Parallel Reaction Monitoring: A Targeted Experiment Performed Using High Resolution and High Mass Accuracy Mass Spectrometry

PubMed Central

Rauniyar, Navin

2015-01-01

The parallel reaction monitoring (PRM) assay has emerged as an alternative method of targeted quantification. The PRM assay is performed in a high resolution and high mass accuracy mode on a mass spectrometer. This review presents the features that make PRM a highly specific and selective method for targeted quantification using quadrupole-Orbitrap hybrid instruments. In addition, this review discusses the label-based and label-free methods of quantification that can be performed with the targeted approach. PMID:26633379

The nature of excellent clinicians at an academic health science center: a qualitative study.

PubMed

Mahant, Sanjay; Jovcevska, Vesna; Wadhwa, Anupma

2012-12-01

To understand the nature of excellent clinicians at an academic health science center by exploring how and why excellent clinicians achieve high performance. From 2008 to 2010, the authors conducted a qualitative study using a grounded theory approach. Members of the Clinical Advisory Committee in the Department of Pediatrics at the University of Toronto nominated peers whom they saw as excellent clinicians. The authors then conducted in-depth interviews with the most frequently nominated clinicians. They audio-recorded and transcribed the interviews and coded the transcripts to identify emergent themes. From interviews with 13 peer-nominated, excellent clinicians, a model emerged. Dominant themes fell into three categories: (1) core philosophy, (2) deliberate activities, and (3) everyday practice. Excellent clinicians are driven by a core philosophy defined by high intrinsic motivation and passion for patient care and humility. They refine their clinical skills through two deliberate activities-reflective clinical practice and scholarship. Their high performance in everyday practice is characterized by clinical skills and cognitive ability, people skills, engagement, and adaptability. A rich theory emerged explaining how excellent clinicians, driven by a core philosophy and engaged in deliberate activities, achieve high performance in everyday practice. This theory of the nature of excellent clinicians provides a holistic perspective of individual performance, informs medical education, supports faculty career development, and promotes clinical excellence in the culture of academic medicine.

High Performance Work Organizations. Myths and Realities.

ERIC Educational Resources Information Center

Kerka, Sandra

Organizations are being urged to become "high performance work organizations" (HPWOs) and vocational teachers have begun considering how best to prepare workers for them. Little consensus exists as to what HPWOs are. Several common characteristics of HPWOs have been identified, and two distinct models of HPWOs are emerging in the United…

Teamwork skills in actual, in situ, and in-center pediatric emergencies: performance levels across settings and perceptions of comparative educational impact.

PubMed

Couto, Thomaz Bittencourt; Kerrey, Benjamin T; Taylor, Regina G; FitzGerald, Michael; Geis, Gary L

2015-04-01

Pediatric emergencies require effective teamwork. These skills are developed and demonstrated in actual emergencies and in simulated environments, including simulation centers (in center) and the real care environment (in situ). Our aims were to compare teamwork performance across these settings and to identify perceived educational strengths and weaknesses between simulated settings. We hypothesized that teamwork performance in actual emergencies and in situ simulations would be higher than for in-center simulations. A retrospective, video-based assessment of teamwork was performed in an academic, pediatric level 1 trauma center, using the Team Emergency Assessment Measure (TEAM) tool (range, 0-44) among emergency department providers (physicians, nurses, respiratory therapists, paramedics, patient care assistants, and pharmacists). A survey-based, cross-sectional assessment was conducted to determine provider perceptions regarding simulation training. One hundred thirty-two videos, 44 from each setting, were reviewed. Mean total TEAM scores were similar and high in all settings (31.2 actual, 31.1 in situ, and 32.3 in-center, P = 0.39). Of 236 providers, 154 (65%) responded to the survey. For teamwork training, in situ simulation was considered more realistic (59% vs. 10%) and more effective (45% vs. 15%) than in-center simulation. In a video-based study in an academic pediatric institution, ratings of teamwork were relatively high among actual resuscitations and 2 simulation settings, substantiating the influence of simulation-based training on instilling a culture of communication and teamwork. On the basis of survey results, providers favored the in situ setting for teamwork training and suggested an expansion of our existing in situ program.

Planning for Emergencies: A Guide for People with Chronic Kidney Disease

MedlinePlus

... 3. Continue to limit calcium and high-phosphorus products and maintain phosphate binder regimen. If you are unable to perform as many exchanges as usual, then follow the basic guidelines as listed in this emergency guideline, including limiting fluid and ... there anything else I ...

Jetting from impact of a spherical drop with a deep layer

NASA Astrophysics Data System (ADS)

Zhang, Li; Toole, Jameson; Fazzaa, Kamel; Deegan, Robert; Deegan Group Team; X-Ray Science Division, Advanced Photon Source Collaboration

2011-11-01

We performed an experimental study of jets during the impact of a spherical drop with a deep layer of same liquid. Using high speed optical and X-ray imaging, we observe two types of jets: the so-called ejecta sheet which emerges almost immediately after impact and the lamella which emerges later. For high Reynolds number the two jets are distinct, while for low Reynolds number the two jets combine into a single continuous jet. We also measured the emergence time, speed, and position of the ejecta sheet and found simple scaling relations for these quantities.

Umbilical paracentesis for incarcerated umbilical hernia in patients with end-stage liver disease.

PubMed

Alonso, S; Donat, M; Carrion, L; Rodriguez, J M; Diego, L; Acin, D; Serrano, A; Perez, E; Pereira, F

2016-08-01

Patients with cirrhosis and ascites are prone to abdominal wall complications largely predominate by umbilical hernia. Elective surgery is indicated in select patients but a high morbidity and mortality rate occurs if it is performed in emergency conditions. We present a clinical case of a patient with advanced alcoholic liver disease who came to the emergency room for an acutely incarcerated umbilical hernia. Due to the high surgical risk, we had to discuss other treatment options. The use of umbilical paracentesis for incarcerated hernia reduction in cirrhotic patients with tense ascites is a safe and reproducible technique. Umbilical paracentesis could be considered as an alternative to emergency surgery in these high-risk patients.

Aircraft Emergencies: Challenge and Response

NASA Technical Reports Server (NTRS)

Burian, Barbara K.

2010-01-01

Emergency and abnormal situations in aviation present flight crews with a number of challenges. Checklists are essential tools that have been developed to assist them to meet these challenges. However, in order for checklists to be most effective in these situations they must be designed with the operational and situational demands of emergencies and abnormal conditions in mind as well as human performance capabilities and limitations under high stress and workload.

Development of an Assessment for Entrustable Professional Activity (EPA) 10: Emergent Patient Management.

PubMed

Thompson, Laura R; Leung, Cynthia G; Green, Brad; Lipps, Jonathan; Schaffernocker, Troy; Ledford, Cynthia; Davis, John; Way, David P; Kman, Nicholas E

2017-01-01

Medical schools in the United States are encouraged to prepare and certify the entrustment of medical students to perform 13 core entrustable professional activities (EPAs) prior to graduation. Entrustment is defined as the informed belief that the learner is qualified to autonomously perform specific patient-care activities. Core EPA-10 is the entrustment of a graduate to care for the emergent patient. The purpose of this project was to design a realistic performance assessment method for evaluating fourth-year medical students on EPA-10. First, we wrote five emergent patient case-scenarios that a medical trainee would likely confront in an acute care setting. Furthermore, we developed high-fidelity simulations to realistically portray these patient case scenarios. Finally, we designed a performance assessment instrument to evaluate the medical student's performance on executing critical actions related to EPA-10 competencies. Critical actions included the following: triage skills, mustering the medical team, identifying causes of patient decompensation, and initiating care. Up to four students were involved with each case scenario; however, only the team leader was evaluated using the assessment instruments developed for each case. A total of 114 students participated in the EPA-10 assessment during their final year of medical school. Most students demonstrated competence in recognizing unstable vital signs (97%), engaging the team (93%), and making appropriate dispositions (92%). Almost 87% of the students were rated as having reached entrustment to manage the care of an emergent patient (99 of 114). Inter-rater reliability varied by case scenario, ranging from moderate to near-perfect agreement. Three of five case-scenario assessment instruments contained items that were internally consistent at measuring student performance. Additionally, the individual item scores for these case scenarios were highly correlated with the global entrustment decision. High-fidelity simulation showed good potential for effective assessment of medical student entrustment of caring for the emergent patient. Preliminary evidence from this pilot project suggests content validity of most cases and associated checklist items. The assessments also demonstrated moderately strong faculty inter-rater reliability.

The relationship between faculty performance assessment and results on the in-training examination for residents in an emergency medicine training program.

PubMed

Ryan, James G; Barlas, David; Pollack, Simcha

2013-12-01

Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (κ  =  0.99) and remained reliable after stratification by year of training (mean κ  =  0.68-0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level.

The Relationship Between Faculty Performance Assessment and Results on the In-Training Examination for Residents in an Emergency Medicine Training Program

PubMed Central

Ryan, James G.; Barlas, David; Pollack, Simcha

2013-01-01

Background Medical knowledge (MK) in residents is commonly assessed by the in-training examination (ITE) and faculty evaluations of resident performance. Objective We assessed the reliability of clinical evaluations of residents by faculty and the relationship between faculty assessments of resident performance and ITE scores. Methods We conducted a cross-sectional, observational study at an academic emergency department with a postgraduate year (PGY)-1 to PGY-3 emergency medicine residency program, comparing summative, quarterly, faculty evaluation data for MK and overall clinical competency (OC) with annual ITE scores, accounting for PGY level. We also assessed the reliability of faculty evaluations using a random effects, intraclass correlation analysis. Results We analyzed data for 59 emergency medicine residents during a 6-year period. Faculty evaluations of MK and OC were highly reliable (κ  =  0.99) and remained reliable after stratification by year of training (mean κ  =  0.68–0.84). Assessments of resident performance (MK and OC) and the ITE increased with PGY level. The MK and OC results had high correlations with PGY level, and ITE scores correlated moderately with PGY. The OC and MK results had a moderate correlation with ITE score. When residents were grouped by PGY level, there was no significant correlation between MK as assessed by the faculty and the ITE score. Conclusions Resident clinical performance and ITE scores both increase with resident PGY level, but ITE scores do not predict resident clinical performance compared with peers at their PGY level. PMID:24455005

Effects of two educational method of lecturing and role playing on knowledge and performance of high school students in first aid at emergency scene

PubMed Central

Hassanzadeh, Akbar; Vasili, Arezu; Zare, Zahra

2010-01-01

BACKGROUND: This study aimed to investigate the effects of two educational methods on students' knowledge and performance regarding first aid at emergency scenes. METHODS: In this semi-experimental study, the sample was selected randomly among male and female public high school students of Isfahan. Each group included 60 students. At first the knowledge and performance of students in first aid at emergency scene was assessed using a researcher-made questionnaire. Then necessary education was provided to the students within 10 sessions of two hours by lecturing and role playing. The students' knowledge and performance was as-sessed again and the results were compared. RESULTS: It was no significant relationship between the frequency distribution of students' age, major and knowledge and performance before the educational course in the two groups. The score of knowledge in performing CPR, using proper way to bandage, immobilizing the injured area, and proper ways of carrying injured person after the education was significantly increased in both groups. Moreover, the performance in proper way to bandage, immobilizing injured area and proper ways of carrying injured person after educational course was significantly higher in playing role group compared to lecturing group after education. CONCLUSIONS: Iran is a developing country with a young generation and it is a country with high risk of natural disasters; so, providing necessary education with more effective methods can be effective in reducing mortality and morbidity due to lack of first aid care in crucial moments. Training with playing role is suggested for this purpose. PMID:21589743

Effects of two educational method of lecturing and role playing on knowledge and performance of high school students in first aid at emergency scene.

PubMed

Hassanzadeh, Akbar; Vasili, Arezu; Zare, Zahra

2010-01-01

This study aimed to investigate the effects of two educational methods on students' knowledge and performance regarding first aid at emergency scenes. In this semi-experimental study, the sample was selected randomly among male and female public high school students of Isfahan. Each group included 60 students. At first the knowledge and performance of students in first aid at emergency scene was assessed using a researcher-made questionnaire. Then necessary education was provided to the students within 10 sessions of two hours by lecturing and role playing. The students' knowledge and performance was as-sessed again and the results were compared. It was no significant relationship between the frequency distribution of students' age, major and knowledge and performance before the educational course in the two groups. The score of knowledge in performing CPR, using proper way to bandage, immobilizing the injured area, and proper ways of carrying injured person after the education was significantly increased in both groups. Moreover, the performance in proper way to bandage, immobilizing injured area and proper ways of carrying injured person after educational course was significantly higher in playing role group compared to lecturing group after education. Iran is a developing country with a young generation and it is a country with high risk of natural disasters; so, providing necessary education with more effective methods can be effective in reducing mortality and morbidity due to lack of first aid care in crucial moments. Training with playing role is suggested for this purpose.

Creating Organizational Structures to Facilitate Collegial Interaction among Teachers: Evidence from a High-Performing Urban Midwestern US District

ERIC Educational Resources Information Center

Ford, Timothy G.; Youngs, Peter A.

2018-01-01

Emerging from concerns about "contrived collegiality" in schools is also the recognition that breaking existing patterns of collegial interaction (or lack thereof) might necessitate some level of leader-initiated (or otherwise organizational) intervention. This paper presents the case of Middleville, a high-performing Midwestern US…

Training Needs for High Performance in the Automotive Industry.

