soil were probably responsible for these changes in the respective populations. A total of 297,808 Culicoides midges belonging to 27 species were identified during this study and 3 of these species (C. sphagnumensis, C. clintoni and C. comosioculatus) were described in Belgium for the first time. PMID:23799137

  15. Are bogs reservoirs for emerging disease vectors? Evaluation of culicoides populations in the Hautes Fagnes Nature Reserve (Belgium).

    PubMed

    Zimmer, Jean-Yves; Smeets, François; Simonon, Grégory; Fagot, Jean; Haubruge, Eric; Francis, Frédéric; Losson, Bertrand

    2013-01-01

    Several species of Culicoides (Diptera: Ceratopogonidae) biting midges serve as biological vectors for the bluetongue virus (BTV) and the recently described Schmallenberg virus (SBV) in northern Europe. Since their recent emergence in this part of the continent, these diseases have caused considerable economic losses to the sheep and cattle industries. Much data is now available that describe the distribution, population dynamics, and feeding habits of these insects. However, little is known regarding the presence of Culicoides in unusual habitats such as peaty marshes, nor their potential vector capacity. This study evaluated Culicoides biting midges present in the bogs of a Belgian nature reserve compared to those residing at a nearby cattle farm. Culicoides were trapped in 2011 at four different sites (broadleaved and coniferous forested areas, open environments, and at a scientific station) located in the Hautes Fagnes Nature Reserve (Belgium). An additional light trap was operated on a nearby cattle farm. Very high numbers of biting midges were captured in the marshy area and most of them (70 to 95%) were Culicoides impunctatus, a potential vector of BTV and other pathogens. In addition, fewer numbers of C. obsoletus/C. scoticus species, C. chiopterus, and C. dewulfi were observed in the bogs compared to the farm. The wet environment and oligotrophic nature of the soil were probably responsible for these changes in the respective populations. A total of 297,808 Culicoides midges belonging to 27 species were identified during this study and 3 of these species (C. sphagnumensis, C. clintoni and C. comosioculatus) were described in Belgium for the first time.

  16. Evaluation of the bedside Quikread go® CRP test in the management of febrile infants at the emergency department.

    PubMed

    Hernández-Bou, S; Trenchs, V; Vanegas, M I; Valls, A F; Luaces, C

    2017-02-03

    Recently C-reactive protein (CRP) point-of-care tests have been developed. We aimed to validate a bedside CRP test (QuikRead go® CRP), to compare it with the laboratory CRP (ARCHITECT c8000 Abbott, Germany) test in children with fever without source (FWS), and to evaluate the optimal CRP cut-off value to identify those patients at a high risk for serious bacterial infection (SBI). The CRP bedside test was prospectively performed in capillary blood samples concurrently with the laboratory CRP testing for 283 well-appearing infants aged 1 to 24 months with FWS attending the emergency department (ED) between May 2013 and August 2015. The mean difference between the laboratory CRP and the QuikRead go CRP values was 0.71 mg/L (p = 0.444). Pearson's correlation coefficient between the CRPs was r = 0.929 (p < 0.001). SBI was diagnosed in 34 patients (12.0%). The area under the receiver operating characteristics (ROC) curve obtained was 0.87 (95%CI: 0.82-0.90) for an optimal CRP cut-off value of > 10 mg/L (sensitivity: 94.1%, specificity: 49.0%, positive predictive value: 20.1%, negative predictive value: 98.4%), as a predictor of SBI. Nearly 45% of the patients were at a low risk for SBI according to CRP value; thus, additional laboratory tests would have been hypothetically avoided. There was a very strong, positive correlation between the QuikRead go CRP test and laboratory CRP determination. The QuikRead go CRP test provides reliable results to rule out SBI. Its implementation at the ED would improve the management of infants with FWS.

  17. Eye Emergencies

    MedlinePlus

    ... Fight for victory. Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...

  18. Childhood Emergencies

    MedlinePlus

    ... SUBSCRIBE Emergency 101 Share this! Home » Emergency 101 Childhood Emergencies Keeping children healthy and safe is every ... and tools to prevent, recognize and address a childhood emergency is the first step in keeping your ...

  19. Can routinely recorded reproductive events be used as indicators of disease emergence in dairy cattle? An evaluation of 5 indicators during the emergence of bluetongue virus in France in 2007 and 2008.

    PubMed

    Marceau, Alexis; Madouasse, Aurélien; Lehébel, Anne; van Schaik, Gerdien; Veldhuis, Anouk; Van der Stede, Yves; Fourichon, Christine

    2014-10-01

    In response to increasing risks of emerging infectious diseases, syndromic surveillance can be a suitable approach to detect outbreaks of such diseases across a large territory in an early phase. To implement a syndromic surveillance system, the primary challenge is to find appropriate health-related data. The objective of this study was to evaluate whether routinely collected dates of reproductive events in dairy cattle could be used to build indicators of health anomalies for syndromic surveillance. The evaluation was performed on data collected in France between 2003 and 2009. First, a set of 5 indicators was proposed to assess several types of reproductive disorders. For each indicator, the demographic coverage over the total number of cattle at risk was analyzed in time and space. Second, the ability to detect an emerging disease in an early phase was retrospectively evaluated during epidemics of bluetongue serotypes 1 and 8 (BTV-1, BTV-8) in France in 2007 and 2008. Reproductive indicators were analyzed weekly during these epidemics for each indicator in each infected French district (16 in 2007 and 50 in 2008 out of 94 districts). The indicators were able to detect the BTV epidemics despite their low demographic coverage on a weekly basis relatively to total number of cattle (median=1.21%; range=0-11.7%). Four indicators related to abortions, late embryonic death, and short gestations were abnormally elevated during both BTV epidemics. Median times to abnormal elevations in these indicators were 20 to 71 d after the first notification of clinical signs of BTV by veterinarians. These results demonstrate that reproduction data can be used as indicators of disease emergences, whereas in the specific case of these BTV epidemics, detection via these indicators was later than clinical detection by veterinarians. The emergence of bluetongue in 2007 in France was associated with gestations that were a few days shorter than expected. A short gestation indicator

  20. Realistic Bomber Training Initiative. Environmental Impact Statement. Volume 1

    DTIC Science & Technology

    2000-01-01

    language for the decisionmaker (in this case the Air Force) and the public the environmental process we used for RBTI. The product that we use to...TABLE OF CONTENTS Realistic Bomber Training Initiative Final EIS TABLE OF CONTENTS Chapter Page EXECUTIVE SUMMARY...Requirements . . . . . . . . . . . . . . . . . . . . . 1-4 1.2.3 Successful Combat Missions Require Realistic, Integrated Training

  1. Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

    PubMed Central

    Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

    2016-01-01

    Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community

  2. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

    PubMed Central

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

    2015-01-01

    Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured

  3. Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients

    PubMed Central

    2013-01-01

    Background Screening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described. Methods/design A randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs—their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation—are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age ≥18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview. Discussion A comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome

  4. Evaluation of a stand-alone computer-aided detection system for acute intra-cranial hemorrhage in emergency environments

    NASA Astrophysics Data System (ADS)

    Fernandez, James; Deshpande, Ruchi; Wang, Ximing; Liu, Brent; Brazaitis, Michael; Munter, Fletcher; Liu, Margaret

    2011-03-01

    Acute intra-cranial hemorrhage (AIH) may result from traumatic brain injury (TBI). Successful management of AIH depends heavily on the speed and accuracy of diagnosis. Timely diagnosis in emergency environments in both civilian and military settings is difficult primarily due to severe time restraints and lack of resources. Often, diagnosis is performed by emergency physicians rather than trained radiologists. As a result, added support in the form of computer-aided detection (CAD) would greatly enhance the decision-making process and help in providing faster and more accurate diagnosis of AIH. This paper discusses the implementation of a CAD system in an emergency environment, and its efficacy in aiding in the detection of AIH.

  5. Towards realistic representation of hydrological processes in integrated WRF-urban modeling system

    NASA Astrophysics Data System (ADS)

    Yang, Jiachuan; Wang, Zhi-hua; Chen, Fei; Miao, Shiguang; Tewari, Mukul; Georgescu, Matei

    2014-05-01

    To meet the demand of the ever-increasing urbanized global population, substantial conversion of natural landscapes to urban terrains is expected in the next few decades. The landscape modification will emerge as the source of many adverse effects that challenge the environmental sustainability of cities under changing climatic patterns. To address these adverse effects and to develop corresponding adaptation/mitigation strategies, physically-based single layer urban canopy model (SLUCM) has been developed and implemented into the Weather Research and Forecasting (WRF) platform. However, due to the lack of realistic representation of urban hydrological processes, simulation of urban climatology by current coupled WRF/SLUCM is inevitably inadequate. Aiming at improving the accuracy of simulations, in this study we implement physically-based parameterization of urban hydrological processes into the model, including (1) anthropogenic latent heat, (2) urban irrigation, (3) evaporation over water-holding engineered pavements, (4) urban oasis effect, and (5) green roof. In addition, we use an advanced Monte Carlo approach to quantify the sensitivity of urban hydrological modeling to parameter uncertainties. Evaluated against field observations at four major metropolitan areas, results show that the enhanced model is significantly improved in accurately predicting turbulent fluxes arising from built surfaces, especially the latent heat flux. Case studies show that green roof is capable of reducing urban surface temperature and sensible heat flux effectively, and modifying local and regional hydroclimate. Meanwhile, it is efficient in decreasing energy loading of buildings, not only cooling demand in summers but also heating demand in winters, through the combined evaporative cooling and insulation effect. Effectiveness of green roof is found to be limited by availability of water resources and highly sensitive to surface roughness heights. The enhanced WRF/SLUCM model

  6. Graphic products used in the evaluation of traditional and emerging remote sensing technologies for the detection of fugitive contamination at selected superfund hazardous waste sites

    USGS Publications Warehouse

    Slonecker, E. Terrence; Fisher, Gary B.

    2011-01-01

    This report presents the overhead imagery and field sampling results used to prepare U.S. Geological Survey Open-File Report 2011-1050, 'Evaluation of Traditional and Emerging Remote Sensing Technologies for the Detection of Fugitive Contamination at Selected Superfund Hazardous Waste Sites'. These graphic products were used in the evaluation of remote sensing technology in postclosure monitoring of hazardous waste sites and represent an ongoing research effort. Soil sampling results presented here were accomplished with field portable x-ray fluoresence (XRF) technology and are used as screening tools only representing the current conditions of metals and other contaminants at selected Superfund hazardous waste sites.

  7. Emergency contraception

    MedlinePlus

    Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception ... Emergency contraception most likely prevents pregnancy in the same way as regular birth control pills: By preventing or delaying ...

  8. Emergency Contraception

    MedlinePlus

    ... contraception are available: emergency contraceptive pills and the copper-containing intrauterine device (IUD).Emergency contraceptive pills include ... for emergency use, talk to your doctor.The copper-containing IUD (brand name: Paragard) is a small, ...

  9. Pediatric Emergency Department Suicidal Patients: Two-Site Evaluation of Suicide Ideators, Single Attempters, and Repeat Attempters

    ERIC Educational Resources Information Center

    Asarnow, Joan Rosenbaum; Baraff, Larry J.; Berk, Michele; Grob, Charles; Devich-Navarro, Mona; Suddath, Robert; Piacentini, John; Tang, Lingqi

    2008-01-01

    The study examines ideators, single attempters, and repeats attempters of suicide to clarify optimal strategies for emergency department management and risk assessment to help them in reducing youth suicide and suicide attempts. Depression was found to be a strong predictor of suicide/suicide attempts along with substance use, externalizing…

  10. A novel two-stage evaluation system based on a Group-G1 approach to identify appropriate emergency treatment technology schemes in sudden water source pollution accidents.

    PubMed

    Qu, Jianhua; Meng, Xianlin; Hu, Qi; You, Hong

    2016-02-01

    Sudden water source pollution resulting from hazardous materials has gradually become a major threat to the safety of the urban water supply. Over the past years, various treatment techniques have been proposed for the removal of the pollutants to minimize the threat of such pollutions. Given the diversity of techniques available, the current challenge is how to scientifically select the most desirable alternative for different threat degrees. Therefore, a novel two-stage evaluation system was developed based on a circulation-correction improved Group-G1 method to determine the optimal emergency treatment technology scheme, considering the areas of contaminant elimination in both drinking water sources and water treatment plants. In stage 1, the threat degree caused by the pollution was predicted using a threat evaluation index system and was subdivided into four levels. Then, a technique evaluation index system containing four sets of criteria weights was constructed in stage 2 to obtain the optimum treatment schemes corresponding to the different threat levels. The applicability of the established evaluation system was tested by a practical cadmium-contaminated accident that occurred in 2012. The results show this system capable of facilitating scientific analysis in the evaluation and selection of emergency treatment technologies for drinking water source security.

  11. Construction of realistic images using R-functions

    SciTech Connect

    Shevchenko, A.N.; Tsukanov, I.G.

    1995-09-01

    Realistic images are plane images of three-dimensional bodies in which volume effects are conveyed by illumination. This is how volume is displayed in photographs and paintings. Photographs achieve a realistic volume effect by choosing a certain arrangement, brightness, and number of light sources. Painters choose for their paintings a color palette based entirely on sensory perception. In this paper, we consider the construction of realistic images on a computer display. The shape of the imaged objects is not always known in advance: it may be generated as a result of complex mathematical computations. The geometrical information is described using R-functions.

  12. Unsteady transonic algorithm improvements for realistic aircraft applications

    NASA Technical Reports Server (NTRS)

    Batina, John T.

    1987-01-01

    Improvements to a time-accurate approximate factorization (AF) algorithm were implemented for steady and unsteady transonic analysis of realistic aircraft configurations. These algorithm improvements were made to the CAP-TSD (Computational Aeroelasticity Program - Transonic Small Disturbance) code developed at the Langley Research Center. The code permits the aeroelastic analysis of complete aircraft in the flutter critical transonic speed range. The AF algorithm of the CAP-TSD code solves the unsteady transonic small-disturbance equation. The algorithm improvements include: an Engquist-Osher (E-O) type-dependent switch to more accurately and efficiently treat regions of supersonic flow; extension of the E-O switch for second-order spatial accuracy in these regions; nonreflecting far field boundary conditions for more accurate unsteady applications; and several modifications which accelerate convergence to steady-state. Calculations are presented for several configurations including the General Dynamics one-ninth scale F-16C aircraft model to evaluate the algorithm modifications. The modifications have significantly improved the stability of the AF algorithm and hence the reliability of the CAP-TSD code in general.

  13. Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' - an emergent approach.

    PubMed

    Soper, Bryony; Buxton, Martin; Hanney, Stephen; Oortwijn, Wija; Scoggins, Amanda; Steel, Nick; Ling, Tom

    2008-10-30

    In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues.

  14. Three-Body Monopole Corrections to Realistic Interactions

    NASA Astrophysics Data System (ADS)

    Zuker, A. P.

    2003-01-01

    It is shown that a very simple three-body monopole term can solve practically all the spectroscopic problems—in the p, sd, and pf shells—that were hitherto assumed to need drastic revisions of the realistic potentials.

  15. Toward a realistic low-field SSC lattice

    SciTech Connect

    Heifets, S.

    1985-10-01

    Three six-fold lattices for 3 T superferric SSC have been generated at TAC. The program based on the first order canonical transformation was used to compare lattices. On this basis the realistic race-track lattices were generated.

  16. [Realistic surgical training. The Aachen model].

    PubMed

    Krones, C J; Binnebösel, M; Stumpf, M; Schumpelick, V

    2010-01-01

    The Aachen model is a practical mode in teaching and advanced training, which is closely geared to the areas of academic acquisition and training. During medical education optional student courses with constitutive curricula offer practical points of contact to the surgical department at all times. Besides improvement of manual training the aims are enhancing interests and acquisition of talents. This guided structure will be intensified with progression into advanced education. Next to the formal guidelines of the curriculum, education logbook and progression conversations, quality, transparency and reliability are particularly emphasized. An evaluation of both the reforms and the surgical trainers is still to be made. In addition procurement of an affirmative occupational image is essential.

  17. Evaluation of the seasonal performance of a water reclamation pond-constructed wetland system for removing emerging contaminants.

    PubMed

    Matamoros, Víctor; Salvadó, Victòria

    2012-01-01

    The capacity of a full-scale reclamation pond-constructed wetland (CW) system to eliminate 27 emerging contaminants (i.e. pharmaceuticals, sunscreen compounds, fragrances, antiseptics, fire retardants, pesticides, and plasticizers) and the seasonal occurrence of these contaminants is studied. The compounds with the highest concentrations in the secondary effluent are diclofenac, caffeine, ketoprofen, and carbamazepine. The results show that the constructed wetland (61%) removes emerging contaminants significantly more efficiently than the pond (51%), presumably due to the presence of plants (Phragmites and Thypa) as well as the higher hydraulic residence time (HRT) in the CW. A greater seasonal trend to the efficient removal of these compounds is observed in the pond than in the CW. The overall mass removal efficiency of each individual compound ranged from 27% to 93% (71% on average), which is comparable to reported data in advanced treatments (photo-fenton and membrane filtration). The seasonal average content of emerging contaminants in the river water (2488 ng L(-1)) next to the water reclamation plant is found to be higher than the content in the final reclaimed water (1490 ng L(-1)), suggesting that the chemical quality of the reclaimed water is better than available surface waters.

  18. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality.