ERIC Educational Resources Information Center

Clyne, Barry; And Others

A project was conducted in Australia to identify the training needs of the emerging industry required to support the development of the high performance areas of the automotive machining and reconditioning field especially as it pertained to auto racing. Data were gathered through a literature search, interviews with experts in the field, and…

Gender Differences in Factors Related to Parenting Styles: A Study of High Performing Science Students.

ERIC Educational Resources Information Center

Hein, Carol; Lewko, John H.

1994-01-01

Examined parenting styles within families of high performing science students and explored gender differences in the factors associated with authoritative parenting style. Found that the authoritative parenting style was predominant among study participants and that a greater number of family-related variables emerge for females, whereas more…

Crisis Resources for Emergency Workers (CREW II): results of a pilot study and simulation-based crisis resource management course for emergency medicine residents.

PubMed

Hicks, Christopher M; Kiss, Alex; Bandiera, Glen W; Denny, Christopher J

2012-11-01

Emergency department resuscitation requires the coordinated efforts of an interdisciplinary team. Aviation-based crisis resource management (CRM) training can improve safety and performance during complex events. We describe the development, piloting, and multilevel evaluation of "Crisis Resources for Emergency Workers" (CREW), a simulation-based CRM curriculum for emergency medicine (EM) residents. Curriculum development was informed by an a priori needs assessment survey. We constructed a 1-day course using simulated resuscitation scenarios paired with focused debriefing sessions. Attitudinal shifts regarding team behaviours were assessed using the Human Factors Attitude Survey (HFAS). A subset of 10 residents participated in standardized pre- and postcourse simulated resuscitation scenarios to quantify the effect of CREW training on our primary outcome of CRM performance. Pre/post scenarios were videotaped and scored by two blinded reviewers using a validated behavioural rating scale, the Ottawa CRM Global Rating Scale (GRS). Postcourse survey responses were highly favourable, with the majority of participants reporting that CREW training can reduce errors and improve patient safety. There was a nonsignificant trend toward improved team-based attitudes as assessed by the HFAS (p  =  0.210). Postcourse performance demonstrated a similar trend toward improved scores in all categories on the Ottawa GRS (p  =  0.16). EM residents find simulation-based CRM instruction to be useful, effective, and highly relevant to their practice. Trends toward improved performance and attitudes may have arisen because our study was underpowered to detect a difference. Future efforts should focus on interdisciplinary training and recruiting a larger sample size.

High Correlated Paternity Leads to Negative Effects on Progeny Performance in Two Mediterranean Shrub Species

PubMed Central

Nora, Sofia; Aparicio, Abelardo; Albaladejo, Rafael G.

2016-01-01

Anthropogenic habitat deterioration can promote changes in plant mating systems that subsequently may affect progeny performance, thereby conditioning plant recruitment for the next generation. However, very few studies yet tested mating system parameters other than outcrossing rates; and the direct effects of the genetic diversity of the pollen received by maternal plants (i.e. correlated paternity) has often been overlooked. In this study, we investigated the relation between correlated paternity and progeny performance in two common Mediterranean shrubs, Myrtus communis and Pistacia lentiscus. To do so, we collected open-pollinated progeny from selected maternal plants, calculated mating system parameters using microsatellite genotyping and conducted sowing experiments under greenhouse and field conditions. Our results showed that some progeny fitness components were negatively affected by the high correlated paternity of maternal plants. In Myrtus communis, high correlated paternity had a negative effect on the proportion and timing of seedling emergence in the natural field conditions and in the greenhouse sowing experiment, respectively. In Pistacia lentiscus, seedling emergence time under field conditions was also negatively influenced by high correlated paternity and a progeny survival analysis in the field experiment showed greater mortality of seedlings from maternal plants with high correlated paternity. Overall, we found effects of correlated paternity on the progeny performance of Myrtus communis, a self-compatible species. Further, we also detected effects of correlated paternity on the progeny emergence time and survival in Pistacia lentiscus, an obligate outcrossed species. This study represents one of the few existing empirical examples which highlight the influence that correlated paternity may exert on progeny performance in multiple stages during early seedling growth. PMID:27835658

High Correlated Paternity Leads to Negative Effects on Progeny Performance in Two Mediterranean Shrub Species.

PubMed

Nora, Sofia; Aparicio, Abelardo; Albaladejo, Rafael G

2016-01-01

Anthropogenic habitat deterioration can promote changes in plant mating systems that subsequently may affect progeny performance, thereby conditioning plant recruitment for the next generation. However, very few studies yet tested mating system parameters other than outcrossing rates; and the direct effects of the genetic diversity of the pollen received by maternal plants (i.e. correlated paternity) has often been overlooked. In this study, we investigated the relation between correlated paternity and progeny performance in two common Mediterranean shrubs, Myrtus communis and Pistacia lentiscus. To do so, we collected open-pollinated progeny from selected maternal plants, calculated mating system parameters using microsatellite genotyping and conducted sowing experiments under greenhouse and field conditions. Our results showed that some progeny fitness components were negatively affected by the high correlated paternity of maternal plants. In Myrtus communis, high correlated paternity had a negative effect on the proportion and timing of seedling emergence in the natural field conditions and in the greenhouse sowing experiment, respectively. In Pistacia lentiscus, seedling emergence time under field conditions was also negatively influenced by high correlated paternity and a progeny survival analysis in the field experiment showed greater mortality of seedlings from maternal plants with high correlated paternity. Overall, we found effects of correlated paternity on the progeny performance of Myrtus communis, a self-compatible species. Further, we also detected effects of correlated paternity on the progeny emergence time and survival in Pistacia lentiscus, an obligate outcrossed species. This study represents one of the few existing empirical examples which highlight the influence that correlated paternity may exert on progeny performance in multiple stages during early seedling growth.

Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing.

PubMed

Cutuli, J J; Herbers, Janette E; Lafavor, Theresa L; Ahumada, Sandra M; Masten, Ann S; Oberg, Charles N

2014-05-01

Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

Emergency radiobioassay preparedness exercises through the NIST radiochemistry intercomparison program.

PubMed

Nour, Svetlana; LaRosa, Jerry; Inn, Kenneth G W

2011-08-01

The present challenge for the international emergency radiobioassay community is to analyze contaminated samples rapidly while maintaining high quality results. The National Institute of Standards and Technology (NIST) runs a radiobioassay measurement traceability testing program to evaluate the radioanalytical capabilities of participating laboratories. The NIST Radiochemistry Intercomparison Program (NRIP) started more than 10 years ago, and emergency performance testing was added to the program seven years ago. Radiobioassay turnaround times under the NRIP program for routine production and under emergency response scenarios are 60 d and 8 h, respectively. Because measurement accuracy and sample turnaround time are very critical in a radiological emergency, response laboratories' analytical systems are best evaluated and improved through traceable Performance Testing (PT) programs. The NRIP provides participant laboratories with metrology tools to evaluate their performance and to improve it. The program motivates the laboratories to optimize their methodologies and minimize the turnaround time of their results. Likewise, NIST has to make adjustments and periodical changes in the bioassay test samples in order to challenge the participating laboratories continually. With practice, radioanalytical measurements turnaround time can be reduced to 3-4 h.

Ultra-Scale Computing for Emergency Evacuation

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

Bhaduri, Budhendra L; Nutaro, James J; Liu, Cheng

2010-01-01

Emergency evacuations are carried out in anticipation of a disaster such as hurricane landfall or flooding, and in response to a disaster that strikes without a warning. Existing emergency evacuation modeling and simulation tools are primarily designed for evacuation planning and are of limited value in operational support for real time evacuation management. In order to align with desktop computing, these models reduce the data and computational complexities through simple approximations and representations of real network conditions and traffic behaviors, which rarely represent real-world scenarios. With the emergence of high resolution physiographic, demographic, and socioeconomic data and supercomputing platforms, itmore » is possible to develop micro-simulation based emergency evacuation models that can foster development of novel algorithms for human behavior and traffic assignments, and can simulate evacuation of millions of people over a large geographic area. However, such advances in evacuation modeling and simulations demand computational capacity beyond the desktop scales and can be supported by high performance computing platforms. This paper explores the motivation and feasibility of ultra-scale computing for increasing the speed of high resolution emergency evacuation simulations.« less

Flight Test of a Propulsion-Based Emergency Control System on the MD-11 Airplane with Emphasis on the Lateral Axis

NASA Technical Reports Server (NTRS)

Burken, John J.; Burcham, Frank W., Jr.; Maine, Trindel A.; Feather, John; Goldthorpe, Steven; Kahler, Jeffrey A.

1996-01-01

A large, civilian, multi-engine transport MD-11 airplane control system was recently modified to perform as an emergency backup controller using engine thrust only. The emergency backup system, referred to as the propulsion-controlled aircraft (PCA) system, would be used if a major primary flight control system fails. To allow for longitudinal and lateral-directional control, the PCA system requires at least two engines and is implemented through software modifications. A flight-test program was conducted to evaluate the PCA system high-altitude flying characteristics and to demonstrate its capacity to perform safe landings. The cruise flight conditions, several low approaches and one landing without any aerodynamic flight control surface movement, were demonstrated. This paper presents results that show satisfactory performance of the PCA system in the longitudinal axis. Test results indicate that the lateral-directional axis of the system performed well at high attitude but was sluggish and prone to thermal upsets during landing approaches. Flight-test experiences and test techniques are also discussed with emphasis on the lateral-directional axis because of the difficulties encountered in flight test.

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

PubMed

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship between ambient temperature and frequency and severity of cardiovascular emergencies: A prospective observational study based on out-of-hospital care data.

PubMed

Hensel, Mario; Stuhr, Markus; Geppert, Daniel; Kersten, Jan F; Lorenz, Jürgen; Kerner, Thoralf

2017-02-01

To test the hypothesis that more cardiovascular emergencies occur at low rather than at high temperatures under moderate climatic conditions. This was a prospective observational study performed in a prehospital setting. Data from the Emergency Medical Service in Hamburg (Germany) and from the local weather station were evaluated over a 5-year period. Temperature data were matched with the associated rescue mission data. Lowess-Regression analysis was performed to assess the relationship between the temperature and the frequency of individual cardiovascular emergencies. In addition, three threshold-temperatures (0°C, 10°C, 20°C) were defined in order to determine the frequency of cardiovascular emergencies above and below each cut-off value. The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system. A total of 35,390 cardiovascular emergencies were treated by Emergency Physicians. Transient Loss of Consciousness increased at high temperatures (above 20°C): +43% (95%-CI: [27%; 59%]). In contrast, Coronary Artery Disease +26% (95%-CI: [17%; 34%]), Cardiac Pulmonary Edema +21% (95%-CI: [14%; 27%]), Hypertensive Urgency +18% (95%-CI: [10%; 25%]) and Cerebrovascular Accident +17% (95%-CI: [8%; 24%]) increased at low temperatures, particularly below 10°C (significance level for all: p<0.001). No temperature-related effect was seen in Cardiac Arrhythmia and Pulmonary Embolism and no significant correlation was found between the severity of emergencies and temperature. Our findings suggest that some cardiovascular emergencies such as Coronary Artery Disease, Cardiac Pulmonary Edema, Hypertensive Urgency and Cerebrovascular Accident are more frequent in low temperatures even under mild climatic conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Tail Rotor Airfoils Stabilize Helicopters, Reduce Noise

NASA Technical Reports Server (NTRS)

2010-01-01

Founded by former Ames Research Center engineer Jim Van Horn, Van Horn Aviation of Tempe, Arizona, built upon a Langley Research Center airfoil design to create a high performance aftermarket tail rotor for the popular Bell 206 helicopter. The highly durable rotor has a lifetime twice that of the original equipment manufacturer blade, reduces noise by 40 percent, and displays enhanced performance at high altitudes. These improvements benefit helicopter performance for law enforcement, military training, wildfire and pipeline patrols, and emergency medical services.

Assessing Advanced Airway Management Performance in a National Cohort of Emergency Medical Services Agencies.

PubMed

Wang, Henry E; Donnelly, John P; Barton, Dustin; Jarvis, Jeffrey L

2018-05-01

Although often the focus of quality improvement efforts, emergency medical services (EMS) advanced airway management performance has few national comparisons, nor are there many assessments with benchmarks accounting for differences in agency volume or patient mix. We seek to assess variations in advanced airway management and conventional intubation performance in a national cohort of EMS agencies. We used EMS data from ESO Solutions, a national EMS electronic health record system. We identified EMS emergency responses with attempted advanced airway management (conventional intubation, rapid sequence intubation, sedation-assisted intubation, supraglottic airway insertion, and cricothyroidotomy). We also separately examined cases with initial conventional intubation. We determined EMS agency risk-standardized advanced airway management and initial conventional intubation success rates by using mixed-effects regression models, fitting agency as a random intercept, adjusting for patient age, sex, race, cardiac arrest, or trauma status, and use of rapid sequence or sedation-assisted intubation, and accounting for reliability variations from EMS agency airway volume. We assessed changes in agency advanced airway management and initial conventional intubation performance rank after risk and reliability adjustment. We also identified high and low performers (reliability-adjusted and risk-standardized success confidence intervals falling outside the mean). During 2011 to 2015, 550 EMS agencies performed 57,209 advanced airway management procedures. Among 401 EMS agencies with greater than or equal to 10 advanced airway management procedures, there were a total of 56,636 procedures. Median reliability-adjusted and risk-standardized EMS agency advanced airway management success was 92.9% (interquartile range 90.1% to 94.8%; minimum 58.2%; maximum 99.0%). There were 56 advanced airway management low-performing and 38 high-performing EMS agencies. Among 342 agencies with greater than or equal to 10 initial conventional intubations, there were a total of 37,360 initial conventional intubations. Median reliability-adjusted and risk-standardized EMS agency initial conventional intubation success was 77.3% (interquartile range 70.9% to 83.6%; minimum 47.1%; maximum 95.8%). There were 64 initial conventional intubation low-performing and 45 high-performing EMS agencies. In this national series, EMS advanced airway management and initial conventional intubation performance varied widely. Reliability adjustment and risk standardization may influence EMS airway management performance assessments. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Distributed virtual environment for emergency medical training

NASA Astrophysics Data System (ADS)

Stytz, Martin R.; Banks, Sheila B.; Garcia, Brian W.; Godsell-Stytz, Gayl M.

1997-07-01

In many professions where individuals must work in a team in a high stress environment to accomplish a time-critical task, individual and team performance can benefit from joint training using distributed virtual environments (DVEs). One professional field that lacks but needs a high-fidelity team training environment is the field of emergency medicine. Currently, emergency department (ED) medical personnel train by using words to create a metal picture of a situation for the physician and staff, who then cooperate to solve the problems portrayed by the word picture. The need in emergency medicine for realistic virtual team training is critical because ED staff typically encounter rarely occurring but life threatening situations only once in their careers and because ED teams currently have no realistic environment in which to practice their team skills. The resulting lack of experience and teamwork makes diagnosis and treatment more difficult. Virtual environment based training has the potential to redress these shortfalls. The objective of our research is to develop a state-of-the-art virtual environment for emergency medicine team training. The virtual emergency room (VER) allows ED physicians and medical staff to realistically prepare for emergency medical situations by performing triage, diagnosis, and treatment on virtual patients within an environment that provides them with the tools they require and the team environment they need to realistically perform these three tasks. There are several issues that must be addressed before this vision is realized. The key issues deal with distribution of computations; the doctor and staff interface to the virtual patient and ED equipment; the accurate simulation of individual patient organs' response to injury, medication, and treatment; and an accurate modeling of the symptoms and appearance of the patient while maintaining a real-time interaction capability. Our ongoing work addresses all of these issues. In this paper we report on our prototype VER system and its distributed system architecture for an emergency department distributed virtual environment for emergency medical staff training. The virtual environment enables emergency department physicians and staff to develop their diagnostic and treatment skills using the virtual tools they need to perform diagnostic and treatment tasks. Virtual human imagery, and real-time virtual human response are used to create the virtual patient and present a scenario. Patient vital signs are available to the emergency department team as they manage the virtual case. The work reported here consists of the system architectures we developed for the distributed components of the virtual emergency room. The architectures we describe consist of the network level architecture as well as the software architecture for each actor within the virtual emergency room. We describe the role of distributed interactive simulation and other enabling technologies within the virtual emergency room project.

3D force/torque characterization of emergency cricothyroidotomy procedure using an instrumented scalpel.

PubMed

Ryason, Adam; Sankaranarayanan, Ganesh; Butler, Kathryn L; DeMoya, Marc; De, Suvranu

2016-08-01

Emergency Cricothyroidotomy (CCT) is a surgical procedure performed to secure a patient's airway. This high-stakes, but seldom-performed procedure is an ideal candidate for a virtual reality simulator to enhance physician training. For the first time, this study characterizes the force/torque characteristics of the cricothyroidotomy procedure, to guide development of a virtual reality CCT simulator for use in medical training. We analyze the upper force and torque thresholds experienced at the human-scalpel interface. We then group individual surgical cuts based on style of cut and cut medium and perform a regression analysis to create two models that allow us to predict the style of cut performed and the cut medium.

The role of nontechnical skills in simulated trauma resuscitation.

PubMed

Briggs, Alexandra; Raja, Ali S; Joyce, Maurice F; Yule, Steven J; Jiang, Wei; Lipsitz, Stuart R; Havens, Joaquim M

2015-01-01

Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks. Retrospective cohort study. Brigham and Women's Hospital, STRATUS Center for Surgical Simulation A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently. NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001). The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Characterizing hydrochemical properties of springs in Taiwan based on their geological origins.

PubMed

Jang, Cheng-Shin; Chen, Jui-Sheng; Lin, Yun-Bin; Liu, Chen-Wuing

2012-01-01

This study was performed to characterize hydrochemical properties of springs based on their geological origins in Taiwan. Stepwise discriminant analysis (DA) was used to establish a linear classification model of springs using hydrochemical parameters. Two hydrochemical datasets-ion concentrations and relative proportions of equivalents per liter of major ions-were included to perform prediction of the geological origins of springs. Analyzed results reveal that DA using relative proportions of equivalents per liter of major ions yields a 95.6% right assignation, which is superior to DA using ion concentrations. This result indicates that relative proportions of equivalents of major hydrochemical parameters in spring water are more highly associated with the geological origins than ion concentrations do. Low percentages of Na(+) equivalents are common properties of springs emerging from acid-sulfate and neutral-sulfate igneous rock. Springs emerging from metamorphic rock show low percentages of Cl( - ) equivalents and high percentages of HCO[Formula: see text] equivalents, and springs emerging from sedimentary rock exhibit high Cl( - )/SO(2-)(4) ratios.

Feasibility analysis of ultra high performance concrete for prestressed concrete bridge applications.

DOT National Transportation Integrated Search

2010-07-01

UHPC is an emerging material technology in which concrete develops very high : compressive strengths and exhibits improved tensile strength and toughness. A : comprehensive literature and historical application review was completed to determine the :...

Model-as-a-service (MaaS) using the cloud service innovation platform (CSIP)

USDA-ARS?s Scientific Manuscript database

Cloud infrastructures for modelling activities such as data processing, performing environmental simulations, or conducting model calibrations/optimizations provide a cost effective alternative to traditional high performance computing approaches. Cloud-based modelling examples emerged into the more...

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

Farrar, Sara; Rothgeb, Stacey; Polly, Ben

The U.S. Department of Energy (DOE) Building America Program enables the transformation of the U.S. housing industry to achieve energy savings through energy-efficient, high-performance homes with improved durability, comfort, and health for occupants. Building America bridges the gap between the development of emerging technologies and the adoption of codes and standards by engaging industry partners in applied research, development, and demonstration of high-performance solutions.

Key performance indicators' assessment to develop best practices in an Emergency Medical Communication Centre.

PubMed

Penverne, Yann; Leclere, Brice; Labady, Julien; Berthier, Frederic; Jenvrin, Joel; Javaudin, Francois; Batard, Eric; Montassier, Emmanuel

2017-05-17

Emergency Medical Communication Centre (EMCC) represents a pivotal link in the chain of survival for those requiring rapid response for out-of-hospital medical emergencies. Assessing and grading the performance of EMCCs are warranted as it can affect the health and safety of the served population. The aim of our work was to describe the activity on an EMCC and to explore the associations between different key performance indicators. We carried out our prospective observational study in the EMCC of Nantes, France, from 6 June 2011 to 6 June 2015. The EMCC performance was assessed with the following key performance indicators: answered calls, Quality of Service 20 s (QS20), occupation rate and average call duration. A total of 35 073 h of dispatch activity were analysed. 1 488 998 emergency calls were answered. The emergency call incidence varied slightly from 274 to 284 calls/1000 citizens/year between 2011 and 2015. The median occupation rate was 35% (25-44). QS20 was correlated negatively with the occupation rate (Spearman's ρ: -0.78). The structural equation model confirmed that the occupation rate was highly correlated with the QS20 (standardized coefficient: -0.89). For an occupation rate of 26%, the target value estimated by our polynomial model, the probability of achieving a QS20 superior or equal to 95% varied between 56 and 84%. The occupation rate appeared to be the most important factor contributing towards the QS20. Our data will be useful to develop best practices and guidelines in the field of emergency medicine communication centres.

SCALING AN URBAN EMERGENCY EVACUATION FRAMEWORK: CHALLENGES AND PRACTICES

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

Karthik, Rajasekar; Lu, Wei

2014-01-01

Critical infrastructure disruption, caused by severe weather events, natural disasters, terrorist attacks, etc., has significant impacts on urban transportation systems. We built a computational framework to simulate urban transportation systems under critical infrastructure disruption in order to aid real-time emergency evacuation. This framework will use large scale datasets to provide a scalable tool for emergency planning and management. Our framework, World-Wide Emergency Evacuation (WWEE), integrates population distribution and urban infrastructure networks to model travel demand in emergency situations at global level. Also, a computational model of agent-based traffic simulation is used to provide an optimal evacuation plan for traffic operationmore » purpose [1]. In addition, our framework provides a web-based high resolution visualization tool for emergency evacuation modelers and practitioners. We have successfully tested our framework with scenarios in both United States (Alexandria, VA) and Europe (Berlin, Germany) [2]. However, there are still some major drawbacks for scaling this framework to handle big data workloads in real time. On our back-end, lack of proper infrastructure limits us in ability to process large amounts of data, run the simulation efficiently and quickly, and provide fast retrieval and serving of data. On the front-end, the visualization performance of microscopic evacuation results is still not efficient enough due to high volume data communication between server and client. We are addressing these drawbacks by using cloud computing and next-generation web technologies, namely Node.js, NoSQL, WebGL, Open Layers 3 and HTML5 technologies. We will describe briefly about each one and how we are using and leveraging these technologies to provide an efficient tool for emergency management organizations. Our early experimentation demonstrates that using above technologies is a promising approach to build a scalable and high performance urban emergency evacuation framework that can improve traffic mobility and safety under critical infrastructure disruption in today s socially connected world.« less

[Gender influence on health related quality of life among resident physicians working in an emergency department].

PubMed

Fernández-Prada, María; González-Cabrera, Joaquín; Torres G, Francisco; Iribar-Ibabe, Concepción; María Peinado, José

2014-02-01

The high emotional burden of physicians working in emergency departments may affect their quality of life perception. To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job.

Wrinkles in Time and Place: Using Performance Assessments to Understand the Knowledge of History Teachers.

ERIC Educational Resources Information Center

Wilson, Suzanne M.; Wineburg, Samuel S.

1993-01-01

Responses of two high school history teachers on three performance assessments of teaching, part of the Stanford University Teacher Assessment Project, were analyzed. Differences that emerged in teacher attitudes and knowledge level illustrate what performance assessment can reveal about pedagogical knowledge and the implications for educational…

Internal curing of high performance concrete using lightweight aggregates and other techniques.

DOT National Transportation Integrated Search

2014-02-01

Internally cured concrete has been rapidly emerging over the last decade as an effective way to improve the : performance of concrete. Internal curing (IC) holds promise for producing concrete with an increased : resistance to early-age cracking and ...

Crew emergency return vehicle autoland feasibility study

NASA Technical Reports Server (NTRS)

Bossi, J. A.; Langehough, M. A.; Lee, K. L.

1989-01-01

The crew emergency return vehicle (CERV) autoland feasibility study focused on determining the controllability of the NASA Langley high lift over drag CERV for performing an automatic landing at a prescribed runway. An autoland system was developed using integral linear quadratic Gaussian (LQG) design techniques. The design was verified using a nonlinear 6 DOF simulation. Simulation results demonstrate that the CERV configuration is a very flyable configuration for performing an autoland mission. Adequate stability and control was demonstrated for wind turbulence and wind shear. Control surface actuator requirements were developed.

Integrated controls pay-off. [for flight/propulsion aircraft systems

NASA Technical Reports Server (NTRS)

Putnam, Terrill W.; Christiansen, Richard S.

1989-01-01

It is shown that the integration of the propulsion and flight control systems for high performance aircraft can help reduce pilot workload while simultaneously increasing overall aircraft performance. Results of the Highly Integrated Digital Electronic Control (HiDEC) flight research program are presented to demonstrate the emerging payoffs of controls integration. Ways in which the performance of fighter aircraft can be improved through the use of propulsion for primary aircraft control are discussed. Research being conducted by NASA with the F-18 High Angle-of Attack Research Vehicle is described.

Enabling Diverse Software Stacks on Supercomputers using High Performance Virtual Clusters.