    PubMed

    Lalezarzadeh, Fariborz; Wisniewski, Paul; Huynh, Katie; Loza, Maria; Gnanadev, Dev

    2009-10-01

    Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

  19. Highly Realistic, Immersive Training for Navy Corpsmen: Preliminary Results

    DTIC Science & Technology

    2014-12-01

    training includes sights, sounds, smells , and distractions to simulate realistic and challenging combat situations. The primary objective of this study was...carefully designed to depict real-life, operational situations. Each scenario used in the training includes sights, sounds, smells , and distractions to...create realistic sights, sounds, and smells . The training is designed to test the students’ Tactical Combat Casualty Care (TCCC) as well as their basic

  20. Cartoons vs. realistic illustration: picture preferences of adolescent patients.

    PubMed

    Dirr, K L; Katz, A A

    1989-01-01

    Illustrations are an important element in patient education materials because they engage the interest of the audience. However, little research has been conducted to determine the style of illustration that most effectively engages a patient population. This study tested the picture preferences of 39 adolescents with phenylketonuria (PKU). A survey instrument asked them to choose between cartoons and realistic illustrations. A significant number preferred realistic illustrations to cartoons.

  1. A chimeric virus-mouse model system for evaluating the function and inhibition of papain-like proteases of emerging coronaviruses.

    PubMed

    Deng, Xufang; Agnihothram, Sudhakar; Mielech, Anna M; Nichols, Daniel B; Wilson, Michael W; StJohn, Sarah E; Larsen, Scott D; Mesecar, Andrew D; Lenschow, Deborah J; Baric, Ralph S; Baker, Susan C

    2014-10-01

    To combat emerging coronaviruses, developing safe and efficient platforms to evaluate viral protease activities and the efficacy of protease inhibitors is a high priority. Here, we exploit a biosafety level 2 (BSL-2) chimeric Sindbis virus system to evaluate protease activities and the efficacy of inhibitors directed against the papain-like protease (PLpro) of severe acute respiratory syndrome coronavirus (SARS-CoV), a biosafety level 3 (BSL-3) pathogen. We engineered Sindbis virus to coexpress PLpro and a substrate, murine interferon-stimulated gene 15 (ISG15), and found that PLpro mediates removal of ISG15 (deISGylation) from cellular proteins. Mutation of the catalytic cysteine residue of PLpro or addition of a PLpro inhibitor blocked deISGylation in virus-infected cells. Thus, deISGylation is a marker of PLpro activity. Infection of alpha/beta interferon receptor knockout (IFNAR(-/-)) mice with these chimeric viruses revealed that PLpro deISGylation activity removed ISG15-mediated protection during viral infection. Importantly, administration of a PLpro inhibitor protected these mice from lethal infection, demonstrating the efficacy of a coronavirus protease inhibitor in a mouse model. However, this PLpro inhibitor was not sufficient to protect the mice from lethal infection with SARS-CoV MA15, suggesting that further optimization of the delivery and stability of PLpro inhibitors is needed. We extended the chimeric-virus platform to evaluate the papain-like protease/deISGylating activity of Middle East respiratory syndrome coronavirus (MERS-CoV) to provide a small-animal model to evaluate PLpro inhibitors of this recently emerged pathogen. This platform has the potential to be universally adaptable to other viral and cellular enzymes that have deISGylating activities. Importance: Evaluating viral protease inhibitors in a small-animal model is a critical step in the path toward antiviral drug development. We modified a biosafety level 2 chimeric virus system to

  2. A Chimeric Virus-Mouse Model System for Evaluating the Function and Inhibition of Papain-Like Proteases of Emerging Coronaviruses

    PubMed Central

    Deng, Xufang; Agnihothram, Sudhakar; Mielech, Anna M.; Nichols, Daniel B.; Wilson, Michael W.; StJohn, Sarah E.; Larsen, Scott D.; Mesecar, Andrew D.; Lenschow, Deborah J.; Baric, Ralph S.

    2014-01-01

    ABSTRACT To combat emerging coronaviruses, developing safe and efficient platforms to evaluate viral protease activities and the efficacy of protease inhibitors is a high priority. Here, we exploit a biosafety level 2 (BSL-2) chimeric Sindbis virus system to evaluate protease activities and the efficacy of inhibitors directed against the papain-like protease (PLpro) of severe acute respiratory syndrome coronavirus (SARS-CoV), a biosafety level 3 (BSL-3) pathogen. We engineered Sindbis virus to coexpress PLpro and a substrate, murine interferon-stimulated gene 15 (ISG15), and found that PLpro mediates removal of ISG15 (deISGylation) from cellular proteins. Mutation of the catalytic cysteine residue of PLpro or addition of a PLpro inhibitor blocked deISGylation in virus-infected cells. Thus, deISGylation is a marker of PLpro activity. Infection of alpha/beta interferon receptor knockout (IFNAR−/−) mice with these chimeric viruses revealed that PLpro deISGylation activity removed ISG15-mediated protection during viral infection. Importantly, administration of a PLpro inhibitor protected these mice from lethal infection, demonstrating the efficacy of a coronavirus protease inhibitor in a mouse model. However, this PLpro inhibitor was not sufficient to protect the mice from lethal infection with SARS-CoV MA15, suggesting that further optimization of the delivery and stability of PLpro inhibitors is needed. We extended the chimeric-virus platform to evaluate the papain-like protease/deISGylating activity of Middle East respiratory syndrome coronavirus (MERS-CoV) to provide a small-animal model to evaluate PLpro inhibitors of this recently emerged pathogen. This platform has the potential to be universally adaptable to other viral and cellular enzymes that have deISGylating activities. IMPORTANCE Evaluating viral protease inhibitors in a small-animal model is a critical step in the path toward antiviral drug development. We modified a biosafety level 2 chimeric virus

  3. Toward realistic gauge-Higgs grand unification

    NASA Astrophysics Data System (ADS)

    Furui, Atsushi; Hosotani, Yutaka; Yamatsu, Naoki

    2016-09-01

    The SO(11) gauge-Higgs grand unification in the Randall-Sundrum warped space is presented. The 4D Higgs field is identified as the zero mode of the fifth-dimensional component of the gauge potentials, or as the fluctuation mode of the Aharonov-Bohm phase θ along the fifth dimension. Fermions are introduced in the bulk in the spinor and vector representations of SO(11). SO(11) is broken to SO(4)×SO(6) by the orbifold boundary conditions, which is broken to SU2×U1×SU3 by a brane scalar. Evaluating the effective potential V(θ), we show that the electroweak symmetry is dynamically broken to U1. The quark-lepton masses are generated by the Hosotani mechanism and brane interactions, with which the observed mass spectrum is reproduced. Proton decay is forbidden thanks to the new fermion number conservation. It is pointed out that there appear light exotic fermions. The Higgs boson mass is determined with the quark-lepton masses given; however, it turns out to be smaller than the observed value.

  4. An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

    PubMed Central

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; Baitello, André Luciano; Lopes, Renato Delascio

    2014-01-01

    OBJECTIVE: To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. METHODS: Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. RESULTS: Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams* (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. CONCLUSIONS: The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry

  5. A Clinically Realistic Large Animal Model of Intra-Articular Fracture

    DTIC Science & Technology

    2013-10-01

    BW, Rudert MJ, Tochigi Y, Baer TE, Fredericks DC, Brown TD. An instrumented pendulum system for measuring energy absorption during fracture insult...fracture insult technique/ system developed for introducing pathophysiologically realistic IAFs in the porcine hock in vivo (Aim 1), to establish post...sensing walkway system (Tekscan Inc., North Boston, MA) was utilized for evaluation of the side-to-side asymmetry of hind-leg usage during walking. Each

  6. Characterization and Monitoring Data for Evaluating Constructed Emergent Sandbar Habitat in the Missouri River Mainstem 2004-2009

    SciTech Connect

    Duberstein, Corey A.

    2011-04-01

    The U.S. Army Corps of Engineers (Corps) provides the primary operational management of the Missouri River Main Stem Reservoir System. Management of the Missouri River has generally reduced peak river flows that form and maintain emergent sandbar habitat. Emergent sandbars provide non-vegetated nesting habitat for the endangered interior least tern (Sternula antillarum athalassos) and the threatened Northern Great Plains piping plover (Charadrius melodus). Since 2000, piping plover nesting habitat within the Gavins Point Reach, Garrison Reach, Lake Oahe, and Lake Sakakawea has fledged the majority of piping plovers produced along the Missouri River system. Habitats within Lewis and Clark Lake have also recently become important plover production areas. Mechanical construction of emergent sandbar habitat (ESH) within some of these reaches within the Missouri River began in 2004. Through 2009, 11 sandbar complexes had been constructed (10 in Gavins Point Reach, 1 in Lewis and Clarke Lake) totaling about 543 ac of piping plover and interior least tern nesting habitat. ESH Construction has resulted in a net gain of tern and plover nesting habitat. Both terns and plovers successfully nest and fledge young on constructed sandbars, and constructed habitats were preferred over natural habitats. Natural processes may limit the viability of constructed sandbars as nesting habitat. Continued research is needed to identify if changes in constructed sandbar engineering and management increase the length of time constructed habitats effectively function as nesting habitat. However, the transfer of information from researchers to planners through technical research reports may not be timely enough to effectively foster the feedback mechanisms of an adaptive management strategy.

  7. Searching for the mechanisms of change: a protocol for a realist review of batterer treatment programmes

    PubMed Central

    Cheff, Rebecca; Finn, Debbie; Davloor, Whitney; O'Campo, Patricia

    2016-01-01

    Introduction Conflicting results reported by evaluations of typical batterer intervention programmes leave many judicial officials and policymakers uncertain about the best way to respond to domestic violence, and whether to recommend and fund these programmes. Traditional evaluations and systematic reviews tend to focus predominantly on whether the programmes ‘worked’ (eg, reduced recidivism) often at the exclusion of understanding for whom they may or may not have worked, under what circumstances, and why. Methods and analysis We are undertaking a realist review of the batterer treatment programme literature with the aim of addressing this gap. Keeping with the goals of realist review, our primary aims are to identify the theory that underlies these programmes, highlight the mechanisms that trigger changes in participant behaviour and finally explain why these programmes help some individuals reduce their use of violence and under what conditions they are effective or not effective. We begin by describing the process of perpetrator treatment, and by proposing an initial theoretical model of behaviour change that will be tested by our review. We then describe the criteria for inclusion of an evaluation into the review, the search strategy we will use to identify the studies, and the plan for data extraction and analysis. Ethics and dissemination The results of this review will be written up using the RAMESES Guidelines for Realist Synthesis, and disseminated through peer-reviewed publications aimed at the practitioner community as well as presented at community forums, and at violence against women conferences. Ethics approval was not needed. PMID:27053268

  8. Evaluation of self-perception of mechanical ventilation knowledge among Brazilian final-year medical students, residents and emergency physicians

    PubMed Central

    Tallo, Fernando Sabia; de Campos Vieira Abib, Simone; de Andrade Negri, Alexandre Jorgi; Filho, Paulo Cesar; Lopes, Renato Delascio; Lopes, Antônio Carlos

    2017-01-01

    OBJECTIVE: To present self-assessments of knowledge about mechanical ventilation made by final-year medical students, residents, and physicians taking qualifying courses at the Brazilian Society of Internal Medicine who work in urgent and emergency settings. METHODS: A 34-item questionnaire comprising different areas of knowledge and training in mechanical ventilation was given to 806 medical students, residents, and participants in qualifying courses at 11 medical schools in Brazil. The questionnaire’s self-assessment items for knowledge were transformed into scores. RESULTS: The average score among all participants was 21% (0-100%). Of the total, 85% respondents felt they did not receive sufficient information about mechanical ventilation during medical training. Additionally, 77% of the group reported that they would not know when to start noninvasive ventilation in a patient, and 81%, 81%, and 89% would not know how to start volume control, pressure control and pressure support ventilation modes, respectively. Furthermore, 86.4% and 94% of the participants believed they would not identify the basic principles of mechanical ventilation in patients with obstructive pulmonary disease and acute respiratory distress syndrome, respectively, and would feel insecure beginning ventilation. Finally, 77% said they would fear for the safety of a patient requiring invasive mechanical ventilation under their care. CONCLUSION: Self-assessment of knowledge and self-perception of safety for managing mechanical ventilation were deficient among residents, students and emergency physicians from a sample in Brazil. PMID:28273238

  9. Evaluation of low‐cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence‐based study

    PubMed Central

    Brem, M H; Böhner, C; Brenning, A; Gelse, K; Radkow, T; Blanke, M; Schlechtweg, P M; Neumann, G; Wu, I Y; Bautz, W; Hennig, F F; Richter, H

    2006-01-01

    Background To compare the diagnostic value of low‐cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room. Methods Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed–digital radiographs of the cervical spine (anterior–posterior, oblique and trans‐oral‐dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3‐point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed‐effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group‐specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model. Results Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78). Conclusion Low‐cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room. PMID:17057136

  10. Boundary conditions towards realistic simulation of jet engine noise

    NASA Astrophysics Data System (ADS)

    Dhamankar, Nitin S.

    Strict noise regulations at major airports and increasing environmental concerns have made prediction and attenuation of jet noise an active research topic. Large eddy simulation coupled with computational aeroacoustics has the potential to be a significant research tool for this problem. With the emergence of petascale computer clusters, it is now computationally feasible to include the nozzle geometry in jet noise simulations. In high Reynolds number experiments on jet noise, the turbulent boundary layer on the inner surface of the nozzle separates into a turbulent free shear layer. Inclusion of a nozzle with turbulent inlet conditions is necessary to simulate this phenomenon realistically. This will allow a reasonable comparison of numerically computed noise levels with the experimental results. Two viscous wall boundary conditions are implemented for modeling the nozzle walls. A characteristic-based approach is compared with a computationally cheaper, extrapolation-based formulation. In viscous flow over a circular cylinder under two different regimes, excellent agreement is observed between the results of the two approaches. The results agree reasonably well with reference experimental and numerical results. Both the boundary conditions are thus found to be appropriate, the extrapolation-based formulation having an edge with its low cost. This is followed with the crucial step of generation of a turbulent boundary layer inside the nozzle. A digital filter-based turbulent inflow condition, extended in a new way to non-uniform curvilinear grids is implemented to achieve this. A zero pressure gradient flat plate turbulent boundary layer is simulated at a high Reynolds number to show that the method is capable of producing sustained turbulence. The length of the adjustment region necessary for synthetic inlet turbulence to recover from modeling errors is estimated. A low Reynolds number jet simulation including a round nozzle geometry is performed and the method

  11. Radiology in emergency medicine

    SciTech Connect

    Levy, R.; Barsan, W.G.

    1986-01-01

    This book gives a discussion of radiologic modalities currently being used in emergency situations. Radiographs, echocardiographs, radionuclide scans and CT scans are systematically analyzed and evaluated to provide a step-by-step diagnostic process for emergency physicians to follow when a radiologist is not present.

  12. Middletown 2010 -- A Realistic Interactive Emergency Simulation and Response System for the US Army

    DTIC Science & Technology

    2006-12-01

    leading Norwegian research institutes (NR and Sintef ) to find a solution to this problem. In the IMST project, approximately $3.0M was invested towards...institutes NR and Sintef to find a solution for this problem. In the IMST project, close to USD 3.0 million has already been invested in designing and...this field ( SINTEF ) that will continue in 2007 and probably will introduce solutions to these problems. 3D visual content and simulation production

  13. Foreword: In situ gas surface interactions: approaching realistic conditions

    NASA Astrophysics Data System (ADS)

    Lundgren, Edvin; Over, Herbert

    2008-03-01

    This special issue is devoted to the application of in situ surface-sensitive techniques in the elucidation of catalysed reactions at (model) catalyst surfaces. Both reaction intermediates and the nature of the catalytically active phase are the targets of these investigations. In situ surface science techniques are also used to study the interaction of water with surfaces under realistic conditions. Since 80% of all technical chemicals are manufactured by utilizing (heterogeneous) catalysis, scientific understanding and technological development of catalysis are of central practical importance in modern society [1]. Heterogeneously catalysed reactions take place at the gas/solid interface. Therefore one of the major topics in surface chemistry and physics is closely related to heterogeneous catalysis, with the aim of developing novel catalysts and to improve catalysts' performances on the basis of atomic scale based knowledge. Despite the economical and environmental rewards—if such a goal is achieved—and despite 40 years of intensive research, practical catalysis is still safely in a black box: the reactivity and selectivity of a catalyst are commercially still optimized on a trial and error basis, applying the high throughput screening approach. The reason for this discrepancy between ambition and reality lies in the inherent complexity of the catalytic system, consisting of the working catalyst and the interaction of the catalyst with the reactant mixture. Practical (solid) catalysts consist of metal or oxide nanoparticles which are dispersed and stabilized on a support and which may be promoted by means of additives. These particles catalyse a reaction in pressures as high as 100 bar. Practical catalysis is in general considered to be far too complex for gaining atomic-scale understanding of the mechanism of the catalysed reaction of an industrial catalyst during its operation. Therefore it has been necessary to introduce idealization and simplification of

  14. Realistic real-time outdoor rendering in augmented reality.

    PubMed

    Kolivand, Hoshang; Sunar, Mohd Shahrizal

    2014-01-01

    Realistic rendering techniques of outdoor Augmented Reality (AR) has been an attractive topic since the last two decades considering the sizeable amount of publications in computer graphics. Realistic virtual objects in outdoor rendering AR systems require sophisticated effects such as: shadows, daylight and interactions between sky colours and virtual as well as real objects. A few realistic rendering techniques have been designed to overcome this obstacle, most of which are related to non real-time rendering. However, the problem still remains, especially in outdoor rendering. This paper proposed a much newer, unique technique to achieve realistic real-time outdoor rendering, while taking into account the interaction between sky colours and objects in AR systems with respect to shadows in any specific location, date and time. This approach involves three main phases, which cover different outdoor AR rendering requirements. Firstly, sky colour was generated with respect to the position of the sun. Second step involves the shadow generation algorithm, Z-Partitioning: Gaussian and Fog Shadow Maps (Z-GaF Shadow Maps). Lastly, a technique to integrate sky colours and shadows through its effects on virtual objects in the AR system, is introduced. The experimental results reveal that the proposed technique has significantly improved the realism of real-time outdoor AR rendering, thus solving the problem of realistic AR systems.

  15. Realistic Real-Time Outdoor Rendering in Augmented Reality

    PubMed Central

    Kolivand, Hoshang; Sunar, Mohd Shahrizal

    2014-01-01

    Realistic rendering techniques of outdoor Augmented Reality (AR) has been an attractive topic since the last two decades considering the sizeable amount of publications in computer graphics. Realistic virtual objects in outdoor rendering AR systems require sophisticated effects such as: shadows, daylight and interactions between sky colours and virtual as well as real objects. A few realistic rendering techniques have been designed to overcome this obstacle, most of which are related to non real-time rendering. However, the problem still remains, especially in outdoor rendering. This paper proposed a much newer, unique technique to achieve realistic real-time outdoor rendering, while taking into account the interaction between sky colours and objects in AR systems with respect to shadows in any specific location, date and time. This approach involves three main phases, which cover different outdoor AR rendering requirements. Firstly, sky colour was generated with respect to the position of the sun. Second step involves the shadow generation algorithm, Z-Partitioning: Gaussian and Fog Shadow Maps (Z-GaF Shadow Maps). Lastly, a technique to integrate sky colours and shadows through its effects on virtual objects in the AR system, is introduced. The experimental results reveal that the proposed technique has significantly improved the realism of real-time outdoor AR rendering, thus solving the problem of realistic AR systems. PMID:25268480

  16. Higher Education Institutional and Program Evaluations in Taiwan and the Emerging Roles of Higher Education Evaluation and Accreditation Council of Taiwan (HEEACT)

    ERIC Educational Resources Information Center

    Lee, Lung-Sheng; Wei, Yen-Shun; Wang, Li-Yun

    2013-01-01

    Post-secondary education institutions in Taiwan are divided into two tracks, general higher education (HE) and technological and vocational education (TVE). The evaluation of all universities/colleges is mandated by the University Act. Higher education institutions receive mandated institutional evaluation every six years and program evaluation…

  17. An evaluation of a natural language processing tool for identifying and encoding allergy information in emergency department clinical notes.

    PubMed

    Goss, Foster R; Plasek, Joseph M; Lau, Jason J; Seger, Diane L; Chang, Frank Y; Zhou, Li

    2014-01-01

    Emergency department (ED) visits due to allergic reactions are common. Allergy information is often recorded in free-text provider notes; however, this domain has not yet been widely studied by the natural language processing (NLP) community. We developed an allergy module built on the MTERMS NLP system to identify and encode food, drug, and environmental allergies and allergic reactions. The module included updates to our lexicon using standard terminologies, and novel disambiguation algorithms. We developed an annotation schema and annotated 400 ED notes that served as a gold standard for comparison to MTERMS output. MTERMS achieved an F-measure of 87.6% for the detection of allergen names and no known allergies, 90% for identifying true reactions in each allergy statement where true allergens were also identified, and 69% for linking reactions to their allergen. These preliminary results demonstrate the feasibility using NLP to extract and encode allergy information from clinical notes.

  18. Emergency Contraception

    MedlinePlus

    ... against STDs even when using another method of birth control. If a condom breaks (or a couple has ... Emergency contraception is not recommended as a regular birth control method . Instead, it is used for emergencies only. ...

  19. Emergency Contraception

    MedlinePlus

    f AQ FREQUENTLY ASKED QUESTIONS FAQ114 CONTRACEPTION Emergency Contraception • What is emergency contraception (EC)? • How does EC work? • What are the different types of EC? • What is the most ...

  20. Past Emergencies

    EPA Pesticide Factsheets

    These activities, some of national significance requiring coordination with other agencies, demonstrate the emergency response program and provide valuable experience so that EPA can better prevent, prepare for, and respond to emergencies in the future.

  1. A probabilistic approach to realistic face synthesis with a single uncalibrated image.

    PubMed

    Shim, Hyunjung

    2012-08-01

    This paper presents a novel approach to automatic face modeling for realistic synthesis from an unknown face image, using a probabilistic face diffuse model and a generic face specular map. We construct a probabilistic face diffuse model for estimating the albedo and normals of the input face. Then, we develop a generic face specular map for estimating the specularity of face. Using the estimated albedo, normal and specular information, we can synthesize the face under arbitrary lighting and viewing directions realistically. Unlike many existing techniques, our approach can extract both the diffuse and specular information of face without involving an intensive 3D matching procedure. We conduct three different experiments to show our improvement over the prior art. First, we compare the proposed algorithm with previous techniques, including the state of the art, to demonstrate our achievement in realistic face synthesis. Moreover, we evaluate the proposed algorithm over non-automatic face modeling techniques through a subjective study. This evaluation is meaningful in that it tells us how far the proposed algorithm as well as others are from the real photograph in terms of the perceptual quality. Finally, we apply our face model for improving the face recognition performance under varying illumination conditions and show that the proposed algorithm is effective to enhance the face recognition rate. Thanks to the compact representation and the effective inference scheme, our technique is applicable for many practical applications, such as avatar creation, digital face cloning, face normalization, deidentification and many others.

  2. Wetland Biomass Production: emergent aquatic management options and evaluations. A final subcontract report. [Includes a bibliography containing 686 references on Typha from biological abstracts

    SciTech Connect

    Pratt, D.C.; Dubbe, D.R.; Garver, E.G.; Linton, P.J.

    1984-07-01

    The high yield potential and attractive chemical composition of Typha make it a particularly viable energy crop. The Minnesota research effort has demonstrated that total annual biomass yields equivalent to 30 dry tonnes/ha (13 tons/acre) are possible in planted stands. This compares with yields of total plant material between 9 and 16 dry tonnes/ha (4 to 7 tons/acre) in a typical Minnesota corn field. At least 50% of the Typha plant is comprised of a belowground rhizome system containing 40% starch and sugar. This high level of easily fermentable carbohydrate makes rhizomes an attractive feedstock for alcohol production. The aboveground portion of the plant is largely cellulose, and although it is not easily fermentable, it can be gasified or burned. This report is organized in a manner that focuses on the evaluation of the management options task. Results from stand management research performed at the University of Minnesota during 1982 and 1983 are integrated with findings from an extensive survey of relevant emergent aquatic plant research and utilization. These results and findings are then arranged in sections dealing with key steps and issues that need to be dealt with in the development of a managed emergent aquatic bio-energy system. A brief section evaluating the current status of rhizome harvesting is also included along with an indexed bibliography of the biology, ecology, and utilization of Typha which was completed with support from this SERI subcontract. 686 references, 11 figures, 17 tables.

  3. Rehand: Realistic electric prosthetic hand created with a 3D printer.

    PubMed

    Yoshikawa, Masahiro; Sato, Ryo; Higashihara, Takanori; Ogasawara, Tsukasa; Kawashima, Noritaka

    2015-01-01

    Myoelectric prosthetic hands provide an appearance with five fingers and a grasping function to forearm amputees. However, they have problems in weight, appearance, and cost. This paper reports on the Rehand, a realistic electric prosthetic hand created with a 3D printer. It provides a realistic appearance that is same as the cosmetic prosthetic hand and a grasping function. A simple link mechanism with one linear actuator for grasping and 3D printed parts achieve low cost, light weight, and ease of maintenance. An operating system based on a distance sensor provides a natural operability equivalent to the myoelectric control system. A supporter socket allows them to wear the prosthetic hand easily. An evaluation using the Southampton Hand Assessment Procedure (SHAP) demonstrated that an amputee was able to operate various objects and do everyday activities with the Rehand.

  4. Southern Schools: An Evaluation of the Effects of the Emergency School Assistance Program and of School Desegregation. Volume I.

    ERIC Educational Resources Information Center

    Crain, Robert L., Ed.

    This evaluation sampled 150 pairs of schools (50 pairs of high schools and 100 pairs of elementary schools) eligible for ESAP funds, randomly designating one school from each pair as a control school to receive no ESAP funds and using a flip of the coin to so designate. The first volume of the report comprises four chapters and seven appendices.…

  5. Homogeneous nucleation of methane hydrates: unrealistic under realistic conditions.

    PubMed

    Knott, Brandon C; Molinero, Valeria; Doherty, Michael F; Peters, Baron

    2012-12-05

    Methane hydrates are ice-like inclusion compounds with importance to the oil and natural gas industry, global climate change, and gas transportation and storage. The molecular mechanism by which these compounds form under conditions relevant to industry and nature remains mysterious. To understand the mechanism of methane hydrate nucleation from supersaturated aqueous solutions, we performed simulations at controlled and realistic supersaturation. We found that critical nuclei are extremely large and that homogeneous nucleation rates are extremely low. Our findings suggest that nucleation of methane hydrates under these realistic conditions cannot occur by a homogeneous mechanism.

  6. Comparative Evaluation of Stroke Triage Algorithms for Emergency Medical Dispatchers (MeDS): Prospective Cohort Study Protocol

    PubMed Central

    2011-01-01

    Background Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage. Methods/Design This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ≥ 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ≥ 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups

  7. The importance of evaluating metal exposure and predicting human health risks in urban-periurban environments influenced by emerging industry.

    PubMed

    Yousaf, Balal; Amina; Liu, Guijian; Wang, Ruwei; Imtiaz, Muhammad; Rizwan, Muhammad Shahid; Zia-Ur-Rehman, Muhammad; Qadir, Abdul; Si, Youbin

    2016-05-01

    The human population boom, urbanization and rapid industrialization have either directly or indirectly resulted in the serious environmental toxification of the soil-food web by metal exposure from anthropogenic sources in most of the developing industrialized world. The present study was conducted to analyze concentrations of Cd, Cr, Cu, Mn, Ni, Pb, and Zn in soil and vegetables in the urban-periurban areas influenced by emerging industry. Vegetables and their corresponding soil samples were collected and analyzed for heavy metals contents from six random sites. According to the results, the potential health risks from metals to the local communities were assessed by following the methodology described by the US-EPA. In general, the total non-carcinogenic risks were shown to be less than the limits set by the US-EPA. However, the potential risk of developing carcinogenicity in humans over a lifetime of exposure could be increased through the dietary intake of Cd, Cr and Ni. In some cases, Pb was also marginally higher than the safe level. It was concluded that some effective remedial approaches should be adopted to mitigate the risks of Cd, Cr, Ni and Pb in the study area because these metal levels have exceeded the safe limits for human health. However, new studies on gastrointestinal bioaccessibility in human are required to heighten our understanding about metals exposure and health risk assessment.

  8. Choosing profile double-sampling designs for survival estimation with application to President's Emergency Plan for AIDS Relief evaluation.

    PubMed

    An, Ming-Wen; Frangakis, Constantine E; Yiannoutsos, Constantin T

    2014-05-30

    Most studies that follow subjects over time are challenged by having some subjects who dropout. Double sampling is a design that selects and devotes resources to intensively pursue and find a subset of these dropouts, then uses data obtained from these to adjust naïve estimates, which are potentially biased by the dropout. Existing methods to estimate survival from double sampling assume a random sample. In limited-resource settings, however, generating accurate estimates using a minimum of resources is important. We propose using double-sampling designs that oversample certain profiles of dropouts as more efficient alternatives to random designs. First, we develop a framework to estimate the survival function under these profile double-sampling designs. We then derive the precision of these designs as a function of the rule for selecting different profiles, in order to identify more efficient designs. We illustrate using data from the United States President's Emergency Plan for AIDS Relief-funded HIV care and treatment program in western Kenya. Our results show why and how more efficient designs should oversample patients with shorter dropout times. Further, our work suggests generalizable practice for more efficient double-sampling designs, which can help maximize efficiency in resource-limited settings.

  9. An analysis of Chemical Stockpile Emergency Preparedness Program exercise results. Volume 2: Preliminary evaluation and analysis of CSEPP exercise database

    SciTech Connect

    Wernette, D.; Lerner, K.

    1998-06-01

    This study investigated the quality and usefulness of the information in the Chemical Stockpile Emergency Preparedness Program (CSEPP) exercise database. It incorporates the results of two separate analytical efforts. The first effort investigated the process of assigning standardized codes to issues identified in CSEPP exercise reports. A small group of issues was coded independently by each of several individuals, and the results of the individual codings were compared. Considerable differences were found among the individuals` codings. The second effort consisted of a statistical multivariate analysis, to investigate whether exercise issues are evenly distributed among exercise tabs, sites, and objectives. It was found that certain tabs, sites, and objectives were disproportionately associated with problem areas in exercises. In some cases, these problem areas have persisted over time, but in other cases they have undergone significant shifts over the time span of the investigation. The study concludes that the database can be a useful resource for analyzing problem areas and setting priorities for CSEPP program resources. However, some further analyses should be performed in order to more fully explore the data and increase confidence in the results.

  10. Life cycle assessment of two emerging sewage sludge-to-energy systems: evaluating energy and greenhouse gas emissions implications.

    PubMed

    Cao, Yucheng; Pawłowski, Artur

    2013-01-01

    A "cradle-to-grave" life cycle assessment was conducted to examine the energy and greenhouse gas (GHG) emission footprints of two emerging sludge-to-energy systems. One system employs a combination of anaerobic digestion (AD) and fast pyrolysis for bioenergy conversion, while the other excludes AD. Each system was divided into five process phases: plant construction, sludge pretreatment, sludge-to-bioenergy conversion, bioenergy utilizations and biochar management. Both systems achieved energy and GHG emission benefits, and the AD-involving system performed better than the AD-excluding system (5.30 vs. 0.63 GJ/t sludge in net energy gain and 0.63 vs. 0.47 t CO(2)eq/t sludge in emission credit for base case). Detailed contribution and sensitivity analyses were conducted to identify how and to what degree the different life-cycle phases are responsible for the energy and emission impacts. The energy and emission performances were significantly affected by variations in bioenergy production, energy requirement for sludge drying and end use of bioenergy.

  11. The Student Volunteer Army: a 'repeat emergent' emergency response organisation.

    PubMed

    Carlton, Sally; Mills, Colleen E

    2017-01-17

    This paper seeks to contribute to understanding of the factors associated with an effective emergent emergency response organisation and to provide new insights into this understudied area. It examines, through an analysis of a range of textual resources, the emergence and re-emergence of the Student Volunteer Army (SVA) during the devastating earthquakes in Canterbury, New Zealand, in 2010-11. This evaluation is conducted in relation to the four key features of an effective emergency response organisation: adaptability; direction; leadership; and communication. In addition, the paper aims to further understanding of 'emergency entrepreneurship' and thus of the values and strategies that underpin social entrepreneur organisations in times of normalcy. The paper concludes that the unique position of the SVA as a 'repeat emergent' emergency response organisation enabled it to innovate continually and to improve repeatedly its systems, relationships, and image, such that it exhibited features common to emergent and established emergency response organisations.

  12. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals

    PubMed Central

    Chien, Ning; Wang, Tzung-Dau; Chang, Yeun-Chung; Lin, Po-Chih; Tseng, Yao-Hui; Lee, Yee-Fan; Ko, Wei-Chun; Lee, Bai-Chin; Lee, Wen-Jeng

    2016-01-01

    Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic individuals. PMID:27122947

  13. Emergence of Joint Attention through Bootstrap Learning based on the Mechanisms of Visual Attention and Learning with Self-evaluation

    NASA Astrophysics Data System (ADS)

    Nagai, Yukie; Hosoda, Koh; Morita, Akio; Asada, Minoru

    This study argues how human infants acquire the ability of joint attention through interactions with their caregivers from a viewpoint of cognitive developmental robotics. In this paper, a mechanism by which a robot acquires sensorimotor coordination for joint attention through bootstrap learning is described. Bootstrap learning is a process by which a learner acquires higher capabilities through interactions with its environment based on embedded lower capabilities even if the learner does not receive any external evaluation nor the environment is controlled. The proposed mechanism for bootstrap learning of joint attention consists of the robot's embedded mechanisms: visual attention and learning with self-evaluation. The former is to find and attend to a salient object in the field of the robot's view, and the latter is to evaluate the success of visual attention, not joint attention, and then to learn the sensorimotor coordination. Since the object which the robot looks at based on visual attention does not always correspond to the object which the caregiver is looking at in an environment including multiple objects, the robot may have incorrect learning situations for joint attention as well as correct ones. However, the robot is expected to statistically lose the learning data of the incorrect ones as outliers because of its weaker correlation between the sensor input and the motor output than that of the correct ones, and consequently to acquire appropriate sensorimotor coordination for joint attention even if the caregiver does not provide any task evaluation to the robot. The experimental results show the validity of the proposed mechanism. It is suggested that the proposed mechanism could explain the developmental mechanism of infants' joint attention because the learning process of the robot's joint attention can be regarded as equivalent to the developmental process of infants' one.

  14. A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain

    PubMed Central

    Holland, Wesley C.; Hunold, Katherine M.; Mangipudi, Sowmya A.; Rittenberg, Alison M.; Yosipovitch, Natalie; Platts-Mills, Timothy F.