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

Younge, Andrew J.; Pedretti, Kevin; Grant, Ryan

While large-scale simulations have been the hallmark of the High Performance Computing (HPC) community for decades, Large Scale Data Analytics (LSDA) workloads are gaining attention within the scientific community not only as a processing component to large HPC simulations, but also as standalone scientific tools for knowledge discovery. With the path towards Exascale, new HPC runtime systems are also emerging in a way that differs from classical distributed com- puting models. However, system software for such capabilities on the latest extreme-scale DOE supercomputing needs to be enhanced to more appropriately support these types of emerging soft- ware ecosystems. In thismore » paper, we propose the use of Virtual Clusters on advanced supercomputing resources to enable systems to support not only HPC workloads, but also emerging big data stacks. Specifi- cally, we have deployed the KVM hypervisor within Cray's Compute Node Linux on a XC-series supercomputer testbed. We also use libvirt and QEMU to manage and provision VMs directly on compute nodes, leveraging Ethernet-over-Aries network emulation. To our knowledge, this is the first known use of KVM on a true MPP supercomputer. We investigate the overhead our solution using HPC benchmarks, both evaluating single-node performance as well as weak scaling of a 32-node virtual cluster. Overall, we find single node performance of our solution using KVM on a Cray is very efficient with near-native performance. However overhead increases by up to 20% as virtual cluster size increases, due to limitations of the Ethernet-over-Aries bridged network. Furthermore, we deploy Apache Spark with large data analysis workloads in a Virtual Cluster, ef- fectively demonstrating how diverse software ecosystems can be supported by High Performance Virtual Clusters.« less

Recent Progress in the Design of Advanced Cathode Materials and Battery Models for High-Performance Lithium-X (X = O2 , S, Se, Te, I2 , Br2 ) Batteries.

PubMed

Xu, Jiantie; Ma, Jianmin; Fan, Qinghua; Guo, Shaojun; Dou, Shixue

2017-07-01

Recent advances and achievements in emerging Li-X (X = O 2 , S, Se, Te, I 2 , Br 2 ) batteries with promising cathode materials open up new opportunities for the development of high-performance lithium-ion battery alternatives. In this review, we focus on an overview of recent important progress in the design of advanced cathode materials and battery models for developing high-performance Li-X (X = O 2 , S, Se, Te, I 2 , Br 2 ) batteries. We start with a brief introduction to explain why Li-X batteries are important for future renewable energy devices. Then, we summarize the existing drawbacks, major progress and emerging challenges in the development of cathode materials for Li-O 2 (S) batteries. In terms of the emerging Li-X (Se, Te, I 2 , Br 2 ) batteries, we systematically summarize their advantages/disadvantages and recent progress. Specifically, we review the electrochemical performance of Li-Se (Te) batteries using carbonate-/ether-based electrolytes, made with different electrode fabrication techniques, and of Li-I 2 (Br 2 ) batteries with various cell designs (e.g., dual electrolyte, all-organic electrolyte, with/without cathode-flow mode, and fuel cell/solar cell integration). Finally, the perspective on and challenges for the development of cathode materials for the promising Li-X (X = O 2 , S, Se, Te, I 2 , Br 2 ) batteries is presented. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Nonprocess solvent use in the furniture refinishing and repair industry: Evaluation of alternative chemical strippers. Final report, September 1993-December 1994

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

Turner, S.L.

1996-02-01

The report gives results of an evaluation of the feasibility of using alternatives to high volatile organic compound/hazardous air pollutant (VOC/HAP) solvent-based, chemical strippers that are currently used in the furniture repair and refinishing industry to remove both traditional high-VOC lacquer and emerging, low-VOC, wood furniture coatings. Objectives of the research were to: (1) conduct a laboratory evaluation of the performance of five alternative chemical stripper formulations and compare their performance to that of a traditional solvent-based chemical stripper formulation on three coatings types found on wood furniture substrates, and (2) assess, in a furniture refinishing facility, the use ofmore » the best performing alternative chemical stripper on traditional furniture coatings and new emerging low-VOC furniture coatings. Alternative chemical strippers were evaluated based on their stripping effectiveness compare to a methylene-chloride-based stripper.« less

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies

PubMed Central

Wang, Jacob; Stiegler, Marjorie P.; Nguyen, Dung; Rebel, Annette; Isaak, Robert S.

2017-01-01

Background Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). Methods PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. Results The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. Conclusions The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase). PMID:29600255

Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies.

PubMed

Kazior, Michael R; Wang, Jacob; Stiegler, Marjorie P; Nguyen, Dung; Rebel, Annette; Isaak, Robert S

2017-01-01

Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).

Surveillance of emerging drugs of abuse in Hong Kong: validation of an analytical tool.

PubMed

Tang, Magdalene H Y; Ching, C K; Tse, M L; Ng, Carol; Lee, Caroline; Chong, Y K; Wong, Watson; Mak, Tony W L

2015-04-01

To validate a locally developed chromatography-based method to monitor emerging drugs of abuse whilst performing regular drug testing in abusers. Cross-sectional study. Eleven regional hospitals, seven social service units, and a tertiary level clinical toxicology laboratory in Hong Kong. A total of 972 drug abusers and high-risk individuals were recruited from acute, rehabilitation, and high-risk settings between 1 November 2011 and 31 July 2013. A subset of the participants was of South Asian ethnicity. In total, 2000 urine or hair specimens were collected. Proof of concept that surveillance of emerging drugs of abuse can be performed whilst conducting routine drug of abuse testing in patients. The method was successfully applied to 2000 samples with three emerging drugs of abuse detected in five samples: PMMA (paramethoxymethamphetamine), TFMPP [1-(3-trifluoromethylphenyl)piperazine], and methcathinone. The method also detected conventional drugs of abuse, with codeine, methadone, heroin, methamphetamine, and ketamine being the most frequently detected drugs. Other findings included the observation that South Asians had significantly higher rates of using opiates such as heroin, methadone, and codeine; and that ketamine and cocaine had significantly higher detection rates in acute subjects compared with the rehabilitation population. This locally developed analytical method is a valid tool for simultaneous surveillance of emerging drugs of abuse and routine drug monitoring of patients at minimal additional cost and effort. Continued, proactive surveillance and early identification of emerging drugs will facilitate prompt clinical, social, and legislative management.

Contextual information influences diagnosis accuracy and decision making in simulated emergency medicine emergencies.

PubMed

McRobert, Allistair Paul; Causer, Joe; Vassiliadis, John; Watterson, Leonie; Kwan, James; Williams, Mark A

2013-06-01

It is well documented that adaptations in cognitive processes with increasing skill levels support decision making in multiple domains. We examined skill-based differences in cognitive processes in emergency medicine physicians, and whether performance was significantly influenced by the removal of contextual information related to a patient's medical history. Skilled (n=9) and less skilled (n=9) emergency medicine physicians responded to high-fidelity simulated scenarios under high- and low-context information conditions. Skilled physicians demonstrated higher diagnostic accuracy irrespective of condition, and were less affected by the removal of context-specific information compared with less skilled physicians. The skilled physicians generated more options, and selected better quality options during diagnostic reasoning compared with less skilled counterparts. These cognitive processes were active irrespective of the level of context-specific information presented, although high-context information enhanced understanding of the patients' symptoms resulting in higher diagnostic accuracy. Our findings have implications for scenario design and the manipulation of contextual information during simulation training.

Ultra-high-Q phononic resonators on-chip at cryogenic temperatures

NASA Astrophysics Data System (ADS)

Kharel, Prashanta; Chu, Yiwen; Power, Michael; Renninger, William H.; Schoelkopf, Robert J.; Rakich, Peter T.

2018-06-01

Long-lived, high-frequency phonons are valuable for applications ranging from optomechanics to emerging quantum systems. For scientific as well as technological impact, we seek high-performance oscillators that offer a path toward chip-scale integration. Confocal bulk acoustic wave resonators have demonstrated an immense potential to support long-lived phonon modes in crystalline media at cryogenic temperatures. So far, these devices have been macroscopic with cm-scale dimensions. However, as we push these oscillators to high frequencies, we have an opportunity to radically reduce the footprint as a basis for classical and emerging quantum technologies. In this paper, we present novel design principles and simple microfabrication techniques to create high performance chip-scale confocal bulk acoustic wave resonators in a wide array of crystalline materials. We tailor the acoustic modes of such resonators to efficiently couple to light, permitting us to perform a non-invasive laser-based phonon spectroscopy. Using this technique, we demonstrate an acoustic Q-factor of 2.8 × 107 (6.5 × 106) for chip-scale resonators operating at 12.7 GHz (37.8 GHz) in crystalline z-cut quartz (x-cut silicon) at cryogenic temperatures.

Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

PubMed

Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

2017-08-22

Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access to emergency and surgical care. However more investments in are necessary to improve small hospitals capabilities to fill this gap.

Building a Natural Language Processing Tool to Identify Patients With High Clinical Suspicion for Kawasaki Disease from Emergency Department Notes.

PubMed

Doan, Son; Maehara, Cleo K; Chaparro, Juan D; Lu, Sisi; Liu, Ruiling; Graham, Amanda; Berry, Erika; Hsu, Chun-Nan; Kanegaye, John T; Lloyd, David D; Ohno-Machado, Lucila; Burns, Jane C; Tremoulet, Adriana H

2016-05-01

Delayed diagnosis of Kawasaki disease (KD) may lead to serious cardiac complications. We sought to create and test the performance of a natural language processing (NLP) tool, the KD-NLP, in the identification of emergency department (ED) patients for whom the diagnosis of KD should be considered. We developed an NLP tool that recognizes the KD diagnostic criteria based on standard clinical terms and medical word usage using 22 pediatric ED notes augmented by Unified Medical Language System vocabulary. With high suspicion for KD defined as fever and three or more KD clinical signs, KD-NLP was applied to 253 ED notes from children ultimately diagnosed with either KD or another febrile illness. We evaluated KD-NLP performance against ED notes manually reviewed by clinicians and compared the results to a simple keyword search. KD-NLP identified high-suspicion patients with a sensitivity of 93.6% and specificity of 77.5% compared to notes manually reviewed by clinicians. The tool outperformed a simple keyword search (sensitivity = 41.0%; specificity = 76.3%). KD-NLP showed comparable performance to clinician manual chart review for identification of pediatric ED patients with a high suspicion for KD. This tool could be incorporated into the ED electronic health record system to alert providers to consider the diagnosis of KD. KD-NLP could serve as a model for decision support for other conditions in the ED. © 2016 by the Society for Academic Emergency Medicine.

Stopping decisions: information order effects on nonfocal evaluations.

PubMed

Yu, Michael; Gonzalez, Cleotilde

2013-08-01

We investigated how the order in which information is presented affects when a person decides to stop performing a task. A stopping decision is a decision to stop performing a task on the basis of a sequence of cues. Previous order-effects models do not account for how these contexts limit available working memory for making such decisions. Participants decided how long to perform a task known as the Work Hazard Game that began by rewarding points but later cost points if work continued after an unannounced "emergency." An additive sequence of cues indicated the probability of an emergency. Study I involved a three-group design with cue sequences that indicated the same risk at each decision point but whose final cue presented a high, medium, or low probability. Study 2 had a 2 x 2 design with high or low final cues and an easy or a challenging task. In Study I, participants stopped sooner when the most recent cue presented a high rather than low probability (p = .09), despite the same emergency risk. In Study 2, participants stopped sooner when the most recent cue presented a high rather than low probability for the challenging task but not for the easy task (p = .08). Stopping decisions appear sensitive to the most recent cue observed while experiencing task load. Participants responded to the same risks differently only on the basis of a change in presentation. Findings may be relevant for research and training for hazardous jobs, such as subsurface coal mining, fishing, and trucking.

WOMBAT: A Scalable and High-performance Astrophysical Magnetohydrodynamics Code

NASA Astrophysics Data System (ADS)

Mendygral, P. J.; Radcliffe, N.; Kandalla, K.; Porter, D.; O'Neill, B. J.; Nolting, C.; Edmon, P.; Donnert, J. M. F.; Jones, T. W.

2017-02-01

We present a new code for astrophysical magnetohydrodynamics specifically designed and optimized for high performance and scaling on modern and future supercomputers. We describe a novel hybrid OpenMP/MPI programming model that emerged from a collaboration between Cray, Inc. and the University of Minnesota. This design utilizes MPI-RMA optimized for thread scaling, which allows the code to run extremely efficiently at very high thread counts ideal for the latest generation of multi-core and many-core architectures. Such performance characteristics are needed in the era of “exascale” computing. We describe and demonstrate our high-performance design in detail with the intent that it may be used as a model for other, future astrophysical codes intended for applications demanding exceptional performance.

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

PubMed

Love, Jennifer S; Karp, David; Delgado, M Kit; Margolis, Gregg; Wiebe, Douglas J; Carr, Brendan G

2016-08-01

Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies. A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering. A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times. Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576-582).

NASA Research in aeropropulsion

NASA Technical Reports Server (NTRS)

Stewart, W. L.; Weber, R. J.

1981-01-01

Selected examples of recent accomplishments and current activities that are relevant to the principal classes of civil and military vehicles: subsonic transports, commuters, supersonic transports, general aviation, rotorcraft, V/STOL, and high performance. Some instances of emerging technologies with potential high impact on further progress are discussed.

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

Unat, Didem; Dubey, Anshu; Hoefler, Torsten

The cost of data movement has always been an important concern in high performance computing (HPC) systems. It has now become the dominant factor in terms of both energy consumption and performance. Support for expression of data locality has been explored in the past, but those efforts have had only modest success in being adopted in HPC applications for various reasons. However, with the increasing complexity of the memory hierarchy and higher parallelism in emerging HPC systems, locality management has acquired a new urgency. Developers can no longer limit themselves to low-level solutions and ignore the potential for productivity andmore » performance portability obtained by using locality abstractions. Fortunately, the trend emerging in recent literature on the topic alleviates many of the concerns that got in the way of their adoption by application developers. Data locality abstractions are available in the forms of libraries, data structures, languages and runtime systems; a common theme is increasing productivity without sacrificing performance. Furthermore, this paper examines these trends and identifies commonalities that can combine various locality concepts to develop a comprehensive approach to expressing and managing data locality on future large-scale high-performance computing systems.« less

Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

PubMed

Weinger, Matthew B; Banerjee, Arna; Burden, Amanda R; McIvor, William R; Boulet, John; Cooper, Jeffrey B; Steadman, Randolph; Shotwell, Matthew S; Slagle, Jason M; DeMaria, Samuel; Torsher, Laurence; Sinz, Elizabeth; Levine, Adam I; Rask, John; Davis, Fred; Park, Christine; Gaba, David M

2017-09-01

We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant's technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist. Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance. Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.