    2016-01-01

    Objectives Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. Methods This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants’ desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. Results Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35

  15. Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital

    PubMed Central

    de Souza, Diego Agra; Silva, Felipe Gama e; Costa, Paulo José Medeiros de Souza

    2013-01-01

    Background Blood products and derivatives are indispensable resources in medical therapies. However, it is important to note that the number of donations is far from ideal. Despite constant campaign efforts, a deficit of 1 million units is expected by 2030. Objectives To determine the adequacy of the indications for red blood cell transfusion in an emergency hospital in Alagoas. Methods This was a cross-sectional observational study conducted at the Alagoas Blood Center. Of a total of 2936 red blood cell transfusion requests in 2009, 334 were randomized and compared with transfusion parameters described in the literature (primary variable). After analysis, the transfusion requests were categorized as adequate, inadequate or inconclusive. This last group included all red blood cell transfusion requests with insufficient clinical information, rendering their classification as adequate or inadequate impossible. The secondary variable involved the reasons for red blood cell transfusion. A 95% confidence interval was used in the statistical analysis. Results Forty-seven (14.07%) requests were adequate and 30 (8.98%) were inadequate. Most of the requests were classified as inconclusive (76.94%). The main indications for transfusion were upper gastrointestinal bleeding (26.95%), anemia (46.71%), hypovolemia/hypovolemic shock (10.78%) and sepsis/septic shock (3.29%). Conclusion It was not possible to reach a conclusion on the adequacy of the indication for transfusion in most of the cases. Therefore, it is important to adopt a transfusion protocol, rigorously analyze blood bank requests, to provide awareness campaigns on the rational use of blood and to implement strategies to use blood products more effectively. PMID:24106444

  16. Evaluation of prediagnosis emergency department presentations in patients with active tuberculosis: the role of chest radiography, risk factors and symptoms

    PubMed Central

    Appleton, S C; Connell, D W; Singanayagam, A; Bradley, P; Pan, D; Sanderson, F; Cleaver, B; Rahman, A; Kon, O M

    2017-01-01

    Introduction London has a high rate of tuberculosis (TB) with 2572 cases reported in 2014. Cases are more common in non-UK born, alcohol-dependent or homeless patients. The emergency department (ED) presents an opportunity for the diagnosis of TB in these patient groups. This is the first study describing the clinico-radiological characteristics of such attendances in two urban UK hospitals for pulmonary TB (PTB) and extrapulmonary TB (EPTB). Methods We conducted a retrospective cohort study using the London TB Register (LTBR) and hospital records to identify patients who presented to two London ED's in the 6 months prior to their ultimate TB diagnosis 2011–2012. Results 397 TB cases were identified. 39% (154/397) had presented to the ED in the 6 months prior to diagnosis. In the study population, the presence of cough, weight loss, fever and night sweats only had prevalence rates of 40%, 34%, 34% and 21%, respectively. Chest radiography was performed in 76% (117/154) of patients. For cases where a new diagnosis of TB was suspected, 73% (41/56) had an abnormal radiograph, compared with 36% (35/98) of patients where it was not. There was an abnormality on a chest radiograph in 73% (55/75) of PTB cases and also in 40% (21/52) of EPTB cases where a film was requested. Conclusions A large proportion of patients with TB present to ED. A diagnosis was more likely in the presence of an abnormal radiograph, suggesting opportunities for earlier diagnosis if risk factors, symptoms and chest radiograph findings are combined. PMID:28123749

  17. Realistic glottal motion and airflow rate during human breathing.

    PubMed

    Scheinherr, Adam; Bailly, Lucie; Boiron, Olivier; Lagier, Aude; Legou, Thierry; Pichelin, Marine; Caillibotte, Georges; Giovanni, Antoine

    2015-09-01

    The glottal geometry is a key factor in the aerosol delivery efficiency for treatment of lung diseases. However, while glottal vibrations were extensively studied during human phonation, the realistic glottal motion during breathing is poorly understood. Therefore, most current studies assume an idealized steady glottis in the context of respiratory dynamics, and thus neglect the flow unsteadiness related to this motion. This is particularly important to assess the aerosol transport mechanisms in upper airways. This article presents a clinical study conducted on 20 volunteers, to examine the realistic glottal motion during several breathing tasks. Nasofibroscopy was used to investigate the glottal geometrical variations simultaneously with accurate airflow rate measurements. In total, 144 breathing sequences of 30s were recorded. Regarding the whole database, two cases of glottal time-variations were found: "static" or "dynamic" ones. Typically, the peak value of glottal area during slow breathing narrowed from 217 ± 54 mm(2) (mean ± STD) during inspiration, to 178 ± 35 mm(2) during expiration. Considering flow unsteadiness, it is shown that the harmonic approximation of the airflow rate underevaluates the inertial effects as compared to realistic patterns, especially at the onset of the breathing cycle. These measurements provide input data to conduct realistic numerical simulations of laryngeal airflow and particle deposition.

  18. Realistic Fiction and the Social Studies. Children's Literature.

    ERIC Educational Resources Information Center

    Mitchell-Powell, Brenda, Ed.

    1995-01-01

    Asserts that children's literature is an effective tool to access and present sophisticated social studies concepts in the elementary classroom. Maintains that realistic fiction can integrate the social sciences with philosophy and religion. Presents a bibliographic essay including children's books and teacher resources. (CFR)

  19. A Sense of Responsibility in Realistic Children's Fiction.

    ERIC Educational Resources Information Center

    Rochelle, Warren

    1991-01-01

    Discusses the qualities of successful realistic children's fiction and examines issues involved in writing and publishing for children. A historical overview of the image of children in fiction is presented; dealing with sensitive, emotional topics is discussed; and concerns of editors and publishers of children's fiction are addressed. (12…

  20. Using a Realist Research Methodology in Policy Analysis

    ERIC Educational Resources Information Center

    Lourie, Megan; Rata, Elizabeth

    2017-01-01

    The article describes the usefulness of a realist methodology in linking sociological theory to empirically obtained data through the development of a methodological device. Three layers of analysis were integrated: 1. the findings from a case study about Maori language education in New Zealand; 2. the identification and analysis of contradictions…

  1. A SPATIALLY REALISTIC MODEL FOR INFORMING FOREST MANAGEMENT DECISIONS

    EPA Science Inventory

    Spatially realistic population models (SRPMs) address a fundamental
    problem commonly confronted by wildlife managers - predicting the
    effects of landscape-scale habitat management on an animal population.
    SRPMs typically consist of three submodels: (1) a habitat submodel...

  2. Synthesis Of Realistic Animations Of A Person Speaking

    NASA Technical Reports Server (NTRS)

    Scott, Kenneth C.; Kagels, David S.; Watson, Stephen H.; Rom, Hillel S.; Lorre, Jean J.; Wright, John R.; Duxbury, Elizabeth D.

    1995-01-01

    Actors computer program implements automated process that synthesizes realistic animations of person speaking. Produces "newscaster" type video sequences. Uses images of person and, therefore, not limited to cartoons and cartoonlike movies. Potential applications also include use of process for automatically producing on-the-fly animations for human/computer interfaces and for reducing bandwidth needed to transmit video telephone signals.

  3. Critical Realist Review: Exploring the Real, beyond the Empirical

    ERIC Educational Resources Information Center

    Edgley, Alison; Stickley, Theodore; Timmons, Stephen; Meal, Andy

    2016-01-01

    This article defines the "critical realist review", a literature-based methodological approach to critical analysis of health care studies (or any discipline charged with social interventions) that is robust, insightful and essential for the complexities of twenty-first century evidence-based health and social care. We argue that this…

  4. "Shut My Mouth Wide Open": Realistic Fiction and Social Action.

    ERIC Educational Resources Information Center

    Tyson, Cynthia A.

    1999-01-01

    Shares the responses of seven urban, male, African-American fifth graders to contemporary realistic fiction, discussing how the tying of this literature to the events in the boys' lives had the potential to move them toward social action. The paper examines the following: literature as a catalyst, reader responses to texts, critical literacy, and…

  5. A Realistic Experimental Design and Statistical Analysis Project

    ERIC Educational Resources Information Center

    Muske, Kenneth R.; Myers, John A.

    2007-01-01

    A realistic applied chemical engineering experimental design and statistical analysis project is documented in this article. This project has been implemented as part of the professional development and applied statistics courses at Villanova University over the past five years. The novel aspects of this project are that the students are given a…

  6. Developing Skills: Realistic Work Environments in Further Education. FEDA Reports.

    ERIC Educational Resources Information Center

    Armstrong, Paul; Hughes, Maria

    To establish the prevalence and perceived value of realistic work environments (RWEs) in colleges and their use as learning resources, all further education (FE) sector colleges in Great Britain were surveyed in the summer of 1998. Of 175 colleges that responded to 2 questionnaires for senior college managers and RWE managers, 127 had at least 1…

  7. Two-Capacitor Problem: A More Realistic View.

    ERIC Educational Resources Information Center

    Powell, R. A.

    1979-01-01

    Discusses the two-capacitor problem by considering the self-inductance of the circuit used and by determining how well the usual series RC circuit approximates the two-capacitor problem when realistic values of L, C, and R are chosen. (GA)

  8. Emerging technologies

    SciTech Connect

    Lu, Shin-yee

    1993-03-01

    The mission of the Emerging Technologies thrust area at Lawrence Livermore National Laboratory is to help individuals establish technology areas that have national and commercial impact, and are outside the scope of the existing thrust areas. We continue to encourage innovative ideas that bring quality results to existing programs. We also take as our mission the encouragement of investment in new technology areas that are important to the economic competitiveness of this nation. In fiscal year 1992, we have focused on nine projects, summarized in this report: (1) Tire, Accident, Handling, and Roadway Safety; (2) EXTRANSYT: An Expert System for Advanced Traffic Management; (3) Odin: A High-Power, Underwater, Acoustic Transmitter for Surveillance Applications; (4) Passive Seismic Reservoir Monitoring: Signal Processing Innovations; (5) Paste Extrudable Explosive Aft Charge for Multi-Stage Munitions; (6) A Continuum Model for Reinforced Concrete at High Pressures and Strain Rates: Interim Report; (7) Benchmarking of the Criticality Evaluation Code COG; (8) Fast Algorithm for Large-Scale Consensus DNA Sequence Assembly; and (9) Using Electrical Heating to Enhance the Extraction of Volatile Organic Compounds from Soil.

  9. Corynebacterium diphtheriae as an emerging pathogen in nephrostomy catheter-related infection: evaluation of traits associated with bacterial virulence.

    PubMed

    Gomes, Débora L R; Martins, Carlos A S; Faria, Lúcia M D; Santos, Louisy S; Santos, Cintia S; Sabbadini, Priscila S; Souza, Mônica C; Alves, Gabriela B; Rosa, Ana C P; Nagao, Prescilla E; Pereira, Gabriela A; Hirata, Raphael; Mattos-Guaraldi, Ana L

    2009-11-01

    Corynebacterium diphtheriae still represents a global medical challenge, particularly due to the significant number of individuals susceptible to diphtheria and the emergence of non-toxigenic strains as the causative agents of invasive infections. In this study, we characterized the clinical and microbiological features of what we believe to be the first case of C. diphtheriae infection of a percutaneous nephrostomy catheter insertion site in an elderly patient with a fatal bladder cancer. Moreover, we demonstrated the potential role of adherence, biofilm formation and fibrin deposition traits in C. diphtheriae from the catheter-related infection. Non-toxigenic C. diphtheriae isolated from the purulent discharge (named strain BR-CAT5003748) was identified by the API Coryne system (code 1 010 324) and a multiplex PCR for detection of dtxR and tox genes. Strain BR-CAT5003748 showed resistance to oxacillin, ceftazidime and ciprofloxacin. In experiments performed in vitro, the catheter isolate was classified as moderately hydrophobic and as moderately adherent to polystyrene surfaces. Glass provided a more effective surface for biofilm formation than polystyrene. Micro-organisms adhered to (>1.5 x 10(6) c.f.u.) and multiplied on surfaces of polyurethane catheters. Microcolony formation (a hallmark of biofilm formation) and amorphous accretions were observed by scanning electron microscopy on both external and luminal catheter surfaces. Micro-organisms yielded simultaneous expression of localized adherence-like and aggregative-like (LAL/AAL) adherence patterns to HEp-2 cells. Interestingly, the coagulase tube test resulted in the formation of a thin layer of fibrin embedded in rabbit plasma by the non-toxigenic BR-CAT5003748 strain. In conclusion, C. diphtheriae should be recognized as a potential cause of catheter-related infections in at-risk populations such as elderly and cancer patients. LAL/AAL strains may be associated with virulence traits that enable C

  10. The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services.

    PubMed

    Sun, D; Aikawa, N

    1999-03-01

    Based on the concept of the systemic inflammatory response syndrome (SIRS), a one-year retrospective study was carried out among a total of 2389 patients transported to the emergency room by ambulance. With respect to 351 patients who had all data necessary for evaluating SIRS criteria in 369 hospitalized patients, 200 met SIRS criteria within 24 hours of admission (24h-SIRS). The mortality rate for 24h-SIRS patients was significantly higher than that of non-SIRS patients. The mortality rate for 24h-SIRS patients increased sequentially as more SIRS criteria were met. In 235 patients who met SIRS criteria during hospitalization (overall-SIRS), 108 had sepsis. Of these, 60 developed severe sepsis, and 50 developed septic shock. The mortality rate for patients who had 3 or more consecutive days of SIRS was significantly higher than that for those with less than 3 consecutive SIRS days. Among 153 patients who had all data necessary for APACHEIII scoring within 24 hours of admission, the mortality rate for SIRS patients whose APACHEIII score was 50 or higher was 40.7%, significantly higher than that of other patients. In conclusion, SIRS criteria were demonstrated to be useful as indicators of severity and for predicting outcome in patients hospitalized through emergency services. Patients who met the following criteria were found to be a high-risk population among hospitalized emergency patients with SIRS: (1) Those who had three or more consecutive days of SIRS. (2) Those whose APACHEIII score was 50 or higher.

  11. Optimizing Wind And Hydropower Generation Within Realistic Reservoir Operating Policy

    NASA Astrophysics Data System (ADS)

    Magee, T. M.; Clement, M. A.; Zagona, E. A.

    2012-12-01

    Previous studies have evaluated the benefits of utilizing the flexibility of hydropower systems to balance the variability and uncertainty of wind generation. However, previous hydropower and wind coordination studies have simplified non-power constraints on reservoir systems. For example, some studies have only included hydropower constraints on minimum and maximum storage volumes and minimum and maximum plant discharges. The methodology presented here utilizes the pre-emptive linear goal programming optimization solver in RiverWare to model hydropower operations with a set of prioritized policy constraints and objectives based on realistic policies that govern the operation of actual hydropower systems, including licensing constraints, environmental constraints, water management and power objectives. This approach accounts for the fact that not all policy constraints are of equal importance. For example target environmental flow levels may not be satisfied if it would require violating license minimum or maximum storages (pool elevations), but environmental flow constraints will be satisfied before optimizing power generation. Additionally, this work not only models the economic value of energy from the combined hydropower and wind system, it also captures the economic value of ancillary services provided by the hydropower resources. It is recognized that the increased variability and uncertainty inherent with increased wind penetration levels requires an increase in ancillary services. In regions with liberalized markets for ancillary services, a significant portion of hydropower revenue can result from providing ancillary services. Thus, ancillary services should be accounted for when determining the total value of a hydropower system integrated with wind generation. This research shows that the end value of integrated hydropower and wind generation is dependent on a number of factors that can vary by location. Wind factors include wind penetration level

  12. Human Performance in a Realistic Instrument-Control Task during Short-Term Microgravity

    PubMed Central

    Steinberg, Fabian; Kalicinski, Michael; Dalecki, Marc; Bock, Otmar

    2015-01-01

    Previous studies have documented the detrimental effects of microgravity on human sensorimotor skills. While that work dealt with simple, laboratory-type skills, we now evaluate the effects of microgravity on a complex, realistic instrument-control skill. Twelve participants controlled a simulated power plant during the short-term microgravity intervals of parabolic flight as well as during level flight. To this end they watched multiple displays, made strategic decisions and used multiple actuators to maximize their virtual earnings from the power plant. We quantified control efficiency as the participants’ net earnings (revenue minus expenses), motor performance as hand kinematics and dynamics, and stress as cortisol level, self-assessed mood and self-assessed workload. We found that compared to normal gravity, control efficiency substantially decreased in microgravity, hand velocity slowed down, and cortisol level and perceived physical strain increased, but other stress and motor scores didn’t change. Furthermore, control efficiency was not correlated with motor and stress scores. From this we conclude that realistic instrument control was degraded in short-term microgravity. This degradation can’t be explained by the motor and/or stress indicators under study, and microgravity affected motor performance differently in our complex, realistic skill than in the simple, laboratory-type skills of earlier studies. PMID:26083473

  13. Experimental evaluation of the reproductive quality of Africanized queen bees (Apis mellifera) on the basis of body weight at emergence.

    PubMed

    De Souza, D A; Bezzera-Laure, M A F; Francoy, T M; Gonçalves, L S

    2013-11-07

    There has been much speculation about which phenotypic traits serve as reliable indicators of productivity in queen honeybees (Apis mellifera). To investigate the predictive value of queen body weight on colony development and quality, we compared colonies in which queens weighed less than 180 mg to those in which queens weighed more than 200 mg. Both groups contained naturally mated and instrumentally inseminated queens. Colonies were evaluated on the basis of performance quality, growth rate, and queen longevity. We found that queen body weight was significantly correlated with fecundity and colony quality. Heavy queens exhibited the most favorable performance and colony quality. In contrast, naturally mated, with the opposite trend being obtained for light-weight queens. We found no statistically significant difference between instrumentally inseminated queens and naturally mated queens. Our results support the use of queen body weight as a reliable visual (physiological) indicator of potential colony productivity in honey bees to enhance genetic lines in genetic improvement programs.

  14. The Implementation and Evaluation of the Emergency Response Dose Assessment System (ERDAS) at Cape Canaveral Air Station/Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Evans, Randolph J.; Tremback, Craig J.; Lyons, Walter A.

    1996-01-01

    The Emergency Response Dose Assessment System (ERDAS) is a system which combines the mesoscale meteorological prediction model RAMS with the diffusion models REEDM and HYPACT. Operators use a graphical user interface to run the models for emergency response and toxic hazard planning at CCAS/KCS. The Applied Meteorology Unit has been evaluating the ERDAS meteorological and diffusion models and obtained the following results: (1) RAMS adequately predicts the occurrence of the daily sea breeze during non-cloudy conditions for several cases. (2) RAMS shows a tendency to predict the sea breeze to occur slightly earlier and to move it further inland than observed. The sea breeze predictions could most likely be improved by better parameterizing the soil moisture and/or sea surface temperatures. (3) The HYPACT/REEDM/RAMS models accurately predict launch plume locations when RAMS winds are accurate and when the correct plume layer is modeled. (4) HYPACT does not adequately handle plume buoyancy for heated plumes since all plumes are presently treated as passive tracers. Enhancements should be incorporated into the ERDAS as it moves toward being a fully operational system and as computer workstations continue to increase in power and decrease in cost. These enhancements include the following: activate RAMS moisture physics; use finer RAMS grid resolution; add RAMS input parameters (e.g. soil moisture, radar, and/or satellite data); automate data quality control; implement four-dimensional data assimilation; modify HYPACT plume rise and deposition physics; and add cumulative dosage calculations in HYPACT.

  15. Evaluating the co-production of a near real time Earthquake Aftershock forecasting tool for humanitarian risk assessment and emergency planning

    NASA Astrophysics Data System (ADS)

    Quinn, Keira; Hope, Max; McCloskey, John; NicBhloscaidh, Mairead; Jimenez, Abigail; Dunlop, Paul

    2015-04-01

    Concern Worldwide and the University of Ulster Geophysics Research Group are engaged in a project to co-produce a suite of software and mapping tools to assess aftershock hazard in near real-time during the emergency response phase of earthquake disaster, and inform humanitarian emergency planning and response activities. This paper uses a social learning approach to evaluate this co-production process. Following Wenger (1999) we differentiate between the earthquake science and humanitarian communities of practice (CoP) along three dimensions: enterprise (the purpose of CoPs and the problems participants are working to address), repertoire (knowledge, skills, language), and identity (values and boundaries). We examine the effectiveness of learning between CoP, focusing on boundary work and objects, and various organisational structures and aspects of the wider political economy of learning that enable and hinder the co-production process. We conclude by identifying a number of ways to more effectively integrate earthquake science into humanitarian decision-making, policy development and programme design.

  16. Images of Poverty in Contemporary Realistic Fiction for Youth: Preliminary Results of a Content Analysis Using a Social Psychological Conceptual Framework.

    ERIC Educational Resources Information Center

    Fitzgibbons, Shirley A.; Tilley, Carol L.

    This preliminary study of 20 contemporary realistic fiction books for youth, in middle school and above, analyzed images of poverty using a framework adapted from the work of Robert Leahy. Findings are related to demographics, images of poverty and emerging themes. Results indicate that, as a whole, the sample of books rely on concrete images of…

  17. Geomorphic Classification and Evaluation of Channel Width and Emergent Sandbar Habitat Relations on the Lower Platte River, Nebraska

    USGS Publications Warehouse

    Elliott, Caroline M.

    2011-01-01

    width and high channel sinuosities at larger scales. The segment from Salt Creek to the Missouri River has narrow valleys and generally low channel sinuosity. Tern and plover nest sites from 2006 through 2009 in the multi-scale multivariate classification indicated relative nesting selection of cluster 2 reaches among the four-cluster classification and reaches containing clusters 2, 3, and 6 from the seven-cluster classification. These classes, with the exception of cluster 6 are common downstream from the Elkhorn River. Trends in total channel width indicated that reaches dominated by dark vegetation (islands) are the widest on the Lower Platte River. Reaches with high percentages of dry sand and dry sand plus light vegetation were the narrowest reaches. This suggests that narrow channel reaches have sufficient transport capacity to maintain sandbars under recent (2006) flow regimes and are likely to be most amenable to maintaining tern and plover habitat in the Lower Platte River. Further investigations into the dynamics of emergent sandbar habitat and the effects of bank stabilization on in-channel habitats will require the collection and analysis of new data, particularly detailed elevation information and an assessment of existing bank stabilization structures.

  18. Effects of Defining Realistic Compositions of the Ocular Melanoma on Proton Therapy

    PubMed Central

    Keshazare, Sh; Masoudi, S F; S Rasouli, F

    2014-01-01

    Background: Recent studies in eye plaque brachytherapy have shown a considerable difference between the dosimetric results using water phantom and a model of human eye containing realistic materials. In spite of this fact, there is a lack of simulation studies based on such a model in proton therapy literatures. In the presented work, the effect of utilizing an eye model with ocular media on proton therapy is investigated using the MCNPX Monte Carlo Code. Methods: Two different eye models are proposed to study the effect of defining realistic materials on dose deposition due to utilizing pencil beam scanning (PBS) method for proton therapy of ocular melanoma. The first model is filled with water, and the second one contains the realistic materials of tumor and vitreous. Spread out Bragg peaks (SOBP) are created to cover a typical tumor volume. Moreover, isodose curves are figured in order to evaluate planar variations of absorbed dose in two models. Results: The results show that the maximum delivered dose in ocular media is approximately 12-32% more than in water phantom. Also it is found that using the optimized weighted beams in water phantom leads to disturbance of uniformity of SOBP in ocular media. Conclusion: Similar to the results reported in eye brachytherapy published papers, considering the ocular media in simulation studies leads to a more realistic assessment of sufficiency of the designed proton beam in tissue. This effect is of special importance in creating SOBP, as well as in delivered dose in the tumor boundaries in proton pencil beam scanning method. PMID:25599060

  19. Application of ICA to realistically simulated 1H-MRS data

    PubMed Central

    Kalyanam, Ravi; Boutte, David; Hutchison, Kent E; Calhoun, Vince D

    2015-01-01

    Introduction 1H-MRS signals from brain tissues capture information on in vivo brain metabolism and neuronal biomarkers. This study aims to advance the use of independent component analysis (ICA) for spectroscopy data by objectively comparing the performance of ICA and LCModel in analyzing realistic data that mimics many of the known properties of in vivo data. Methods This work identifies key features of in vivo 1H-MRS signals and presents methods to simulate realistic data, using a basis set of 12 metabolites typically found in the human brain. The realistic simulations provide a much needed ground truth to evaluate performances of various MRS analysis methods. ICA is applied to collectively analyze multiple realistic spectra and independent components identified with our generative model to obtain ICA estimates. These same data are also analyzed using LCModel and the comparisons between the ground-truth and the analysis estimates are presented. The study also investigates the potential impact of modeling inaccuracies by incorporating two sets of model resonances in simulations. Results The simulated fid signals incorporating line broadening, noise, and residual water signal closely resemble the in vivo signals. Simulation analyses show that the resolution performances of both LCModel and ICA are not consistent across metabolites and that while ICA resolution can be improved for certain resonances, ICA is as effective as, or better than, LCModel in resolving most model resonances. Conclusion The results show that ICA can be an effective tool in comparing multiple spectra and complements existing approaches for providing quantified estimates. PMID:26221570

  20. Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

    PubMed

    Ferrara, Gineen; Ramponi, Denise; Cline, Thomas W

    2016-01-01

    Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR.

  1. Dermatologic emergencies.

    PubMed

    Sica, P A

    1986-03-01

    Being able to recognize and treat a dermatologic emergency is extremely important to the primary care physician. This ability is very rewarding for the patient and gratifying to the physician. In this article, some of the more commonly encountered emergencies are discussed.

  2. Corneal Emergencies.

    PubMed

    Belknap, Ellen B

    2015-09-01

    Corneal emergencies can be due to a number of different causes and may be vision threatening if left untreated. In an attempt to stabilize the cornea, it is of benefit to place an Elizabethan collar on the patient to prevent further corneal damage. This article discusses the diagnosis, prognosis, and management of corneal emergencies in dogs and cats.

  3. Psychiatric Emergencies

    PubMed Central

    Bayrakal, Sadi

    1972-01-01

    Dr. Bayrakal believes that the time has come for the family physician to deal with minor psychiatric disturbances in his office as well as psychiatric emergencies in the emergency department. The newly emerging medico-social philosophy of both the federal and provincial governments, he says, is giving greater responsibility and authority to the family physician in every area of medicine, including psychiatry. The author discusses major psychiatric emergencies (suicide, suicidal attempt, homicide, social scandal, as well as other psychiatric emergencies) on the ward including adolescent psychiatry. (The descriptions and treatment procedures are given on a concrete clinical level without theoretical overload.) In the family physician's work, psychological understanding is of profound importance. Giving him the added scope of psychiatric consideration to see the patient in bio-psycho-social totality will enable him to practice a more humanized form of medicine. PMID:20468779

  4. Chemical and toxicological evaluation of an emerging pollutant (enrofloxacin) by catalytic wet air oxidation and ozonation in aqueous solution.

    PubMed

    Li, Yan; Zhang, Feifang; Liang, Xinmiao; Yediler, Ayfer

    2013-01-01

    This study evaluates the degradation efficiency of enrofloxacin (ENR) by catalytic wet air oxidation (CWAO) and ozonation. Results obtained by CWAO experiments show that 99.5% degradation, 37.0% chemical oxidation demand (COD) removal and 51.0% total organic carbon (TOC) conversion were obtained when 100 mol% FeCl(3) and 25 mol% NaNO(2) at 150 °C under 0.5 MPa oxygen pressure after 120 min are used. The degradation products are identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS), gas chromatography-mass spectrometry (GC-MS) and ion chromatography (IC). The oxidation end products, F(-), NO(3)(-) and NH(4)(+) were determined by IC. The BOD(5)/COD ratio as a measure of the biodegradability of the parent compound increased from 0.01 to 0.12 after 120 min of reaction time, indicating an improved biodegradability of the parent compound. The inhibition of bioluminescence of the marine bacteria V. fischeri decreased from 43% to 12% demonstrating a loss in toxicity of ENR during CWAO. Ozonation of 0.2 mM ENR was carried out with an ozone concentration of 7.3 g m(-3) at pH 7. ENR decomposition with a degradation rate of 87% was obtained corresponding to the reaction time. Moderate changes in COD (18%) and TOC (17%) removal has been observed. The bioluminescence inhibition increased from 8% to 50%, due to the generation of toxic degradation products during ozonation. In comparison to the widely use of well developed method of ozonation CWAO exhibits better performance in terms of COD, TOC removals and generates less toxic products.

  5. Realistic Modeling of Multi-Scale MHD Dynamics of the Solar Atmosphere

    NASA Technical Reports Server (NTRS)

    Kitiashvili, Irina; Mansour, Nagi N.; Wray, Alan; Couvidat, Sebastian; Yoon, Seokkwan; Kosovichev, Alexander

    2014-01-01

    Realistic 3D radiative MHD simulations open new perspectives for understanding the turbulent dynamics of the solar surface, its coupling to the atmosphere, and the physical mechanisms of generation and transport of non-thermal energy. Traditionally, plasma eruptions and wave phenomena in the solar atmosphere are modeled by prescribing artificial driving mechanisms using magnetic or gas pressure forces that might arise from magnetic field emergence or reconnection instabilities. In contrast, our 'ab initio' simulations provide a realistic description of solar dynamics naturally driven by solar energy flow. By simulating the upper convection zone and the solar atmosphere, we can investigate in detail the physical processes of turbulent magnetoconvection, generation and amplification of magnetic fields, excitation of MHD waves, and plasma eruptions. We present recent simulation results of the multi-scale dynamics of quiet-Sun regions, and energetic effects in the atmosphere and compare with observations. For the comparisons we calculate synthetic spectro-polarimetric data to model observational data of SDO, Hinode, and New Solar Telescope.

  6. Evidence of Multistability in a Realistic Computer Simulation of Hippocampus Subfield CA1

    PubMed Central

    Siekmeier, Peter J.

    2009-01-01

    The manner in which hippocampus processes neural signals is thought to be central to the memory encoding process. A theoretically-oriented literature has suggested that this is carried out via “attractors” or distinctive spatio-temporal patterns of activity. However, these ideas have not been thoroughly investigated using computational models featuring both realistic single-cell physiology and detailed cell-to-cell connectivity. Here we present a 452 cell simulation based on Traub et al’s pyramidal cell [81] and interneuron [83] models, incorporating patterns of synaptic connectivity based on an extensive review of the neuroanatomic literature. When stimulated with a one second physiologically realistic input, our simulated tissue shows the ability to hold activity on-line for several seconds; furthermore, its spiking activity, as measured by frequency and interspike interval (ISI) distributions, resembles that of in vivo hippocampus. An interesting emergent property of the system is its tendency to transition from stable state to stable state, a behavior consistent with recent experimental findings [73]. Inspection of spike trains and simulated blockade of KAHP channels suggest that this is mediated by spike frequency adaptation. This finding, in conjunction with studies showing that apamin, a KAHP channel blocker, enhances the memory consolidation process in laboratory animals, suggests the formation of stable attractor states is central to the process by which memories are encoded. Ways that this methodology could shed light on the etiology of mental illness, such as schizophrenia, are discussed. PMID:19378385

  7. Hybrid neural networks--combining abstract and realistic neural units.

    PubMed

    Lytton, William W; Hines, Michael

    2004-01-01

    There is a trade-off in neural network simulation between simulations that embody the details of neuronal biology and those that omit these details in favor of abstractions. The former approach appeals to physiologists and pharmacologists who can directly relate their experimental manipulations to parameter changes in the model. The latter approach appeals to physicists and mathematicians who seek analytic understanding of the behavior of large numbers of coupled simple units. This simplified approach is also valuable for practical reasons a highly simplified unit will run several orders of magnitude faster than a complex, biologically realistic unit. In order to have our cake and eat it, we have developed hybrid networks in the Neuron simulator package. These make use of Neuron's local variable timestep method to permit simplified integrate-and-fire units to move ahead quickly while realistic neurons in the same network are integrated slowly.

  8. Realistic Covariance Prediction for the Earth Science Constellation

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellation (ESC) include collision risk assessment between members of the constellation and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed using Monte Carlo techniques as well as by numerically integrating relative state probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by the NASA/Goddard Space Flight Center's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the Earth Science Constellation satellites: Aqua, Aura and Terra.

  9. Realistic Covariance Prediction For the Earth Science Constellations

    NASA Technical Reports Server (NTRS)

    Duncan, Matthew; Long, Anne

    2006-01-01

    Routine satellite operations for the Earth Science Constellations (ESC) include collision risk assessment between members of the constellations and other orbiting space objects. One component of the risk assessment process is computing the collision probability between two space objects. The collision probability is computed via Monte Carlo techniques as well as numerically integrating relative probability density functions. Each algorithm takes as inputs state vector and state vector uncertainty information for both objects. The state vector uncertainty information is expressed in terms of a covariance matrix. The collision probability computation is only as good as the inputs. Therefore, to obtain a collision calculation that is a useful decision-making metric, realistic covariance matrices must be used as inputs to the calculation. This paper describes the process used by NASA Goddard's Earth Science Mission Operations Project to generate realistic covariance predictions for three of the ESC satellites: Aqua, Aura, and Terra

  10. Realistic fetus skin color processing for ultrasound volume rendering

    NASA Astrophysics Data System (ADS)

    Kim, Yun-Tae; Kim, Kyuhong; Park, Sung-Chan; Kang, Jooyoung; Kim, Jung-Ho

    2014-01-01

    This paper proposes realistic fetus skin color processing using a 2D color map and a tone mapping function (TMF) for ultrasound volume rendering. The contributions of this paper are a 2D color map generated through a gamut model of skin color and a TMF that depends on the lighting position. First, the gamut model of fetus skin color is calculated by color distribution of baby images. The 2D color map is created using a gamut model for tone mapping of ray casting. For the translucent effect, a 2D color map in which lightness is inverted is generated. Second, to enhance the contrast of rendered images, the luminance, color, and tone curve TMF parameters are changed using 2D Gaussian function that depends on the lighting position. The experimental results demonstrate that the proposed method achieves better realistic skin color reproduction than the conventional method.

  11. Increasing Completion Rate of an M4 Emergency Medicine Student End-of-Shift Evaluation Using a Mobile Electronic Platform and Real-Time Completion

    PubMed Central

    Tews, Matthew C.; Treat, Robert W.; Nanes, Maxwell

    2016-01-01

    Introduction Medical students on an emergency medicine rotation are traditionally evaluated at the end of each shift with paper-based forms, and data are often missing due to forms not being turned in or completed. Because students’ grades depend on these evaluations, change was needed to increase form rate of return. We analyzed a new electronic evaluation form and modified completion process to determine if it would increase the completion rate without altering how faculty scored student performance. Methods During fall 2013, 29 faculty completed paper N=339 evaluations consisting of seven competencies for 33 students. In fall 2014, an electronic evaluation form with the same competencies was designed using an electronic platform and completed N=319 times by 27 faculty using 25 students’ electronic devices. Feedback checkboxes were added to facilitate collection of common comments. Data was analyzed with IBM® SPSS® 21.0 using multi-factor analysis of variance with the students’ global rating (GR) as an outcome. Inter-item reliability was determined with Cronbach alpha. Results There was a significantly higher completion rate (p=0.001) of 98% electronic vs. 69% paper forms, lower (p=0.001) missed GR rate (1% electronic. vs 12% paper), and higher mean scores (p=0.001) for the GR with the electronic (7.0±1.1) vs. paper (6.8±1.2) form. Feedback checkboxes were completed on every form. The inter-item reliability for electronic and paper forms was each alpha=0.95. Conclusion The use of a new electronic form and modified completion process for evaluating students at the end of shift demonstrated a higher faculty completion rate, a lower missed data rate, a higher global rating and consistent collection of common feedback. The use of the electronic form and the process for obtaining the information made our end-of-shift evaluation process for students more reliable and provided more accurate, up-to-date information for student feedback and when determining

  12. Identification and evaluation of reference genes for expression studies by RT-qPCR during embryonic development of the emerging model organism, Macrobrachium olfersii.