Preliminary study of the pilot's workload during emergency procedures in helicopters air operations.

PubMed

Bezerra, Flávio G V; Ribeiro, Selma L O

2012-01-01

Military air operations and law enforcement operations in helicopters are examples of activities that require high performance of the operator. This article aimed at presenting a preliminary analysis of data obtained in the initial study in order to validate the instruments and the research protocol that focuses on the analysis of the workload imposed on helicopter pilots in emergency situations. The research was conducted in an environment of real flight training and used the NASA-TLX Scale to assess the workload and an interview guide to obtain reports on the main tasks performed. Preliminary data obtained is related to the participation of 10 (ten) volunteer pilots with experience in different types of helicopters. Four scenarios involving helicopter emergency procedures of HB-350 "Squirrel" were outlined. For this article, the analysis used only the data regarding the Physical and Mental Demands of the NASA-TLX Scale. Preliminarily, the results indicate that the "time pressure" as a factor contributing to increase mental requirement in emergency situations in flight, and that this increase was reflected in the request of mental processes such as: identification of the breakdown, attention and monitoring parameters. Future steps include extending the sample and adding physiological tools to better understand the effects of these types of emergencies on pilot performance and flight safety.

From Smart-Eco Building to High-Performance Architecture: Optimization of Energy Consumption in Architecture of Developing Countries

NASA Astrophysics Data System (ADS)

Mahdavinejad, M.; Bitaab, N.

2017-08-01

Search for high-performance architecture and dreams of future architecture resulted in attempts towards meeting energy efficient architecture and planning in different aspects. Recent trends as a mean to meet future legacy in architecture are based on the idea of innovative technologies for resource efficient buildings, performative design, bio-inspired technologies etc. while there are meaningful differences between architecture of developed and developing countries. Significance of issue might be understood when the emerging cities are found interested in Dubaization and other related booming development doctrines. This paper is to analyze the level of developing countries’ success to achieve smart-eco buildings’ goals and objectives. Emerging cities of West of Asia are selected as case studies of the paper. The results of the paper show that the concept of high-performance architecture and smart-eco buildings are different in developing countries in comparison with developed countries. The paper is to mention five essential issues in order to improve future architecture of developing countries: 1- Integrated Strategies for Energy Efficiency, 2- Contextual Solutions, 3- Embedded and Initial Energy Assessment, 4- Staff and Occupancy Wellbeing, 5- Life-Cycle Monitoring.

[Burnout syndrome in pre-hospital and hospital emergency. Cognitive study in two cohorts of nurses].

PubMed

Cicchitti, Chiara; Cannizzaro, Giorgia; Rosi, Fabrizio; Maccaroni, Roberto; Menditto, Vincenzo G

2014-01-01

Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The emergency department and the pre-hospital healthcare services are highly stressful environments. Little is known about the BOS in critical care nursing staff. The objective of the study is to compare the incidence of BOS and its three domains, namely, emotional exhaustion, depersonalization and reduced professional accomplishment, in two cohorts of critical care nurses: a pre-hospital and a hospital emergency service. A survey using a questionnaire (the Maslach Burnout Inventory-General Survey, MBI-GS), among nurses of two Italian emergency services has been performed: a hospital emergency service (HES, Emergency Department or "Pronto Soccorso") and a pre-hospital emergency service (PHES, territorial healthcare service or "Centrale Operativa 118"). All 60 nurses surveyed (82% female) filled the questionnaires. BOS-related symptoms have been identified in at least 50% of the nurses in the HES: 50% suffered a medium-high emotional exhaustion, 75% had a medium-high depersonalization and 92.5% had a medium-high reduced professional accomplishment. Among the PEHS nurses, BOS-related symptoms have been identified in at least 60% of the respondents: 60% had a medium-high emotional exhaustion, 70% had a medium-high depersonalization and 95% had a medium-high reduced professional accomplishment. Moreover, the likelihood that a nurse has a severe BOS, that is at least one degree of high burnout or ≥2 degrees of medium burnout, is significantly higher in the group of the PHES than in the HES (90% vs 60%, p <0.02). At least two-thirds of critical care nursing staff had a severe BOS. The incidence of BOS appeared to be similar among PHES and HES nurses with a higher trend for the former. Further interventional studies are needed to investigate the determinants of BOS among critical care nurses and the potentially preventive strategies.

Sex differences in verbal working memory performance emerge at very high loads of common neuroimaging tasks.

PubMed

Reed, Jessica L; Gallagher, Natalie M; Sullivan, Marie; Callicott, Joseph H; Green, Adam E

2017-04-01

Working memory (WM) supports a broad range of intelligent cognition and has been the subject of rich cognitive and neural characterization. However, the highest ranges of WM have not been fully characterized, especially for verbal information. Tasks developed to test multiple levels of WM demand (load) currently predominate brain-based WM research. These tasks are typically used at loads that allow most healthy participants to perform well, which facilitates neuroimaging data collection. Critically, however, high performance at lower loads may obscure differences that emerge at higher loads. A key question not yet addressed at high loads concerns the effect of sex. Thoroughgoing investigation of high-load verbal WM is thus timely to test for potential hidden effects, and to provide behavioral context for effects of sex observed in WM-related brain structure and function. We tested 111 young adults, matched on genotype for the WM-associated COMT-Val 108/158 Met polymorphism, on three classic WM tasks using verbal information. Each task was tested at four WM loads, including higher loads than those used in previous studies of sex differences. All tasks loaded on a single factor, enabling comparison of verbal WM ability at a construct level. Results indicated sex effects at high loads across tasks and within each task, such that males had higher accuracy, even among groups that were matched for performance at lower loads. Published by Elsevier Inc.

A study of bedside ocular ultrasonography in the emergency department.

PubMed

Blaivas, Michael; Theodoro, Daniel; Sierzenski, Paul R

2002-08-01

The use of ocular ultrasonography for the evaluation of emergency patients has recently been described in the emergency medicine (EM) literature. There are a number of potential uses that may greatly aid the emergency physician (EP) and avoid lengthy consultation or other diagnostic tests. To examine the accuracy of bedside ultrasonography as performed by EPs for the evaluation of ocular pathology. This prospective, observational study took place in a high-volume, suburban community hospital with an EM residency program. All patients arriving with a history of eye trauma or acute change in vision were eligible to participate in the study. A 10-MHz linear-array transducer was used for imaging. All imaging was performed through a closed eyelid, using water-soluble ultrasound gel. Investigators filled out standardized data sheets and all examinations were taped for review. All ultrasound examinations were followed by orbital computed tomography or complete ophthalmologic evaluation from the ophthalmology service. Statistical analysis included sensitivity, specificity, and positive and negative predictive values. Sixty-one patients were enrolled in the study; 26 were found to have intraocular pathology on ultrasound. Of these, three had penetrating globe injuries, nine had retinal detachments, one had central retinal artery occlusion, and two had lens dislocations. The remaining pathology included vitreous hemorrhage and vitreous detachment. Emergency sonologists were in agreement with the criterion standard examination in 60 out of 61 cases. Emergency bedside ultrasound is highly accurate for ruling out and diagnosing ocular pathology in patients presenting to the emergency department. Further, it accurately differentiates between pathology that needs immediate ophthalmologic consultation and that which can be followed up on an outpatient basis.

Active material, optical mode and cavity impact on nanoscale electro-optic modulation performance

NASA Astrophysics Data System (ADS)

Amin, Rubab; Suer, Can; Ma, Zhizhen; Sarpkaya, Ibrahim; Khurgin, Jacob B.; Agarwal, Ritesh; Sorger, Volker J.

2017-10-01

Electro-optic modulation is a key function in optical data communication and possible future optical compute engines. The performance of modulators intricately depends on the interaction between the actively modulated material and the propagating waveguide mode. While a variety of high-performance modulators have been demonstrated, no comprehensive picture of what factors are most responsible for high performance has emerged so far. Here we report the first systematic and comprehensive analytical and computational investigation for high-performance compact on-chip electro-optic modulators by considering emerging active materials, model considerations and cavity feedback at the nanoscale. We discover that the delicate interplay between the material characteristics and the optical mode properties plays a key role in defining the modulator performance. Based on physical tradeoffs between index modulation, loss, optical confinement factors and slow-light effects, we find that there exist combinations of bias, material and optical mode that yield efficient phase or amplitude modulation with acceptable insertion loss. Furthermore, we show how material properties in the epsilon near zero regime enable reduction of length by as much as by 15 times. Lastly, we introduce and apply a cavity-based electro-optic modulator figure of merit, Δλ/Δα, relating obtainable resonance tuning via phase shifting relative to the incurred losses due to the fundamental Kramers-Kronig relations suggesting optimized device operating regions with optimized modulation-to-loss tradeoffs. This work paves the way for a holistic design rule of electro-optic modulators for high-density on-chip integration.

WOMBAT: A Scalable and High-performance Astrophysical Magnetohydrodynamics Code

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

Mendygral, P. J.; Radcliffe, N.; Kandalla, K.

2017-02-01

We present a new code for astrophysical magnetohydrodynamics specifically designed and optimized for high performance and scaling on modern and future supercomputers. We describe a novel hybrid OpenMP/MPI programming model that emerged from a collaboration between Cray, Inc. and the University of Minnesota. This design utilizes MPI-RMA optimized for thread scaling, which allows the code to run extremely efficiently at very high thread counts ideal for the latest generation of multi-core and many-core architectures. Such performance characteristics are needed in the era of “exascale” computing. We describe and demonstrate our high-performance design in detail with the intent that it maymore » be used as a model for other, future astrophysical codes intended for applications demanding exceptional performance.« less

Developments in variational methods for high performance plate and shell elements

NASA Technical Reports Server (NTRS)

Felippa, Carlos A.; Militello, Carmelo

1991-01-01

High performance elements are simple finite elements constructed to deliver engineering accuracy with coarse arbitrary grids. This is part of a series on the variational foundations of high-performance elements, with emphasis on plate and shell elements constructed with the free formulation (FF) and assumed natural strain (ANS) methods. Parameterized variational principles are studied that provide a common foundation for the FF and ANS methods, as well as for a combination of both. From this unified formulation a variant of the ANS formulation, called the assumed natural deviatoric strain (ANDES) formulation, emerges as an important special case. The first ANDES element, a high-performance 9 degrees of freedom triangular Kirchhoff plate bending element, is briefly described to illustrate the use of the new formulation.

High-performance wireless powering for peripheral nerve neuromodulation systems.

PubMed

Tanabe, Yuji; Ho, John S; Liu, Jiayin; Liao, Song-Yan; Zhen, Zhe; Hsu, Stephanie; Shuto, Chika; Zhu, Zi-Yi; Ma, Andrew; Vassos, Christopher; Chen, Peter; Tse, Hung Fat; Poon, Ada S Y

2017-01-01

Neuromodulation of peripheral nerves with bioelectronic devices is a promising approach for treating a wide range of disorders. Wireless powering could enable long-term operation of these devices, but achieving high performance for miniaturized and deeply placed devices remains a technological challenge. We report the miniaturized integration of a wireless powering system in soft neuromodulation device (15 mm length, 2.7 mm diameter) and demonstrate high performance (about 10%) during in vivo wireless stimulation of the vagus nerve in a porcine animal model. The increased performance is enabled by the generation of a focused and circularly polarized field that enhances efficiency and provides immunity to polarization misalignment. These performance characteristics establish the clinical potential of wireless powering for emerging therapies based on neuromodulation.

High-performance wireless powering for peripheral nerve neuromodulation systems

PubMed Central

Liu, Jiayin; Liao, Song-Yan; Zhen, Zhe; Hsu, Stephanie; Shuto, Chika; Zhu, Zi-Yi; Ma, Andrew; Vassos, Christopher; Chen, Peter; Tse, Hung Fat; Poon, Ada S. Y.

2017-01-01

Neuromodulation of peripheral nerves with bioelectronic devices is a promising approach for treating a wide range of disorders. Wireless powering could enable long-term operation of these devices, but achieving high performance for miniaturized and deeply placed devices remains a technological challenge. We report the miniaturized integration of a wireless powering system in soft neuromodulation device (15 mm length, 2.7 mm diameter) and demonstrate high performance (about 10%) during in vivo wireless stimulation of the vagus nerve in a porcine animal model. The increased performance is enabled by the generation of a focused and circularly polarized field that enhances efficiency and provides immunity to polarization misalignment. These performance characteristics establish the clinical potential of wireless powering for emerging therapies based on neuromodulation. PMID:29065141

Agent-based Large-Scale Emergency Evacuation Using Real-Time Open Government Data

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

Lu, Wei; Liu, Cheng; Bhaduri, Budhendra L

The open government initiatives have provided tremendous data resources for the transportation system and emergency services in urban areas. This paper proposes a traffic simulation framework using high temporal resolution demographic data and real time open government data for evacuation planning and operation. A comparison study using real-world data in Seattle, Washington is conducted to evaluate the framework accuracy and evacuation efficiency. The successful simulations of selected area prove the concept to take advantage open government data, open source data, and high resolution demographic data in emergency management domain. There are two aspects of parameters considered in this study: usermore » equilibrium (UE) conditions of traffic assignment model (simple Non-UE vs. iterative UE) and data temporal resolution (Daytime vs. Nighttime). Evacuation arrival rate, average travel time, and computation time are adopted as Measure of Effectiveness (MOE) for evacuation performance analysis. The temporal resolution of demographic data has significant impacts on urban transportation dynamics during evacuation scenarios. Better evacuation performance estimation can be approached by integrating both Non-UE and UE scenarios. The new framework shows flexibility in implementing different evacuation strategies and accuracy in evacuation performance. The use of this framework can be explored to day-to-day traffic assignment to support daily traffic operations.« less

Burnout and Associated Factors among Iranian Emergency Medicine Practitioners.

PubMed

Jalili, Mohammad; Sadeghipour Roodsari, Gholamreza; Bassir Nia, Anahita

2013-09-01

Emergency physicians are at risk of burnout, which can affect their mental health, as well as patient care. We assessed burnout level among Iranian emergency physicians and investigated demographic, work-related factors and stressors associated with higher burnout. In a cross-sectional study, we surveyed all 188 emergency medicine residents and practitioners in Iran. We measured burnout using 22-item Maslach Burnout Inventory assessing emotional exhaustion, depersonalization and personal accomplishment, also demographic factors, work related factors and sources of stress in emergency department using anonymous self-administered questionnaire. Descriptive analysis, univariate analysis to evaluate association with higher score of burnout, and multivariate logistic regression analysis to predict high burnout in 3 subscales was performed. Totally, 165 questionnaires were filled (response rate: 88%; mean age: 33.6 years, 91% male). Mean burnout scores were 22.94 for emotional exhaustion (95% CI=20.78-25.01; moderate), 9.3 for depersonalization (95% CI=8.24-10.36; moderate to high), and 31.47 for personal accomplishment (95% CI=29.87-33.07; moderate to high). Frequent reported sources of stress were shortage of equipment, problem with work physical environment, and relationship with other services. All 19 sources of stress were associated with higher score of emotional exhaustion and depersonalization; while twelve out of 19 were significantly associated with lower level of personal accomplishment. In logistic regression model, the significant predictors for high emotional exhaustion were work overload, feeling of insecurity for future career and difficulties to balance professional and private life. Burnout is high among Iranian emergency medicine practitioners and some interventions can be proposed to reduce stress.

[Burnout in Nursing Professionals Performing Overtime Workdays in Emergency and Critical Care Departments. Spain].

PubMed

Cañadas-De la Fuente, Guillermo Arturo; Albendín-García, Luis; de la Fuente, Emilia Inmaculada; San Luis, Concepción; Gómez-Urquiza, José Luis; Cañadas, Gustavo Raúl

2016-09-14

Burnout syndrome is a disorder that seriously affects people who suffer it, the institutions in which they work and the quality of healthcare. It is of great interest to advance in burnout research for its possible prevention. The aim of this work was to study the levels of burnout syndrome in nurses of emergency department with overtime workdays and to know the relationship between burnout and personality characteristics. Multicenter cross-sectional study with a sample of 1225 emergency nurses from the Andalusian Health Service. Demographic, social and occupational variables were recorded. Burnout was assessed with Maslach Burnout Inventory and personality factors with NEO-Five Factor Inventory. Descriptive analysis of the variables, independent means hypothesis contrast and bayesian analysis were done. 44.1% of nurses who perform overtime workdays have high burnout versus a 38% for those without such overload. These differences have been also found in burnout dimensions, especially in emotional exhaustion (15.3% versus 10.8%) and depersonalization (17.9% versus 11.8%). Overtime workdays performed by emergency nurses seems to have a negative on them and it could also influence the development of burnout syndrome.

Psychosocial risks and stress as predictors of burnout in junior doctors performing emergency guards

PubMed

Fernández-Prada, María; González-Cabrera, Joaquín; Iribar-Ibabe, Concepción; Peinado, José María

2017-01-01

To study the stress, the psychosocial risks associated to the job and the burnout, in a group of junior doctors working at the emergency ward; and to analyze what of those variables could predict and are better related with burnout. Cross-sectional study, with a sample of 42 junior doctors which are on duty in the emergency ward of the University Hospital San Cecilio, Granada (Spain). The Spanish adapted version of the Perceived Stress Scale was used to evaluate stress, the Maslach Burnout Inventory (MBI) to evaluate the professional burnout and the adapted and scaled questionnaire for the self-evaluation of psychosocial risks at work (CopSoQ-ISTAS21). 78% of the junior doctors are in the unfavorable or intermediate range for all CopSoQ-ISTAS21 dimensions, being particularly relevant that 90% of them display unfavorable score in psychological demands. In addition, MBI results show that 45% of our population presents high emotional exhaustion simultaneously to high depersonalization. ISTAS21 psychological demands dimensions (ß = 0.393; p < 0.003) and stress scores (ß = 0.451; p < 0.001) significantly predict emotional exhaustion (r 2 = 0.443). Finally, 38% of junior doctors experienced a threat/aggression during their work in the emergency ward urgencies. Junior doctors develop its professional activity under adverse circumstances probably due to the high psychosocial risk associated to the job. Psychological demands are suggested as the main predicting factor of burnout. These results indicate the need of psychological and structural interventions in order to improve the professional performance of junior doctors at the emergency ward. Copyright: © 2017 SecretarÍa de Salud

Emergency and microfog lubrication and cooling of bearings for Army helicopters

NASA Technical Reports Server (NTRS)

Rosenlieb, J. W.

1978-01-01

An analysis and system study was performed to provide design information regarding lubricant and coolant flow rates and flow paths for effective utilization of the lubricant and coolant in a once-through oil-mist (microfog) and coolant air system. A system was designed, manufactured, coupled with an existing rig and evaluation tests were performed using 46 mm bore split-inner angular-contact ball bearings under 1779N (400 lb.) thrust load. An emergency lubrication aspirator system was also manufactured and tested under lost lubricant conditions. The testing demonstrated the feasibility of using a mist oil and cooling air system to lubricate and cool a high speed helicopter engine mainshaft bearing. The testing also demonstrated the feasibility of using an emergency aspirator lubrication system as a viable survivability concept for helicopter mainshaft engine bearing for periods as long as 30 minutes.

Progress of air-breathing cathode in microbial fuel cells

NASA Astrophysics Data System (ADS)

Wang, Zejie; Mahadevan, Gurumurthy Dummi; Wu, Yicheng; Zhao, Feng

2017-07-01

Microbial fuel cell (MFC) is an emerging technology to produce green energy and vanquish the effects of environmental contaminants. Cathodic reactions are vital for high electrical power density generated from MFCs. Recently tremendous attentions were paid towards developing high performance air-breathing cathodes. A typical air-breathing cathode comprises of electrode substrate, catalyst layer, and air-diffusion layer. Prior researches demonstrated that each component influenced the performance of air-breathing cathode MFCs. This review summarized the progress in development of the individual component and elaborated main factors to the performance of air-breathing cathode.

High-Performance Federal Buildings Act of 2011

THOMAS, 112th Congress

Rep. Carnahan, Russ [D-MO-3

2011-11-04

House - 11/07/2011 Referred to the Subcommittee on Economic Development, Public Buildings and Emergency Management. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Information technology and emergency management: preparedness and planning in US states.

PubMed

Reddick, Christopher

2011-01-01

The purpose of this paper is to examine the impact of information technology (IT) on emergency preparedness and planning by analysing a survey of US state government departments of emergency management. The research results show that there has been a significant impact of IT on emergency planning. IT has proven to be effective for all phases of emergency management, but especially for the response phase. There are numerous technologies used in emergency management, ranging from the internet, Geographic Information Systems and wireless technologies to more advanced hazard analysis models. All were generally viewed as being effective. Lack of financial resources and support from elected officials is a perennial problem in public administration, and was found to be prevalent in this study of IT and emergency management. There was evidence that state governments rating high on a performance index were more likely to use IT for emergency management. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Autogenic-feedback training improves pilot performance during emergency flying conditions

NASA Technical Reports Server (NTRS)

Kellar, Michael A.; Folen, Raymond A.; Cowings, Patricia S.; Toscano, William B.; Hisert, Glen L.

1994-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group comprised three pilots of HC-130 Hercules aircraft and four HH-65 Dolphin helicopter pilots; the control group comprised three pilots of HC-130's and six Dolphin helicopter pilots. During an initial flight, physiological data were recorded for each crew member and individual crew performance was rated by an instructor pilot. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training (AFT). The remaining subjects received no training. During a second flight, treatment subjects showed significant improvement in performance, while controls did not improve. The results indicate that AFT management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

Trends in data locality abstractions for HPC systems

DOE PAGES

Unat, Didem; Dubey, Anshu; Hoefler, Torsten; ...

2017-05-10

The cost of data movement has always been an important concern in high performance computing (HPC) systems. It has now become the dominant factor in terms of both energy consumption and performance. Support for expression of data locality has been explored in the past, but those efforts have had only modest success in being adopted in HPC applications for various reasons. However, with the increasing complexity of the memory hierarchy and higher parallelism in emerging HPC systems, locality management has acquired a new urgency. Developers can no longer limit themselves to low-level solutions and ignore the potential for productivity andmore » performance portability obtained by using locality abstractions. Fortunately, the trend emerging in recent literature on the topic alleviates many of the concerns that got in the way of their adoption by application developers. Data locality abstractions are available in the forms of libraries, data structures, languages and runtime systems; a common theme is increasing productivity without sacrificing performance. Furthermore, this paper examines these trends and identifies commonalities that can combine various locality concepts to develop a comprehensive approach to expressing and managing data locality on future large-scale high-performance computing systems.« less

Autogenic-feedback training improves pilot performance during emergency flying conditions

NASA Technical Reports Server (NTRS)

Kellar, Michael A.; Folen, Raymond A.; Cowings, Patricia S.; Toscano, William B.; Hisert, Glen L.

1993-01-01

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. The effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance was examined. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group comprised four pilots of HC-130 Hercules aircraft and four HH-65 Dolphin helicopter pilots; the control group comprised three pilots of HC-130's and six Dolphin helicopter pilots. During an initial flight physiological data were recorded for each crewmember and individual crew performance and rated by an instructor pilot. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training (AFT). The remaining subjects received no training. During a second flight, treatment subjects showed significant improvement in performance, while controls did not improve. The results indicate that AFT management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators.

PubMed

Marjanovic, Nicolas; L'Her, Erwan

2016-05-01

Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and user-friendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ± 1.4 vs 3.9 ± 1.2, P = .002 and 4.3 ± 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport ventilators. The choice of a device not only depends on its technical characteristics but should take into account its clinical operational setting and ergonomics in order to decrease mental work load. Sophisticated emergency and transport ventilators should only be used by clinicians who demonstrate expertise in mechanical ventilation. Copyright © 2016 by Daedalus Enterprises.

Radiation Effects On Emerging Electronic Materials And Devices

DTIC Science & Technology

2010-01-17

RADIATION EFFECTS ON EMERGING ELECTRONIC MATERIALS AND DEVICES FINAL PERFORMANCE REPORT PREPARED FOR: Kitt Reinhardt AFOSR/NE 875 N...and the other with metal gates and a high-K gate dielectric. These devices were programmed using both back-gate pulse and gate induced drain leakage... metal gate process GIDL method Fig. 1. Sensing margin as a function of total ionizing dose for nMOS 1T-DRAM cells programmed by back-gate pulse and

Hadoop-GIS: A High Performance Spatial Data Warehousing System over MapReduce.

PubMed

Aji, Ablimit; Wang, Fusheng; Vo, Hoang; Lee, Rubao; Liu, Qiaoling; Zhang, Xiaodong; Saltz, Joel

2013-08-01

Support of high performance queries on large volumes of spatial data becomes increasingly important in many application domains, including geospatial problems in numerous fields, location based services, and emerging scientific applications that are increasingly data- and compute-intensive. The emergence of massive scale spatial data is due to the proliferation of cost effective and ubiquitous positioning technologies, development of high resolution imaging technologies, and contribution from a large number of community users. There are two major challenges for managing and querying massive spatial data to support spatial queries: the explosion of spatial data, and the high computational complexity of spatial queries. In this paper, we present Hadoop-GIS - a scalable and high performance spatial data warehousing system for running large scale spatial queries on Hadoop. Hadoop-GIS supports multiple types of spatial queries on MapReduce through spatial partitioning, customizable spatial query engine RESQUE, implicit parallel spatial query execution on MapReduce, and effective methods for amending query results through handling boundary objects. Hadoop-GIS utilizes global partition indexing and customizable on demand local spatial indexing to achieve efficient query processing. Hadoop-GIS is integrated into Hive to support declarative spatial queries with an integrated architecture. Our experiments have demonstrated the high efficiency of Hadoop-GIS on query response and high scalability to run on commodity clusters. Our comparative experiments have showed that performance of Hadoop-GIS is on par with parallel SDBMS and outperforms SDBMS for compute-intensive queries. Hadoop-GIS is available as a set of library for processing spatial queries, and as an integrated software package in Hive.