    PubMed

    Jaramillo, Michael L; Ammar, Dib; Quispe, Ruth L; Guzman, Frank; Margis, Rogerio; Nazari, Evelise M; Müller, Yara M R

    2017-01-20

    RT-qPCR is a sensitive and highly efficient technique that is widely used in gene expression analysis and to provide insight into the molecular mechanisms underlying embryonic development. The freshwater prawn, Macrobrachium olfersii is an emerging model organism, but, the stable reference genes of this species need to be identified and validated for RT-qPCR analysis. Thus, the aim of this study was to evaluate the expression stability of six genes (β-act, GAPDH, EF-1α, RpL8, RpS6, AK) in embryos and in adult tissues (cerebral ganglia, muscle and hepatopancreas) of M. olfersii. The expression stabilities of these genes were evaluated using geNorm, NormFinder, BestKeeper, ΔCt method and integrated tool RefFinder. In the general ranking, RpL8 and RpS6 were the most stable genes in embryos, while RpS6 and RpL8 were the most stable in a combined adult tissue analysis. Analysis of the adult tissues revealed that β-act and AK were the most stable genes in cerebral ganglia, RpL8 and AK in muscle, and RpS6 and β-act in hepatopancreas. EF-1α and GAPDH were the least stable genes and as normalizer genes in RT-qPCR affected expression of the Distal-less gene during M. olfersii development. This study provides suitable reference genes for RT-qPCR analysis and allows future studies of the gene expression in M. olfersii for understanding the molecular mechanisms of their development. To our knowledge, this is the first published study that identifies and evaluates reference genes for RT-qPCR analysis in M. olfersii and could be useful as basis for evaluations of reference genes in other prawns.

  13. Realistic modeling of chamber transport for heavy-ion fusion

    SciTech Connect

    Sharp, W.M.; Grote, D.P.; Callahan, D.A.; Tabak, M.; Henestroza, E.; Yu, S.S.; Peterson, P.F.; Welch, D.R.; Rose, D.V.

    2003-05-01

    Transport of intense heavy-ion beams to an inertial-fusion target after final focus is simulated here using a realistic computer model. It is found that passing the beam through a rarefied plasma layer before it enters the fusion chamber can largely neutralize the beam space charge and lead to a usable focal spot for a range of ion species and input conditions.

  14. A realistic model for charged strange quark stars

    NASA Astrophysics Data System (ADS)

    Thirukkanesh, S.; Ragel, F. C.

    2017-01-01

    We report a general approach to solve an Einstein-Maxwell system to describe a static spherically symmetric anisotropic strange matter distribution with linear equation of state in terms of two generating functions. It is examined by choosing Tolmann IV type potential for one of the gravitational potentials and a physically reasonable choice for the electric field. Hence, the generated model satisfies all the required major physical properties of a realistic star. The effect of electric charge on physical properties is highlighted.

  15. Simulation of human ischemic stroke in realistic 3D geometry

    NASA Astrophysics Data System (ADS)

    Dumont, Thierry; Duarte, Max; Descombes, Stéphane; Dronne, Marie-Aimée; Massot, Marc; Louvet, Violaine

    2013-06-01

    In silico research in medicine is thought to reduce the need for expensive clinical trials under the condition of reliable mathematical models and accurate and efficient numerical methods. In the present work, we tackle the numerical simulation of reaction-diffusion equations modeling human ischemic stroke. This problem induces peculiar difficulties like potentially large stiffness which stems from the broad spectrum of temporal scales in the nonlinear chemical source term as well as from the presence of steep spatial gradients in the reaction fronts, spatially very localized. Furthermore, simulations on realistic 3D geometries are mandatory in order to describe correctly this type of phenomenon. The main goal of this article is to obtain, for the first time, 3D simulations on realistic geometries and to show that the simulation results are consistent with those obtain in experimental studies or observed on MRI images in stroke patients. For this purpose, we introduce a new resolution strategy based mainly on time operator splitting that takes into account complex geometry coupled with a well-conceived parallelization strategy for shared memory architectures. We consider then a high order implicit time integration for the reaction and an explicit one for the diffusion term in order to build a time operator splitting scheme that exploits efficiently the special features of each problem. Thus, we aim at solving complete and realistic models including all time and space scales with conventional computing resources, that is on a reasonably powerful workstation. Consequently and as expected, 2D and also fully 3D numerical simulations of ischemic strokes for a realistic brain geometry, are conducted for the first time and shown to reproduce the dynamics observed on MRI images in stroke patients. Beyond this major step, in order to improve accuracy and computational efficiency of the simulations, we indicate how the present numerical strategy can be coupled with spatial

  16. Behaviorly realistic simulations of stock market traders with a soul

    NASA Astrophysics Data System (ADS)

    Solomon, Sorin

    1999-09-01

    The price fluctuations of the stocks in the financial markets are the result of the individual operations by many individual investors. However for many decades the financial theory did not use directly this “microscopic representation” of the markets. The main difficulties preventing this approach were solved recently with the advent of modern computer technology: - massive detailed data on the individual market operations became available; - “microscopic simulations” of the stock markets in terms of their individual participating agents allow very realistic treatment of the problem. By taking advantage of the modern computer processing and simulation techniques, we are now able to confront real market data with the results of simulating “microscopic” realistic models of the markets. These models have the potential to include and study the effects on the market of any desired feature in the investors behavior: departures from rationality, herding effects, heterogeneous investor-specific trading strategies. We propose to use the comparison of computer simulations of microscopic models with the actual market data in order to validate and enhance the knowledge on the financial behavior of individuals. Moreover we hope to explain, understand (and may be predict and control) macroscopic market dynamical features (e.g., cycles of booms and crashes, investors wealth distribution, market returns probability distribution etc.) based on realistic models using this knowledge.

  17. Depigmented Skin and Phantom Color Measurements for Realistic Prostheses

    PubMed Central

    Tanner, Paul; Leachman, Sancy; Boucher, Kenneth; Ozçelik, Tunçer Burak

    2013-01-01

    Purpose The purpose of this study was to test the hypothesis that regardless of human skin phototype, areas of depigmented skin, as seen in vitiligo, are optically indistinguishable among skin phototypes. The average of the depigmented skin measurements can be used to develop the base color of realistic prostheses. Methods and Materials Data from 20 of 32 recruited vitiligo study participants. Diffuse reflectance spectroscopy measurements were made from depigmented skin and adjacent pigmented skin, then compared to 66 pigmented polydimethylsiloxane phantoms to determine pigment concentrations in turbid media for making realistic facial prostheses. Results The Area Under spectral intensity Curve (AUC) was calculated for average spectroscopy measurements of pigmented sites in relation to skin phototype (p=0.0505) and depigmented skin in relation to skin phototype (p=0.59). No significant relationship exists between skin phototypes and depigmented skin spectroscopy measurements. The average of the depigmented skin measurements (AUC 19,129) was the closest match to phantom 6.4 (AUC 19,162) Conclusions Areas of depigmented skin are visibly indistinguishable per skin phototype, yet spectrometry shows that depigmented skin measurements varied and were unrelated to skin phototype. Possible sources of optical variation of depigmented skin include age, body site, blood flow, quantity/quality of collagen, and other chromophores. The average of all depigmented skin measurements can be used to derive the pigment composition and concentration for realistic facial prostheses. PMID:23750920

  18. Mixed method nursing studies: a critical realist critique.

    PubMed

    Lipscomb, Martin

    2008-01-01

    Mixed method study designs are becoming increasingly popular among nurse researchers. Mixed studies can have advantages over single method or methodological investigative designs. However, these advantages may be squandered where researchers fail to think through and justify their theoretic decisions. This paper argues that nurse researchers do not always pay sufficient heed to the philosophic and theoretic elements of research design and, in consequence, some mixed study reports lack argumentative coherence and validity. It is here suggested that Hempel's concept of equivalence can be stretched to usefully illustrate one of the main threats to argumentative coherence in mixed study design. The critical realist theory of Roy Bhaskar is then introduced and this, it is proposed, offers one means by which Hempel's equivalence dilemma can be overcome. Critical realists recognize the existence of logical connections between the ontological, epistemological, and methodological premises that underpin their work. They are therefore more likely to produce coherent studies than uncritical pragmatists who ignore such linkages and, paradoxically, critical realists can be epistemological pluralists because, in re-conceptualizing the ontological basis of inquiry, problems associated with the mixing of alternative metaphysics are circumvented.

  19. Relating realist metatheory to issues of gender and mental health.

    PubMed

    Bergin, M; Wells, John S G; Owen, Sara

    2010-06-01

    This paper seeks to advance the debate that considers critical realism as an alternative approach for understanding gender and mental health and its relatedness to mental health research and practice. The knowledge base of how 'sex' and 'gender' affect mental health and illness is expanding. However, the way we conceptualize gender is significant and challenging as quite often our ability to think about 'gender' as independent of 'sex' is not common. The influences and interplay of how sex (biological) and gender (social) affect mental health and illness requires consideration. Critical realism suggests a shared ontology and epistemology for the natural and social sciences. While much of the debate surrounding gender is guided within a constructivist discourse, an exploration of the concept 'gender' is reflected on and some key realist propositions are considered for mental health research and practice. This is achieved through the works of some key realist theorists. Critical realism offers potential for research and practice in relation to gender and mental health because it facilitates changes in our understanding, while simultaneously, not discarding that which is already known. In so doing, it allows the biological (sex) and social (gender) domains of knowledge for mental health and illness to coexist, without either being reduced to or defined by the other. Arguably, greater depth and explanations for gender and mental health issues are presented within a realist metatheory.

  20. Emergency contraception.

    PubMed

    Van Look, P F; von Hertzen, H

    1993-01-01

    The term 'emergency contraception', as employed in this paper, refers to methods that are used as emergency procedures to prevent pregnancy following unprotected intercourse. Alternative, less appropriate, terms are postcoital and 'morning-after' contraception. References to postcoital preparations can be found as far back as 1500 BC in Egyptian papyri, but it was not until fairly recently that contraceptive research has been able to at least partially fulfill that need. The development of hormonal methods of emergency contraception goes back to the 1960s when the first human trials of postcoitally administered high-dose oestrogens were undertaken. Combined oestrogen- progestogen combination therapy (the so-called Yuzpe regimen) was introduced in the early 1970s, while the postcoital insertion of an intrauterine contraceptive device (IUD) for emergency contraception was first reported in 1976. Other compounds that have been tested more recently include levonorgestrel, the antiprogestogen mifepristone, and danazol. Although there is some debate about the magnitude of the protective effect, few people question the important role that emergency contraception can play in preventing unwanted pregnancy and hence maternal mortality and morbidity resulting from unsafe abortion. Given that the most often used methods of emergency contraception, namely the Yuzpe regimen and postcoital insertion of an IUD, rely on technology that has been available for some 30 years, family planning programmes that claim to be concerned with improving women's reproductive health, cannot really be excused if they do not provide emergency contraception as part of their routine services.

  1. Swimming Emergencies

    PubMed Central

    Beerman, Stephen B.

    1988-01-01

    Persons who have undergone swimming emergencies are seen in emergency departments everywhere. They are frequently young healthy citizens. In some instances they will receive better care in large specialized referral hospitals. Other problems can be managed well at local facilities. This article attempts to equip all family physicians with some knowledge and management guidelines for dealing with swimming emergencies, submersion injuries including near-drowning, accidental hypothermia, and triathalon hypothermia. The unique problems of hot tub near-drowning, infant water intoxication, and spinal injuries caused by diving are presented. PMID:21253260

  2. Biophysically realistic filament bending dynamics in agent-based biological simulation.

    PubMed

    Alberts, Jonathan B

    2009-01-01

    An appealing tool for study of the complex biological behaviors that can emerge from networks of simple molecular interactions is an agent-based, computational simulation that explicitly tracks small-scale local interactions--following thousands to millions of states through time. For many critical cell processes (e.g. cytokinetic furrow specification, nuclear centration, cytokinesis), the flexible nature of cytoskeletal filaments is likely to be critical. Any computer model that hopes to explain the complex emergent behaviors in these processes therefore needs to encode filament flexibility in a realistic manner. Here I present a numerically convenient and biophysically realistic method for modeling cytoskeletal filament flexibility in silico. Each cytoskeletal filament is represented by a series of rigid segments linked end-to-end in series with a variable attachment point for the translational elastic element. This connection scheme allows an empirically tuning, for a wide range of segment sizes, viscosities, and time-steps, that endows any filament species with the experimentally observed (or theoretically expected) static force deflection, relaxation time-constant, and thermal writhing motions. I additionally employ a unique pair of elastic elements--one representing the axial and the other the bending rigidity- that formulate the restoring force in terms of single time-step constraint resolution. This method is highly local -adjacent rigid segments of a filament only interact with one another through constraint forces-and is thus well-suited to simulations in which arbitrary additional forces (e.g. those representing interactions of a filament with other bodies or cross-links / entanglements between filaments) may be present. Implementation in code is straightforward; Java source code is available at www.celldynamics.org.

  3. Emergency Response

    EPA Pesticide Factsheets

    Information for first responders, industry, federal, state and local governments on EPA's role and available resources for response to oil spills, chemical, biological, radiological releases, and large-scale national emergencies.

  4. Emerging Issues.

    ERIC Educational Resources Information Center

    Carter, Denise

    1988-01-01

    Youth services programs and cholesterol in children's diets, two topics that may emerge as issues in schools and school districts in the near future, are addressed. Resources for further information are listed. (CB)

  5. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

    PubMed Central

    Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

    2015-01-01

    Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress. PMID:26374468

  6. Evaluation of Meropenem Regimens Suppressing Emergence of Resistance in Acinetobacter baumannii with Human Simulated Exposure in an In Vitro Intravenous-Infusion Hollow-Fiber Infection Model

    PubMed Central

    Li, Xin; Wang, Lin; Zhang, Xian-Jia; Yang, Yang; Gong, Wei-Tao; Xu, Bin; Zhu, Ying-Qun

    2014-01-01

    The emergence of resistance to carbapenems in Pseudomonas aeruginosa can be suppressed by optimizing the administration of meropenem. However, whether the same is true for Acinetobacter baumannii is not fully understood. We assessed the bactericidal activity of meropenem and its potency to suppress the emergence of resistance in A. baumannii with human simulated exposure in an in vitro intravenous-infusion hollow-fiber infection model (HFIM). Two clinical strains of carbapenem-susceptible multidrug-resistant A. baumannii (CS-MDRAB), CSRA24 and CSRA91, were used, and their MICs and mutant prevention concentrations (MPCs) were determined. Six meropenem dosage regimens (0.5, 1.0, or 2.0 g given every 8 h [q8h] with a 0.5-h or 3-h infusion for seven consecutive days) were simulated and then evaluated in the HFIM. Both the total population and resistant subpopulations of the two strains were quantified. Drug concentrations were measured by high-performance liquid chromatography. All dosage regimens, except for the lowest dosage (0.5 g for both the 0.5-h and 3-h infusions), showed 3-log CFU/ml bacterial killing. Dosage regimens of 2.0 g with 0.5-h and 3-h infusions exhibited an obvious bactericidal effect and suppressed resistance. Selective amplification of subpopulations with reduced susceptibility to meropenem was suppressed with a percentage of the dosage interval in which meropenem concentrations exceeded the MPC (T>MPC) of ≥20% or with a ratio of T>MPC to the percentage of the dosage interval in which drug concentrations are within the mutant selection window of ≥0.25. Our in vitro data support the use of a high dosage of meropenem (2.0 g q8h) for the treatment of severe infection caused by CS-MDRAB. PMID:25182633

  7. Emergency contraception.

    PubMed

    Grimes, David A; Raymond, Elizabeth G

    2002-08-06

    Emergency contraception is used to prevent pregnancy after a coital act not adequately protected by a regular method of contraception. In contrast to early medical abortion, emergency contraception prevents a pregnancy from starting and does not disrupt an established pregnancy. The most commonly used approaches consist of two oral doses of contraceptive steroids. The levonorgestrel-only regimen (levonorgestrel, 0.75 mg, repeated in 12 hours) appears to be more effective and better tolerated than the Yuzpe regimen (ethinyl estradiol, 100 microg, and levonorgestrel, 0.5 mg, repeated in 12 hours). In the largest randomized, controlled trial to date, levonorgestrel prevented about 85% of pregnancies that would have occurred without its use. Hormonal emergency contraception has no known medical contraindications, although it is not indicated for suspected or confirmed pregnancy. However, if hormonal emergency contraception is inadvertently taken in early pregnancy, neither the woman nor the fetus will be harmed. Nausea and vomiting associated with the Yuzpe regimen can be reduced by prophylactic use of meclizine. A strong medical and legal case exists for making hormonal emergency contraception available over the counter, as has happened in countries other than the United States. Easier access to and wider use of emergency contraception could dramatically lower the high rates of unintended pregnancy and induced abortion in the United States.

  8. Anorectal emergencies

    PubMed Central

    Lohsiriwat, Varut

    2016-01-01

    Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up. PMID:27468181

  9. Anorectal emergencies.

    PubMed

    Lohsiriwat, Varut

    2016-07-14

    Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.

  10. Emergency contraception.

    PubMed

    1994-01-01

    Two oral postcoital contraceptive agents are currently available. The first is a 2 x 2 pill; the second is a 5 x 5. Both release a higher dose of hormones than conventional contraceptive pills. Success rates range between 96% and 99%. They must be taken within 72 hours of intercourse. Side effects include nausea and vomiting. Contraindications are the same as for the common oral contraceptives. The contraceptive mode of action can be any of the following: 1) by making the lining of the uterus unreceptive; 2) by slowing the movement of the egg in the fallopian tube; or 3) by affecting the release of the egg. Emergency contraceptive pills have no effect once implantation takes place. The IUD can be used as an emergency postcoital contraceptive method if placed within 10 days of coitus. They are usually placed within 5-7 days because of laws regarding when birth control becomes abortion. One failure has been reported in Great Britain (December, 1993). Side effects are the same as with regular use. RU486/PG may be used in the future as an emergency contraceptive agent. Research is in progress on success rates and side effects. This agent could potentially be used at any time. Currently, emergency contraception can only be obtained by prescription. Limited hours and interrogating staff are obstacles in such emergencies. British women's groups are asking that emergency oral contraceptive pills be made available over the counter with advice from the pharmacist.

  11. Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.

    PubMed

    Stern, Robert A; Seichepine, Daniel; Tschoe, Christine; Fritts, Nathan G; Alosco, Michael L; Berkowitz, Oren; Burke, Peter; Howland, Jonathan; Olshaker, Jonathan; Cantu, Robert C; Baugh, Christine M; Holsapple, James W

    2017-02-15

    Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.

  12. Low resolution brain electromagnetic tomography in a realistic geometry head model: a simulation study

    NASA Astrophysics Data System (ADS)

    Ding, Lei; Lai, Yuan; He, Bin

    2005-01-01

    It is of importance to localize neural sources from scalp recorded EEG. Low resolution brain electromagnetic tomography (LORETA) has received considerable attention for localizing brain electrical sources. However, most such efforts have used spherical head models in representing the head volume conductor. Investigation of the performance of LORETA in a realistic geometry head model, as compared with the spherical model, will provide useful information guiding interpretation of data obtained by using the spherical head model. The performance of LORETA was evaluated by means of computer simulations. The boundary element method was used to solve the forward problem. A three-shell realistic geometry (RG) head model was constructed from MRI scans of a human subject. Dipole source configurations of a single dipole located at different regions of the brain with varying depth were used to assess the performance of LORETA in different regions of the brain. A three-sphere head model was also used to approximate the RG head model, and similar simulations performed, and results compared with the RG-LORETA with reference to the locations of the simulated sources. Multi-source localizations were discussed and examples given in the RG head model. Localization errors employing the spherical LORETA, with reference to the source locations within the realistic geometry head, were about 20-30 mm, for four brain regions evaluated: frontal, parietal, temporal and occipital regions. Localization errors employing the RG head model were about 10 mm over the same four brain regions. The present simulation results suggest that the use of the RG head model reduces the localization error of LORETA, and that the RG head model based LORETA is desirable if high localization accuracy is needed.

  13. HackAttack: Game-Theoretic Analysis of Realistic Cyber Conflicts

    SciTech Connect

    Ferragut, Erik M; Brady, Andrew C; Brady, Ethan J; Ferragut, Jacob M; Ferragut, Nathan M; Wildgruber, Max C

    2016-01-01

    Game theory is appropriate for studying cyber conflict because it allows for an intelligent and goal-driven adversary. Applications of game theory have led to a number of results regarding optimal attack and defense strategies. However, the overwhelming majority of applications explore overly simplistic games, often ones in which each participant s actions are visible to every other participant. These simplifications strip away the fundamental properties of real cyber conflicts: probabilistic alerting, hidden actions, unknown opponent capabilities. In this paper, we demonstrate that it is possible to analyze a more realistic game, one in which different resources have different weaknesses, players have different exploits, and moves occur in secrecy, but they can be detected. Certainly, more advanced and complex games are possible, but the game presented here is more realistic than any other game we know of in the scientific literature. While optimal strategies can be found for simpler games using calculus, case-by-case analysis, or, for stochastic games, Q-learning, our more complex game is more naturally analyzed using the same methods used to study other complex games, such as checkers and chess. We define a simple evaluation function and employ multi-step searches to create strategies. We show that such scenarios can be analyzed, and find that in cases of extreme uncertainty, it is often better to ignore one s opponent s possible moves. Furthermore, we show that a simple evaluation function in a complex game can lead to interesting and nuanced strategies.

  14. Analytical theory of extraordinary optical transmission through realistic metallic screens.

    PubMed

    Delgado, V; Marqués, R; Jelinek, L

    2010-03-29

    An analytical theory of extraordinary optical transmission (EOT) through realistic metallic screens perforated by a periodic array of subwavelength holes is presented. The theory is based on our previous work on EOT through perfect conducting screens and on the surface impedance concept. The proposed theory is valid for the complete frequency range where EOT has been reported, including microwaves and optics. A reasonably good agreement with electromagnetic simulations is shown in all this frequency range. We feel that the proposed theory may help to clarify the physics underlying EOT and serve as a first step to more accurate analysis.

  15. Photoabsorption on He4 with a Realistic Nuclear Force

    NASA Astrophysics Data System (ADS)

    Gazit, Doron; Bacca, Sonia; Barnea, Nir; Leidemann, Winfried; Orlandini, Giuseppina

    2006-03-01

    The He4 total photoabsorption cross section is calculated with the realistic nucleon-nucleon potential Argonne V18 and the three-nucleon force (3NF) Urbana IX. Final state interaction is included rigorously via the Lorentz integral transform method. A rather pronounced giant resonance with peak cross sections of 3.0 (3.2) mb is obtained with (without) the 3NF. Above 50 MeV strong 3NF effects, up to 35%, are present. Good agreement with experiment is found close to threshold. A comparison in the giant resonance region is inconclusive, since data do not show a unique picture.

  16. Optical Communications Performance with Realistic Weather and Automated Repeat Query

    NASA Astrophysics Data System (ADS)

    Clare, L.; Miles, G.; Breidenthal, J.

    2016-05-01

    Deep-space optical communications are subject to outages arising from deterministic clear line-of-sight dynamics as well as unpredictable weather effects at the ground station. These effects can be mitigated using buffering and automatic retransmission techniques. We provide an analysis that incorporates a realistic weather model based on a two-state Markov chain. Performance for a hypothetical Mars 2022 optical mission is derived incorporating dynamics over an entire 728-day synodic cycle, during which link passes and link data rate vary. Buffer sizing is addressed and operational implications are identified. Also, buffer occupancy results are extended for deep-space missions spanning a range of link data rates.

  17. Recovering the quantum formalism from physically realist axioms.

    PubMed

    Auffèves, Alexia; Grangier, Philippe

    2017-03-03

    We present a heuristic derivation of Born's rule and unitary transforms in Quantum Mechanics, from a simple set of axioms built upon a physical phenomenology of quantization. This approach naturally leads to the usual quantum formalism, within a new realistic conceptual framework that is discussed in details. Physically, the structure of Quantum Mechanics appears as a result of the interplay between the quantized number of "modalities" accessible to a quantum system, and the continuum of "contexts" that are required to define these modalities. Mathematically, the Hilbert space structure appears as a consequence of a specific "extra-contextuality" of modalities, closely related to the hypothesis of Gleason's theorem, and consistent with its conclusions.

  18. Turbulence studies in Tokamak boundary plasmas with realistic divertor geometry

    SciTech Connect

    Xu, X.Q.

    1998-10-14

    Results are presented from the 3D nonlocal electromagnetic turbulence code BOUT [1] and the linearized shooting code BAL[2] to study turbulence in tokamak boundary plasmas and its relationship to the L-H transition, in a realistic divertor plasma geometry. The key results include: (1) the identification of the dominant, resistive X-point mode in divertor geometry and (2) turbulence suppression in the L-H transition by shear in the ExB drift speed, ion diamagnetism and finite polarization. Based on the simulation results, a parameterization of the transport is given that includes the dependence on the relevant physical parameters.

  19. A continuous family of realistic Susy SU(5) GUTs

    NASA Astrophysics Data System (ADS)

    Bajc, Borut

    2016-06-01

    It is shown that the minimal renormalizable supersymmetric SU(5) is still realistic providing the supersymmetric scale is at least few tens of TeV or large R-parity violating terms are considered. In the first case the vacuum is metastable, and different consistency constraints can give a bounded allowed region in the tan β - msusy plane. In the second case the mass eigenstate electron (down quark) is a linear combination of the original electron (down quark) and Higgsino (heavy colour triplet), and the mass ratio of bino and wino is determined. Both limits lead to light gravitino dark matter.

  20. Realistic modeling of the electronic properties of doped amorphous silicon

    SciTech Connect

    Hack, M.; Street, R.A.

    1988-09-19

    In this letter we describe a fundamental approach to calculating the electronic properties of doped amorphous silicon which takes into account the thermal history of the material. Above the equilibrium temperature, the material is in a thermodynamically stable state, and this is derived by minimizing the free energy using a simple density of states model. The calculations are based on the defect compensation model of doping, introducing distributions of formation energies for neutral dangling bonds and fourfold dopant atoms while preserving charge neutrality. Our results are in good agreement with experimental data providing a realistic model for use in device simulation programs.

  1. Cold fusion in palladium: a more realistic calculation.

    PubMed

    Parmenter, R H; Lamb, W E

    1990-11-01

    The Thomas-Fermi-Mott equation is modified to take account of the fact that conduction electrons in a metal may be considered to have an effective mass at wave-numbers comparable with or less than the inverse Debye screening length, but they should be considered to have the free-electron mass at much larger wavenumbers. This modification allows for a more realistic calculation of the fusion rate of deuteron pairs in palladium, this rate being 10(-23) sec-1, comparable with some experimental results. The Oppenheimer-Phillips process enhances the rate by a factor of 2.262.

  2. Measurement of automobile exhaust emissions under realistic road conditions

    SciTech Connect

    Staab, J.; Schurmann, D.

    1987-01-01

    An exhaust gas measurement system for on-board use has been developed, which enables the direct and continuous determination of the exhaust mass emissions in vehicles on the road. Such measurements under realistic traffic conditions are a valuable supplement to measurements taken on test benches, the latter, however, still being necessary. In the last two years numerous test runs were undertaken. The reliability of the on-board system could be demonstrated and a very informative view of the exhaust emissions behavior of a vehicle on the road was obtained from the test results.

  3. Arresting HIV: Fostering Partnerships between Sex Workers and Police to Reduce HIV Risk and Promote Professionalization within Policing Institutions: A Realist Review.

    PubMed

    Tenni, Brigitte; Carpenter, Jenae; Thomson, Nicholas

    2015-01-01

    In many countries around the world sex work is criminalised and its regulatory control is therefore often in the hands of the police. In addition to the impact of this criminalised legal environment, much literature describes the negative impact that certain police practices can have on the ability of sex workers and the programs that work with sex workers to access essential HIV prevention, treatment, care and support services. This situation has resulted in persistent concentrated HIV epidemics among sex workers in many countries of the world. The need for multi-sector partnerships between police and HIV programs is increasingly recognised in various UN declarations and resolutions yet descriptions of the process or key ingredients required to actually establish and sustain these necessary partnerships between police and sex workers [or the programs that provide essential services to sex workers] are sparse. The paper seeks to establish key considerations and critical processes that are required to foster partnerships that if further investigated and scaled up, could result in an enhanced enabling environment for the provision of essential HIV services for sex workers around the globe. This paper is based on a realist review that investigated isolated examples of partnership formation between law enforcement and HIV programs working with sex workers. This methodology research is designed to work with complex social interventions and is based on the emerging 'realist' approach to evaluation. A realist review methodology was chosen given the paucity of relevant literature in this vein and the authors' familiarity with the grey literature and relationships with experts who work in this sphere. The review found that political and police leadership, civil society strengthening and police reform in relation to HIV, are critical factors and key ingredients in changing the enabling environment in which sex work takes place to ensure that HIV prevention, individual and

  4. Arresting HIV: Fostering Partnerships between Sex Workers and Police to Reduce HIV Risk and Promote Professionalization within Policing Institutions: A Realist Review

    PubMed Central

    Tenni, Brigitte; Carpenter, Jenae; Thomson, Nicholas

    2015-01-01

    In many countries around the world sex work is criminalised and its regulatory control is therefore often in the hands of the police. In addition to the impact of this criminalised legal environment, much literature describes the negative impact that certain police practices can have on the ability of sex workers and the programs that work with sex workers to access essential HIV prevention, treatment, care and support services. This situation has resulted in persistent concentrated HIV epidemics among sex workers in many countries of the world. The need for multi-sector partnerships between police and HIV programs is increasingly recognised in various UN declarations and resolutions yet descriptions of the process or key ingredients required to actually establish and sustain these necessary partnerships between police and sex workers [or the programs that provide essential services to sex workers] are sparse. The paper seeks to establish key considerations and critical processes that are required to foster partnerships that if further investigated and scaled up, could result in an enhanced enabling environment for the provision of essential HIV services for sex workers around the globe. This paper is based on a realist review that investigated isolated examples of partnership formation between law enforcement and HIV programs working with sex workers. This methodology research is designed to work with complex social interventions and is based on the emerging 'realist' approach to evaluation. A realist review methodology was chosen given the paucity of relevant literature in this vein and the authors’ familiarity with the grey literature and relationships with experts who work in this sphere. The review found that political and police leadership, civil society strengthening and police reform in relation to HIV, are critical factors and key ingredients in changing the enabling environment in which sex work takes place to ensure that HIV prevention, individual and

  5. Outcomes and Costs of Poisoned Patients Admitted to an Adult Emergency Department of a Spanish Tertiary Hospital: Evaluation through a Toxicovigilance Program

    PubMed Central

    Quintana, Manuel; Martínez, Ana; Carcas, Antonio J.

    2016-01-01

    Abstract Toxicovigilance is the active process of identifying and evaluating the toxic risks existing in a community, and evaluating the measures taken to reduce or eliminate them. Objective Through a validated toxicovigilance program (SAT-HULP) we examined the characteristics of acute poisoning cases (APC) attended in the Emergency Department (ED) of La Paz Hospital (Madrid, Spain) and assessed their economic impact on the health system. Material and Methods The active poisoning surveillance system performs a daily search for cases in the hospital´s computerized case records. Found cases are entered into a database for recording of type of poisoning episode, reasons for exposure, causative agent, signs and symptoms and treatment. We carried out a cross-sectional epidemiological study with analytical projection, based on an impact study on cost per survivor. The data for the costs attributable to cases of APC observed at HULP (outpatients and inpatients) was obtained from the based on the information provided by the diagnosis-related groups (DRG) through the corresponding hospital discharge reports (available through SAT-HULP). Results During the first 30 month of SAT-HULP operation we found a total of 3,195 APC, a cumulative incidence rate of 1.75% of patients attended in the ED. The mean (SD) patient age was 40.9 (17.8) years and 51.2% were men. Drug abuse accounted for 47.5% of the cases. Suicide attempt was the second most frequent category (38.1%) and other causes accounted for 14.5% of APC. The total cost of hospital care for our hospital rose to €1,825,263.24 (approximately €730,105.30/year) resulting in a permanent occupation of 4 beds/year. Conclusions SAT-HULP constitutes a validated toxicovigilance tool, which continuously integrates available data in real-time and helps health services manage APC data flexibly, including the consumption of resources from the health system. PMID:27100460

  6. Abnormal lipoprotein(a) levels predict coronary artery calcification in Southeast Asians but not in Caucasians: use of noninvasive imaging for evaluation of an emerging risk factor.

    PubMed

    Sharma, Abhinav; Kasim, Manoefris; Joshi, Parag H; Qian, Zhen; Krivitsky, Eric; Akram, Kamran; Rinehart, Sarah; Vazquez, Gustavo; Miller, Joseph; Rohman, Mohammad Saifur; Voros, Szilard

    2011-08-01

    Subclinical atherosclerosis can be quantified by coronary artery calcium (CAC) scoring. Due to its high specificity for atherosclerosis, CAC is an excellent phenotypic tool for the evaluation of emerging risk markers. Lipoprotein(a) [Lp(a)] is atherogenic due to the presence of apoB and may be thrombogenic through its apo(a) component. Lp(a) has been linked to cardiovascular events in Caucasians; however, its link to atherosclerosis in various ethnicities remains unclear. We evaluated the ability of Lp(a) mass to predict subclinical atherosclerosis in Southeast Asians and Caucasians, as measured by CAC. Traditional lipid measurements, Lp(a) measurements, and CAC by 64-slice multidetector computed tomography was performed in 103 consecutive patients in the USA and in 104 consecutive patients in Jakarta, Indonesia. Proportion of positive CAC and median CAC in Southeast Asians and in Caucasians was 61.5% and 63.1%, and 23.5 (interquartile range, 0-270) and 13 (interquartile range, 0-388), respectively. Significantly higher proportion of Southeast Asians had elevated Lp(a) levels, compared to Caucasians (51.0% vs. 29.2%; p = 0.005). In Southeast Asians, Lp(a) remained an independent predictor of CAC with an odds ratio of 4.97 (95% confidence interval, 1.56-15.88; p < 0.0001), but not in Caucasians. Receiver operating characteristic analysis showed an improvement in area under the curve from 0.81 to 0.86 (p = 0.05) when including Lp(a) in the predictive model in Southeast Asians. This translated to 7% of Southeast Asians reclassified to correct CAC status. Lp(a) measurements may have a role in risk stratification of Southeast Asians. Ethnic variation should be taken into account when considering the use of Lp(a) measurements in risk assessment.

  7. Chernobyl nuclear accident hydrologic analysis and emergency evaluation of radionuclide distributions in the Dnieper River, Ukraine, during the 1993 summer flood

    SciTech Connect

    Voitsekhovitch, O.V.; Zheleznyak, M.J.; Onishi, Y.