Hadoop-GIS: A High Performance Spatial Data Warehousing System over MapReduce

PubMed Central

Aji, Ablimit; Wang, Fusheng; Vo, Hoang; Lee, Rubao; Liu, Qiaoling; Zhang, Xiaodong; Saltz, Joel

2013-01-01

Support of high performance queries on large volumes of spatial data becomes increasingly important in many application domains, including geospatial problems in numerous fields, location based services, and emerging scientific applications that are increasingly data- and compute-intensive. The emergence of massive scale spatial data is due to the proliferation of cost effective and ubiquitous positioning technologies, development of high resolution imaging technologies, and contribution from a large number of community users. There are two major challenges for managing and querying massive spatial data to support spatial queries: the explosion of spatial data, and the high computational complexity of spatial queries. In this paper, we present Hadoop-GIS – a scalable and high performance spatial data warehousing system for running large scale spatial queries on Hadoop. Hadoop-GIS supports multiple types of spatial queries on MapReduce through spatial partitioning, customizable spatial query engine RESQUE, implicit parallel spatial query execution on MapReduce, and effective methods for amending query results through handling boundary objects. Hadoop-GIS utilizes global partition indexing and customizable on demand local spatial indexing to achieve efficient query processing. Hadoop-GIS is integrated into Hive to support declarative spatial queries with an integrated architecture. Our experiments have demonstrated the high efficiency of Hadoop-GIS on query response and high scalability to run on commodity clusters. Our comparative experiments have showed that performance of Hadoop-GIS is on par with parallel SDBMS and outperforms SDBMS for compute-intensive queries. Hadoop-GIS is available as a set of library for processing spatial queries, and as an integrated software package in Hive. PMID:24187650

Seedling Emergence and Phenotypic Response of Common Bean Germplasm to Different Temperatures under Controlled Conditions and in Open Field.

PubMed

De Ron, Antonio M; Rodiño, Ana P; Santalla, Marta; González, Ana M; Lema, María J; Martín, Isaura; Kigel, Jaime

2016-01-01

Rapid and uniform seed germination and seedling emergence under diverse environmental conditions is a desirable characteristic for crops. Common bean genotypes (Phaseolus vulgaris L.) differ in their low temperature tolerance regarding growth and yield. Cultivars tolerant to low temperature during the germination and emergence stages and carriers of the grain quality standards demanded by consumers are needed for the success of the bean crop. The objectives of this study were (i) to screen the seedling emergence and the phenotypic response of bean germplasm under a range of temperatures in controlled chamber and field conditions to display stress-tolerant genotypes with good agronomic performances and yield potential, and (ii) to compare the emergence of bean seedlings under controlled environment and in open field conditions to assess the efficiency of genebanks standard germination tests for predicting the performance of the seeds in the field. Three trials were conducted with 28 dry bean genotypes in open field and in growth chamber under low, moderate, and warm temperature. Morpho-agronomic data were used to evaluate the phenotypic performance of the different genotypes. Cool temperatures resulted in a reduction of the rate of emergence in the bean genotypes, however, emergence and early growth of bean could be under different genetic control and these processes need further research to be suitably modeled. Nine groups arose from the Principal Component Analysis (PCA) representing variation in emergence time and proportion of emergence in the controlled chamber and in the open field indicating a trend to lower emergence in large and extra-large seeded genotypes. Screening of seedling emergence and phenotypic response of the bean germplasm under a range of temperatures in controlled growth chambers and under field conditions showed several genotypes, as landraces 272, 501, 593, and the cultivar Borlotto, with stress-tolerance at emergence, and high yield potential that could be valuable genetic material for breeding programs. Additionally, the potential genetic erosion in genebanks was assessed. Regarding bean commercial traits, under low temperature at sowing time seed reached larger size, and crop yield was higher compared to warmer temperatures at the sowing time. Therefore, early sowing of bean is strongly recommended.

Seedling Emergence and Phenotypic Response of Common Bean Germplasm to Different Temperatures under Controlled Conditions and in Open Field

PubMed Central

De Ron, Antonio M.; Rodiño, Ana P.; Santalla, Marta; González, Ana M.; Lema, María J.; Martín, Isaura; Kigel, Jaime

2016-01-01

Rapid and uniform seed germination and seedling emergence under diverse environmental conditions is a desirable characteristic for crops. Common bean genotypes (Phaseolus vulgaris L.) differ in their low temperature tolerance regarding growth and yield. Cultivars tolerant to low temperature during the germination and emergence stages and carriers of the grain quality standards demanded by consumers are needed for the success of the bean crop. The objectives of this study were (i) to screen the seedling emergence and the phenotypic response of bean germplasm under a range of temperatures in controlled chamber and field conditions to display stress-tolerant genotypes with good agronomic performances and yield potential, and (ii) to compare the emergence of bean seedlings under controlled environment and in open field conditions to assess the efficiency of genebanks standard germination tests for predicting the performance of the seeds in the field. Three trials were conducted with 28 dry bean genotypes in open field and in growth chamber under low, moderate, and warm temperature. Morpho-agronomic data were used to evaluate the phenotypic performance of the different genotypes. Cool temperatures resulted in a reduction of the rate of emergence in the bean genotypes, however, emergence and early growth of bean could be under different genetic control and these processes need further research to be suitably modeled. Nine groups arose from the Principal Component Analysis (PCA) representing variation in emergence time and proportion of emergence in the controlled chamber and in the open field indicating a trend to lower emergence in large and extra-large seeded genotypes. Screening of seedling emergence and phenotypic response of the bean germplasm under a range of temperatures in controlled growth chambers and under field conditions showed several genotypes, as landraces 272, 501, 593, and the cultivar Borlotto, with stress-tolerance at emergence, and high yield potential that could be valuable genetic material for breeding programs. Additionally, the potential genetic erosion in genebanks was assessed. Regarding bean commercial traits, under low temperature at sowing time seed reached larger size, and crop yield was higher compared to warmer temperatures at the sowing time. Therefore, early sowing of bean is strongly recommended. PMID:27532005

Emergency aortic valve replacement and Caesarian section in a primigravida with severe aortic stenosis: a case report.

PubMed

Kochhar, Puneet K; Zutshi, V; Shamsunder, S; Batra, S; Ghosh, P

2011-01-01

Congenital bicuspid aortic valve with severe aortic stenosis (AS) is a rare condition (3-6% of patients with congenital heart disease). Pregnancy in these patients carries a high risk of maternal and fetal mortality. With advancing gestational age, these women may develop cardiac failure due to increased cardiorespiratory requirements. When medical therapy proves insufficient, cardiac surgery becomes mandatory to save the patient's life. Balloon valvuloplasty is only palliative treatment, the duration of benefit being only 6 months. Valve replacement is thus recommended. Cardiopulmonary bypass (CPB) surgery with valve replacement has been reported to carry a lower risk of maternal mortality (1.5-13%) but a very high fetal risk (16-40%). This paper reports the case of a 30-year-old primigravida with severe AS with bicuspid aortic valve and pulmonary congestion clinically uncontrolled, in whom CPB surgery and aortic valve replacement was performed as an emergency procedure, along with a lower segment Caesarian section. The outcome of unrelieved severe symptomatic AS in pregnancy is poor. Multidisciplinary management is important to avoid deterioration in cardiac performance in parturients with severe AS. CPB during pregnancy carries a high risk to the fetus. Therefore, open heart surgery during pregnancy should be advised only in extreme emergencies (ie, heart failure refractory to conventional therapy).

Emergency pancreatoduodenectomy (whipple procedure) for massive upper gastrointestinal bleeding caused by a diffuse B-cell lymphoma of the duodenum: report of a case.

PubMed

Stratigos, Panagiotis; Kouskos, Efstratios; Kouroglou, Maria; Chrisafis, Ioannis; Fois, Lucia; Mavrogiorgis, Anastasios; Axiotis, Efthimios; Zamtrakis, Sotirios

2007-01-01

We herein report a rare case of a massive upper gastrointestinal (GI) bleeding, caused by high-grade diffuse B-cell lymphoma of the duodenum, secondary to immunoproliferative small intestinal disease (IPSID) and treated with an emergency partial pancreatoduodenectomy. A 42-year-old man was admitted to our hospital because of hematemesis. Upper GI endoscopy was unrevealing because of the copious bleeding. Initially, the patient underwent conservative treatment, thus resulting in the temporary cessation of the bleeding. Later, the hemorrhage massively relapsed. An urgent abdominal ultrasound raised the suspicion of a large, possibly bleeding, neoplasm of the duodenum, which was finally confirmed by abdominal computed tomography. The patient underwent an emergency laparotomy, during which a partial pancreatoduodenectomy was performed (Whipple procedure). Histologically, the tumor was a high-grade B-cell lymphoma of the duodenum. The nearby small intestinal mucosa was suggestive of IPSID. A massive upper GI hemorrhage from a high-grade B-cell non-Hodgkin lymphoma of the duodenum, which develops secondary to IPSID, is a very rare clinical demonstration of this disease. Our case is one of the few reports in the English literature, for which the Whipple procedure has been performed as a curative treatment.

Seedling performance covaries with dormancy thresholds: maintaining cryptic seed heteromorphism in a fire-prone system.

PubMed

Liyanage, Ganesha S; Ayre, David J; Ooi, Mark K J

2016-11-01

The production of morphologically different seeds or fruits by the same individual plant is known as seed heteromorphism. Such variation is expected to be selected for in disturbance-prone environments to allow germination into inherently variable regeneration niches. However, there are few demonstrations that heteromorphic seed characteristics should be favored by selection or how they may be maintained. In fire-prone ecosystems, seed heteromorphism is found in the temperatures needed to break physical dormancy, with seeds responding to high or low temperatures, ensuring emergence under variable fire-regime-related soil heating. Because of the relationship between dormancy-breaking temperature thresholds and fire severity, we hypothesize that different post-fire resource conditions have selected for covarying seedling traits, which contribute to maintenance of such heteromorphism. Seeds with low thresholds emerge into competitive conditions, either after low-severity fire or in vegetation gaps, and are therefore likely to experience selection for seedling characteristics that make them good competitors. On the other hand, high-temperature-threshold seeds would emerge into less competitive environments, indicative of stand-clearing high-severity fires, and would not experience the same selective forces. We identified high and low-threshold seed morphs via dormancy-breaking heat treatments and germination trials for two study species and compared seed mass and other morphological characteristics between morphs. We then grew seedlings from the two different morphs, with and without competition, and measured growth and biomass allocation as indicators of seedling performance. Seedlings from low-threshold seeds of both species performed better than their high-threshold counterparts, growing more quickly under competitive conditions, confirming that different performance can result from this seed characteristic. Seed mass or appearance did not differ between morphs, indicating that dormancy-breaking temperature threshold variation is a form of cryptic heteromorphism. The potential shown for the selective influence of different post-fire environmental conditions on seedling performance provides evidence of a mechanism for the maintenance of heteromorphic variation in dormancy-breaking temperature thresholds. © 2016 The Authors. Ecology, published by Wiley Periodicals, Inc., on behalf of the Ecological Society of America.

Identification of the Critical Nontechnical Skills for Surgeons Needed for High Performance in a Variable-resource Context (NOTSS-VRC).

PubMed

Scott, John W; Lin, Yihan; Ntakiyiruta, Georges; Mutabazi, Zeta; Davis, William A; Morris, Megan A; Smink, Douglas S; Riviello, Robert; Yule, Steven

2018-05-17

To identify the critical nontechnical skills (NTS) required for high performance in variable-resource contexts (VRC). As surgical training and capacity increase in low- and middle-income countries (LMICs), new strategies for improving surgical education and care in these settings are required. NTS are critical for high performance in surgery around the world. However, the essential NTS used by surgeons operating in LMICs to overcome the challenges specific to their contexts have never been described. Using a constructivist grounded theory approach, 52 intraoperative team observations as well as 34 critical incident interviews with surgical providers (surgeons, anesthetists, and nurses) were performed at the 4 tertiary referral hospitals in Rwanda. Interview transcripts and field notes from observations were analyzed using line-by-line coding to identify emerging themes until thematic saturation was achieved. Four skill categories of situation awareness, decision-making, communication/teamwork, and leadership emerged. This provided the framework for a contextually informed skills taxonomy consisting of 12 skill elements with examples of specific behaviors indicative of high performance. While the main skill categories were consistent with those encountered in high-income countries, the specific behaviors associated with these skills often focused on overcoming the frequently encountered variability in resources, staff, systems support, and language in this context. This is the first description of the critical nontechnical skills, and associated example behaviors, used by surgeons in a VRC to overcome common challenges to safe and effective surgical patient care. Improvements in the NTS used by surgeons operating in VRCs have the potential to improve surgical care delivery worldwide.