    1994-06-01

    This report describes joint activities of Program 7.1.F, ``Radionuclide Transport in Water and Soil Systems,`` of the USA/Commonwealth of Independent States (CIS) Joint Coordinating Committee of Civilian Nuclear Reactor Safety to study the hydrogeochemical behavior of radionuclides released to the Pripyat and Dnieper rivers from the Chernobyl Nuclear Power Plant in Ukraine. These joint activities included rapid evaluation of radionuclide distributions in the Pripyat and Dnieper river system and field data evaluation and modeling for the 1993 summer flood to assist the Ukrainian government in their emergency response during the flood. In July-August 1993, heavy rainfall over the Pripyat River Catchment in Belarus and Ukraine caused severe flooding, significantly raising {sup 90}Sr concentrations in the river. Near the Chernobyl area, the maximum {sup 90}Sr concentration in the Pripyat River reached 20--25 PCi/L in early August; near the Pripyat River mouth, the concentration rose to 35 pCi/L. The peak {sup 90}Sr concentration in the Kiev Reservoir (a major source of drinking water for Kiev) was 12 pCi/L. Based on these measured radionuclide levels, additional modeling results and the assumption of water purification in a water treatment station, {sup 90}Sr concentrations in Kiev`s drinking water were estimated to be less than 8 pCi/L. Unlike {sup 90}Sr, {sup 137}Cs concentrations in the Pripyat River during the flood did not rise significantly to the pre-flood levels. Estimated {sup 137}Cs concentrations for the Kiev drinking water were two orders of magnitude lower than the drinking water standard of 500 pCi/L for {sup 137}Cs.

  8. Validation of a realistic simulator for veterinary gastrointestinal endoscopy training.

    PubMed

    Usón-Gargallo, Jesús; Usón-Casaús, Jesús M; Pérez-Merino, Eva M; Soria-Gálvez, Federico; Morcillo, Esther; Enciso, Silvia; Sánchez-Margallo, Francisco M

    2014-01-01

    This article reports on the face, content, and construct validity of a new realistic composite simulator (Simuldog) used to provide training in canine gastrointestinal flexible endoscopy. The basic endoscopic procedures performed on the simulator were esophagogastroduodenoscopy (EGD), gastric biopsy (GB), and gastric foreign body removal (FBR). Construct validity was assessed by comparing the performance of novices (final-year veterinary students and recent graduates without endoscopic experience, n=30) versus experienced subjects (doctors in veterinary medicine who had performed more than 50 clinical upper gastrointestinal endoscopic procedures as a surgeon, n=15). Tasks were scored based on completion time, and specific rating scales were developed to assess performance. Internal consistency and inter-rater agreement were assessed. Face and content validity were determined using a 5-point Likert-type scale questionnaire. The novices needed considerably more time than the experts to perform EGD, GB, and FBR, and their performance scores were significantly lower (p<.010). Inter-rater agreement and the internal validity of the rating scales were good. Face validity was excellent, and both groups agreed that the endoscopy scenarios were very realistic. The experts highly valued the usefulness of Simuldog for veterinary training and as a tool for assessing endoscopic skills. Simuldog is the first validated model specifically developed to be used as a training tool for endoscopy techniques in small animals.

  9. Neuronize: a tool for building realistic neuronal cell morphologies

    PubMed Central

    Brito, Juan P.; Mata, Susana; Bayona, Sofia; Pastor, Luis; DeFelipe, Javier; Benavides-Piccione, Ruth

    2013-01-01

    This study presents a tool, Neuronize, for building realistic three-dimensional models of neuronal cells from the morphological information extracted through computer-aided tracing applications. Neuronize consists of a set of methods designed to build 3D neural meshes that approximate the cell membrane at different resolution levels, allowing a balance to be reached between the complexity and the quality of the final model. The main contribution of the present study is the proposal of a novel approach to build a realistic and accurate 3D shape of the soma from the incomplete information stored in the digitally traced neuron, which usually consists of a 2D cell body contour. This technique is based on the deformation of an initial shape driven by the position and thickness of the first order dendrites. The addition of a set of spines along the dendrites completes the model, building a final 3D neuronal cell suitable for its visualization in a wide range of 3D environments. PMID:23761740

  10. CHARMM-GUI Membrane Builder toward realistic biological membrane simulations.

    PubMed

    Wu, Emilia L; Cheng, Xi; Jo, Sunhwan; Rui, Huan; Song, Kevin C; Dávila-Contreras, Eder M; Qi, Yifei; Lee, Jumin; Monje-Galvan, Viviana; Venable, Richard M; Klauda, Jeffery B; Im, Wonpil

    2014-10-15

    CHARMM-GUI Membrane Builder, http://www.charmm-gui.org/input/membrane, is a web-based user interface designed to interactively build all-atom protein/membrane or membrane-only systems for molecular dynamics simulations through an automated optimized process. In this work, we describe the new features and major improvements in Membrane Builder that allow users to robustly build realistic biological membrane systems, including (1) addition of new lipid types, such as phosphoinositides, cardiolipin (CL), sphingolipids, bacterial lipids, and ergosterol, yielding more than 180 lipid types, (2) enhanced building procedure for lipid packing around protein, (3) reliable algorithm to detect lipid tail penetration to ring structures and protein surface, (4) distance-based algorithm for faster initial ion displacement, (5) CHARMM inputs for P21 image transformation, and (6) NAMD equilibration and production inputs. The robustness of these new features is illustrated by building and simulating a membrane model of the polar and septal regions of E. coli membrane, which contains five lipid types: CL lipids with two types of acyl chains and phosphatidylethanolamine lipids with three types of acyl chains. It is our hope that CHARMM-GUI Membrane Builder becomes a useful tool for simulation studies to better understand the structure and dynamics of proteins and lipids in realistic biological membrane environments.

  11. Realistic simulation of the Space-borne Compton Polarimeter POLAR

    NASA Astrophysics Data System (ADS)

    Xiao, Hualin

    2016-07-01

    POLAR is a compact wide field space-borne detector dedicated for precise measurements of the linear polarization of hard x-rays emitted by transient sources. Its energy range sensitivity is optimized for the detection of the prompt emission of Gamma-ray bursts (GRBs). POLAR is developed by an international collaboration of China, Switzerland and Poland. It is planned to be launched into space in 2016 onboard the Chinese space laboratory TG2. The energy range of POLAR spans between 50 keV and 500 keV. POLAR detects gamma rays with an array of 1600 plastic scintillator bars read out by 25 muti-anode PMTs (MAPMTs). Polarization measurements use Compton scattering process and are based on detection of energy depositions in the scintillator bars. Reconstruction of the polarization degree and polarization angle of GRBs requires comparison of experimental modulation curves with realistic simulations of the full instrument response. In this paper we present a method to model and parameterize the detector response including efficiency of the light collection, contributions from crosstalk and non-uniformity of MAPMTs as well as dependency on low energy detection thresholds and noise from readout electronics. The performance of POLAR for determination of polarization is predicted with such realistic simulations and carefully cross-checked with dedicated laboratory tests.

  12. Unsteady transonic flow calculations for realistic aircraft configurations

    NASA Technical Reports Server (NTRS)

    Batina, John T.; Seidel, David A.; Bland, Samuel R.; Bennett, Robert M.

    1987-01-01

    A transonic unsteady aerodynamic and aeroelasticity code has been developed for application to realistic aircraft configurations. The new code is called CAP-TSD which is an acronym for Computational Aeroelasticity Program - Transonic Small Disturbance. The CAP-TSD code uses a time-accurate approximate factorization (AF) algorithm for solution of the unsteady transonic small-disturbance equation. The AF algorithm is very efficient for solution of steady and unsteady transonic flow problems. It can provide accurate solutions in only several hundred time steps yielding a significant computational cost savings when compared to alternative methods. The new code can treat complete aircraft geometries with multiple lifting surfaces and bodies including canard, wing, tail, control surfaces, launchers, pylons, fuselage, stores, and nacelles. Applications are presented for a series of five configurations of increasing complexity to demonstrate the wide range of geometrical applicability of CAP-TSD. These results are in good agreement with available experimental steady and unsteady pressure data. Calculations for the General Dynamics one-ninth scale F-16C aircraft model are presented to demonstrate application to a realistic configuration. Unsteady results for the entire F-16C aircraft undergoing a rigid pitching motion illustrated the capability required to perform transonic unsteady aerodynamic and aeroelastic analyses for such configurations.

  13. Modeling of Transmembrane Potential in Realistic Multicellular Structures before Electroporation.

    PubMed

    Murovec, Tomo; Sweeney, Daniel C; Latouche, Eduardo; Davalos, Rafael V; Brosseau, Christian

    2016-11-15

    Many approaches for studying the transmembrane potential (TMP) induced during the treatment of biological cells with pulsed electric fields have been reported. From the simple analytical models to more complex numerical models requiring significant computational resources, a gamut of methods have been used to recapitulate multicellular environments in silico. Cells have been modeled as simple shapes in two dimensions as well as more complex geometries attempting to replicate realistic cell shapes. In this study, we describe a method for extracting realistic cell morphologies from fluorescence microscopy images to generate the piecewise continuous mesh used to develop a finite element model in two dimensions. The preelectroporation TMP induced in tightly packed cells is analyzed for two sets of pulse parameters inspired by clinical irreversible electroporation treatments. We show that high-frequency bipolar pulse trains are better, and more homogeneously raise the TMP of tightly packed cells to a simulated electroporation threshold than conventional irreversible electroporation pulse trains, at the expense of larger applied potentials. Our results demonstrate the viability of our method and emphasize the importance of considering multicellular effects in the numerical models used for studying the response of biological tissues exposed to electric fields.

  14. Generation of anatomically realistic numerical phantoms for optoacoustic breast imaging

    NASA Astrophysics Data System (ADS)

    Lou, Yang; Mitsuhashi, Kenji; Appleton, Catherine M.; Oraevsky, Alexander; Anastasio, Mark A.

    2016-03-01

    Because optoacoustic tomography (OAT) can provide functional information based on hemoglobin contrast, it is a promising imaging modality for breast cancer diagnosis. Developing an effective OAT breast imaging system requires balancing multiple design constraints, which can be expensive and time-consuming. Therefore, computer- simulation studies are often conducted to facilitate this task. However, most existing computer-simulation studies of OAT breast imaging employ simple phantoms such as spheres or cylinders that over-simplify the complex anatomical structures in breasts, thus limiting the value of these studies in guiding real-world system design. In this work, we propose a method to generate realistic numerical breast phantoms for OAT research based on clinical magnetic resonance imaging (MRI) data. The phantoms include a skin layer that defines breast-air boundary, major vessel branches that affect light absorption in the breast, and fatty tissue and fibroglandular tissue whose acoustical heterogeneity perturbs acoustic wave propagation. By assigning realistic optical and acoustic parameters to different tissue types, we establish both optic and acoustic breast phantoms, which will be exported into standard data formats for cross-platform usage.

  15. Simulation of Combustion Systems with Realistic g-jitter

    NASA Technical Reports Server (NTRS)

    Mell, William E.; McGrattan, Kevin B.; Baum, Howard R.

    2003-01-01

    In this project a transient, fully three-dimensional computer simulation code was developed to simulate the effects of realistic g-jitter on a number of combustion systems. The simulation code is capable of simulating flame spread on a solid and nonpremixed or premixed gaseous combustion in nonturbulent flow with simple combustion models. Simple combustion models were used to preserve computational efficiency since this is meant to be an engineering code. Also, the use of sophisticated turbulence models was not pursued (a simple Smagorinsky type model can be implemented if deemed appropriate) because if flow velocities are large enough for turbulence to develop in a reduced gravity combustion scenario it is unlikely that g-jitter disturbances (in NASA's reduced gravity facilities) will play an important role in the flame dynamics. Acceleration disturbances of realistic orientation, magnitude, and time dependence can be easily included in the simulation. The simulation algorithm was based on techniques used in an existing large eddy simulation code which has successfully simulated fire dynamics in complex domains. A series of simulations with measured and predicted acceleration disturbances on the International Space Station (ISS) are presented. The results of this series of simulations suggested a passive isolation system and appropriate scheduling of crew activity would provide a sufficiently "quiet" acceleration environment for spherical diffusion flames.

  16. Realistic haptic rendering of interacting deformable objects in virtual environments.

    PubMed

    Duriez, Christian; Dubois, Frédéric; Kheddar, Abderrahmane; Andriot, Claude

    2006-01-01

    A new computer haptics algorithm to be used in general interactive manipulations of deformable virtual objects is presented. In multimodal interactive simulations, haptic feedback computation often comes from contact forces. Subsequently, the fidelity of haptic rendering depends significantly on contact space modeling. Contact and friction laws between deformable models are often simplified in up to date methods. They do not allow a "realistic" rendering of the subtleties of contact space physical phenomena (such as slip and stick effects due to friction or mechanical coupling between contacts). In this paper, we use Signorini's contact law and Coulomb's friction law as a computer haptics basis. Real-time performance is made possible thanks to a linearization of the behavior in the contact space, formulated as the so-called Delassus operator, and iteratively solved by a Gauss-Seidel type algorithm. Dynamic deformation uses corotational global formulation to obtain the Delassus operator in which the mass and stiffness ratio are dissociated from the simulation time step. This last point is crucial to keep stable haptic feedback. This global approach has been packaged, implemented, and tested. Stable and realistic 6D haptic feedback is demonstrated through a clipping task experiment.

  17. Diffusive and dynamical radiating stars with realistic equations of state

    NASA Astrophysics Data System (ADS)

    Brassel, Byron P.; Maharaj, Sunil D.; Goswami, Rituparno

    2017-03-01

    We model the dynamics of a spherically symmetric radiating dynamical star with three spacetime regions. The local internal atmosphere is a two-component system consisting of standard pressure-free, null radiation and an additional string fluid with energy density and nonzero pressure obeying all physically realistic energy conditions. The middle region is purely radiative which matches to a third region which is the Schwarzschild exterior. A large family of solutions to the field equations are presented for various realistic equations of state. We demonstrate that it is possible to obtain solutions via a direct integration of the second order equations resulting from the assumption of an equation of state. A comparison of our solutions with earlier well known results is undertaken and we show that all these solutions, including those of Husain, are contained in our family. We then generalise our class of solutions to higher dimensions. Finally we consider the effects of diffusive transport and transparently derive the specific equations of state for which this diffusive behaviour is possible.

  18. Toward the classification of the realistic free fermionic models

    SciTech Connect

    Faraggi, A.E.

    1997-08-01

    The realistic free fermionic models have had remarkable success in providing plausible explanations for various properties of the Standard Model which include the natural appearance of three generations, the explanation of the heavy top quark mass and the qualitative structure of the fermion mass spectrum in general, the stability of the proton and more. These intriguing achievements makes evident the need to understand the general space of these models. While the number of possibilities is large, general patterns can be extracted. In this paper the author presents a detailed discussion on the construction of the realistic free fermionic models with the aim of providing some insight into the basic structures and building blocks that enter the construction. The role of free phases in the determination of the phenomenology of the models is discussed in detail. The author discusses the connection between the free phases and mirror symmetry in (2,2) models and the corresponding symmetries in the case of (2,0) models. The importance of the free phases in determining the effective low energy phenomenology is illustrated in several examples. The classification of the models in terms of boundary condition selection rules, real world-sheet fermion pairings, exotic matter states and the hidden sector is discussed.

  19. Radiation-Spray Coupling for Realistic Flow Configurations

    NASA Technical Reports Server (NTRS)

    El-Asrag, Hossam; Iannetti, Anthony C.

    2011-01-01

    Three Large Eddy Simulations (LES) for a lean-direct injection (LDI) combustor are performed and compared. In addition to the cold flow simulation, the effect of radiation coupling with the multi-physics reactive flow is analyzed. The flame let progress variable approach is used as a subgrid combustion model combined with a stochastic subgrid model for spray atomization and an optically thin radiation model. For accurate chemistry modeling, a detailed Jet-A surrogate mechanism is utilized. To achieve realistic inflow, a simple recycling technique is performed at the inflow section upstream of the swirler. Good comparison is shown with the experimental data mean and root mean square profiles. The effect of combustion is found to change the shape and size of the central recirculation zone. Radiation is found to change the spray dynamics and atomization by changing the heat release distribution and the local temperature values impacting the evaporation process. The simulation with radiation modeling shows wider range of droplet size distribution by altering the evaporation rate. The current study proves the importance of radiation modeling for accurate prediction in realistic spray combustion configurations, even for low pressure systems.

  20. A general realistic treatment of the disk paradox

    NASA Astrophysics Data System (ADS)

    Pantazis, George; Perivolaropoulos, Leandros

    2017-01-01

    Mechanical angular momentum is not conserved in systems involving electromagnetic fields with non-zero electromagnetic field angular momentum. Conservation is restored only if the total (mechanical and field) angular momentum is considered. Previous studies have investigated this effect, known as ‘Feynman’s Electromagnetic Paradox’ or simply ‘Disk Paradox’ in the context of idealized systems (infinite or infinitesimal solenoids and charged cylinders etc). In the present analysis we generalize previous studies by considering more realistic systems with finite components and demonstrating explicitly the conservation of the total angular momentum. This is achieved by expressing both the mechanical and the field angular momentum in terms of charges and magnetic field fluxes through various system components. Using this general expression and the closure of magnetic field lines, we demonstrate explicitly the conservation of total angular momentum in both idealized and realistic systems (finite solenoid concentric with two charged cylinders, much longer than the solenoid) taking all the relevant terms into account including the flux outside of the solenoid. This formalism has the potential to facilitate a simpler and more accurate demonstration of total angular momentum conservation in undergraduate physics electromagnetism laboratories.