Opportunities for nonvolatile memory systems in extreme-scale high-performance computing

DOE PAGES

Vetter, Jeffrey S.; Mittal, Sparsh

2015-01-12

For extreme-scale high-performance computing systems, system-wide power consumption has been identified as one of the key constraints moving forward, where DRAM main memory systems account for about 30 to 50 percent of a node's overall power consumption. As the benefits of device scaling for DRAM memory slow, it will become increasingly difficult to keep memory capacities balanced with increasing computational rates offered by next-generation processors. However, several emerging memory technologies related to nonvolatile memory (NVM) devices are being investigated as an alternative for DRAM. Moving forward, NVM devices could offer solutions for HPC architectures. Researchers are investigating how to integratemore » these emerging technologies into future extreme-scale HPC systems and how to expose these capabilities in the software stack and applications. In addition, current results show several of these strategies could offer high-bandwidth I/O, larger main memory capacities, persistent data structures, and new approaches for application resilience and output postprocessing, such as transaction-based incremental checkpointing and in situ visualization, respectively.« less

Low-power, transparent optical network interface for high bandwidth off-chip interconnects.

PubMed

Liboiron-Ladouceur, Odile; Wang, Howard; Garg, Ajay S; Bergman, Keren

2009-04-13

The recent emergence of multicore architectures and chip multiprocessors (CMPs) has accelerated the bandwidth requirements in high-performance processors for both on-chip and off-chip interconnects. For next generation computing clusters, the delivery of scalable power efficient off-chip communications to each compute node has emerged as a key bottleneck to realizing the full computational performance of these systems. The power dissipation is dominated by the off-chip interface and the necessity to drive high-speed signals over long distances. We present a scalable photonic network interface approach that fully exploits the bandwidth capacity offered by optical interconnects while offering significant power savings over traditional E/O and O/E approaches. The power-efficient interface optically aggregates electronic serial data streams into a multiple WDM channel packet structure at time-of-flight latencies. We demonstrate a scalable optical network interface with 70% improvement in power efficiency for a complete end-to-end PCI Express data transfer.

A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department.

PubMed

Chong, Shu-Ling; Ong, Gene Yong-Kwang; Chin, Wendy Yi Wen; Chua, John Mingzhou; Nair, Praseetha; Ong, Alicia Shu Zhen; Ng, Kee Chong; Maconochie, Ian

2018-01-01

Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED. We documented the primary outcome of SI for each infant, as well as the clinical findings, vital signs, and Severity Index Score (SIS). We assessed the performance of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS), Advanced Pediatric Life Support (APLS) guidelines and Fleming normal reference values, using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristics curve (AUC). 1057 infants were analyzed, with 326 (30.6%) infants diagnosed with SI. High temperature, tachycardia, and low SIS score were significantly associated with SI. Item analysis showed that the SIS performance was driven by the presence of mottling (p = 0.003) and high temperature (p<0.001). The APLS guideline had the highest sensitivity (66.0%, 95% CI 60.5-71.1%), NPV (73.3%, 95% CI 69.7-76.5%) and AUC (0.538), while the PaedCTAS (2 standard deviation from normal) had the highest specificity (98.5%, 95% CI 97.3-99.3%) and PPV (55.2%, 95% CI 32.7-71.0%). Current guidelines on infantile heart rates have a variable performance. In our study, the APLS heart rate guidelines performed with the highest sensitivity, but no individual guideline predicted for SIs satisfactorily.

Workload differences across command levels and emergency response organizations during a major joint training exercise.

PubMed

Prytz, Erik G; Rybing, Jonas; Jonson, Carl-Oscar

2016-01-01

This study reports on an initial test using a validated workload measurement method, the NASA Task Load Index (TLX), as an indicator of joint emergency exercise effectiveness. Prior research on emergency exercises indicates that exercises must be challenging, ie, result in high workload, to be effective. However, this is often problematic with some participants being underloaded and some overloaded. The NASA TLX was used to test for differences in workload between commanders and subordinates and among three different emergency response organizations during a joint emergency exercise. Questionnaire-based evaluation with professional emergency responders. The study was performed in conjunction with a large-scale interorganizational joint emergency exercise in Sweden. A total of 20 participants from the rescue services, 12 from the emergency medical services, and 12 from the police participated in the study (N=44). Ten participants had a command-level role during the exercise and the remaining 34 were subordinates. The main outcome measures were the workload subscales of the NASA TLX: mental demands, physical demands, temporal demands, performance, effort, and frustration. The results showed that the organizations experienced different levels of workload, that the commanders experienced a higher workload than the subordinates, and that two out of three organizations fell below the twenty-fifth percentile of average workload scores compiled from 237 prior studies. The results support the notion that the NASA TLX could be a useful complementary tool to evaluate exercise designs and outcomes. This should be further explored and verified in additional studies.

Response, Emergency Staging, Communications, Uniform Management, and Evacuation (R.E.S.C.U.M.E.) : report on functional and performance requirements, and high-level data and communication needs.

DOT National Transportation Integrated Search

1995-06-01

INTELLIGENT VEHICLE INITIATIVE OR IVI ABSTRACT THE GOAL OF THE TRAVTEK CAMERA CAR STUDY WAS TO FURNISH A DETAILED EVALUATION OF DRIVING AND NAVIGATION PERFORMANCE, SYSTEM USABILITY, AND SAFETY FOR THE TRAVTEK SYSTEM. TO ACHIEVE THIS GOAL, AN INSTRUME...

[Treatment of emergencies in the hospital--problems and management].

PubMed

Sablotzki, A; Schubert, S; Kuhn, C; Radke, J; Czeslick, E

2003-01-01

Due to the growing number of high-risk patients, the increasing proportion of geriatric patients and the expansion of surgical and invasive-diagnostic procedures, medical stuff in hospitals are confronted with a rising number of emergency situations. Nearly 50% are of cardio-circulatory origin and occur during surgical interventions or immediately afterwards. Another cause of life-threatening complications are side-effects of orally or intravenously administered agents, especially after treatment with antibiotics, anaesthetics, analgetics and sedatives. Due to a lack of emergency training and management in most hospitals, the survival rate after cardiopulmonary resuscitation in general wards lies between just two and 35%. Thus it seems necessary to perform special training in CPR procedures and emergency management at regular intervals for the entire medical stuff. In addition, a special infrastructure for giving sufficient treatment in emergencies has to be established (emergency team, emergency telephone number, intra-hospital emergency car). The second part of this review presents current diagnostic and therapeutic strategies for the most common emergency situations, e.g. anaphylaxis, myocardial infarction, pulmonary embolism, gastrointestinal bleeding, and heparin-induced thrombocytopenia (HIT).

A 12-month descriptive analysis of emergency intubations at Brooke Army Medical Center: a National Emergency Airway Registry study.

PubMed

April, Michael D; Schauer, Steven G; Brown Rd, Calvin A; Ng, Patrick C; Fernandez, Jessie; Fantegrossi, Andrea E; Maddry, Joseph K; Summers, Shane; Sessions, Daniel J; Barnwell, Robert M; Antonacci, Mark

2017-01-01

Emergency airway management is a critical skill for military healthcare providers. Our goal was to describe the Emergency Department (ED) intubations at Brooke Army Medical Center (BAMC) over a 12-month period. Physicians performing endotracheal intubations in the BAMC ED complete data collection forms for each intubation event as part of the National Emergency Airway Registry, including patient demographics, intubation techniques, success and failure rates, adverse events, and patient disposition. We cross-referenced these forms against the numbers of intubation events reported in the ED nursing daily reports to ensure capture of all intubations. Providers completed forms for every intubation within 6 weeks of the procedure. We analyzed data from March 28, 2016, to March 27, 2017. During the study period, providers performed 259 intubations in the BAMC ED. Reasons for intubation were related to trauma for 184 patients (71.0%) and medical conditions for 75 patients (29.0%). Overall, first-attempt success was 83.0%. Emergency medicine residents performed a majority of first attempts (95.0%). Most common devices chosen on first attempt were a video laryngoscope for 143 patients (55.2%) and a direct laryngoscope for 115 patients (44.4%). One patient underwent cricothyrotomy. The 2 most common induction agents were ketamine (59.8%; 95% CI, 55.2%-67.4%) and etomidate (19.3%; 95% CI, 14.7%-24.7%). The most common neuromuscular blocking agents were rocuronium (62.9%; 95% CI, 56.7%-68.8%) and succinylcholine (18.9%; 95% CI, 14.3%-24.2%). In the BAMC ED, emergency intubation most commonly occurred for trauma indications using video laryngoscopy with a high first-pass success.

Assessment of a membrane drinking water filter in an emergency setting.

PubMed

Ensink, Jeroen H J; Bastable, Andy; Cairncross, Sandy

2015-06-01

The performance and acceptability of the Nerox(TM) membrane drinking water filter were evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6-month period, 230 households were visited and filter performance and use were assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals), together with high temperatures and large family size were likely to have contributed to poor performance and uptake of the filters.

Trauma and Hypothermia in Antarctica: An Emergency Medicine Marine Simulation Scenario

PubMed Central

Horwood, Chrystal; Skinner, Tate; Brown, Robert; Renouf, Tia; Dubrowski, Adam

2017-01-01

Simulation has been shown to improve both learner knowledge and patient outcomes. Many emergency medicine training programs incorporate simulation into their curricula to provide learners with experiences that are rare to encounter in practice, yet performance with a high degree of competence is critical. One rare encounter, which is depicted in the report, is the management of a trauma patient who was hypothermic after falling from an expedition vessel into the cold Southern Ocean. The unique scenario presented in this technical report incorporates CanMEDS learning objectives including the communicator, health advocate, and collaborator roles. Using medical simulation facilities, marine performance simulation facilities, and a video, this scenario provides teaching that is uncommon in traditional emergency medicine training. As such, it is valuable for trainees who intend to practice rural, remote, or expedition medicine, or provide coverage for ships and marine installations. PMID:28706765

Predicting Positive Education Outcomes for Emerging Adults in Mental Health Systems of Care.

PubMed

Brennan, Eileen M; Nygren, Peggy; Stephens, Robert L; Croskey, Adrienne

2016-10-01

Emerging adults who receive services based on positive youth development models have shown an ability to shape their own life course to achieve positive goals. This paper reports secondary data analysis from the Longitudinal Child and Family Outcome Study including 248 culturally diverse youth ages 17 through 22 receiving mental health services in systems of care. After 12 months of services, school performance was positively related to youth ratings of school functioning and service participation and satisfaction. Regression analysis revealed ratings of young peoples' perceptions of school functioning, and their experience in services added to the significant prediction of satisfactory school performance, even controlling for sex and attendance. Finally, in addition to expected predictors, participation in planning their own services significantly predicted enrollment in higher education for those who finished high school. Findings suggest that programs and practices based on positive youth development approaches can improve educational outcomes for emerging adults.

The predictive performance of a path-dependent exotic-option credit risk model in the emerging market

NASA Astrophysics Data System (ADS)

Chen, Dar-Hsin; Chou, Heng-Chih; Wang, David; Zaabar, Rim

2011-06-01

Most empirical research of the path-dependent, exotic-option credit risk model focuses on developed markets. Taking Taiwan as an example, this study investigates the bankruptcy prediction performance of the path-dependent, barrier option model in the emerging market. We adopt Duan's (1994) [11], (2000) [12] transformed-data maximum likelihood estimation (MLE) method to directly estimate the unobserved model parameters, and compare the predictive ability of the barrier option model to the commonly adopted credit risk model, Merton's model. Our empirical findings show that the barrier option model is more powerful than Merton's model in predicting bankruptcy in the emerging market. Moreover, we find that the barrier option model predicts bankruptcy much better for highly-leveraged firms. Finally, our findings indicate that the prediction accuracy of the credit risk model can be improved by higher asset liquidity and greater financial transparency.

Burnout and Associated Factors among Iranian Emergency Medicine Practitioners

PubMed Central

JALILI, Mohammad; SADEGHIPOUR ROODSARI, Gholamreza; BASSIR NIA, Anahita

2013-01-01

Abstract Background Emergency physicians are at risk of burnout, which can affect their mental health, as well as patient care. We assessed burnout level among Iranian emergency physicians and investigated demographic, work-related factors and stressors associated with higher burnout. Methods In a cross-sectional study, we surveyed all 188 emergency medicine residents and practitioners in Iran. We measured burnout using 22-item Maslach Burnout Inventory assessing emotional exhaustion, depersonalization and personal accomplishment, also demographic factors, work related factors and sources of stress in emergency department using anonymous self-administered questionnaire. Descriptive analysis, univariate analysis to evaluate association with higher score of burnout, and multivariate logistic regression analysis to predict high burnout in 3 subscales was performed. Results Totally, 165 questionnaires were filled (response rate: 88%; mean age: 33.6 years, 91% male). Mean burnout scores were 22.94 for emotional exhaustion (95% CI=20.78-25.01; moderate), 9.3 for depersonalization (95% CI=8.24-10.36; moderate to high), and 31.47 for personal accomplishment (95% CI=29.87-33.07; moderate to high). Frequent reported sources of stress were shortage of equipment, problem with work physical environment, and relationship with other services. All 19 sources of stress were associated with higher score of emotional exhaustion and depersonalization; while twelve out of 19 were significantly associated with lower level of personal accomplishment. In logistic regression model, the significant predictors for high emotional exhaustion were work overload, feeling of insecurity for future career and difficulties to balance professional and private life. Conclusion Burnout is high among Iranian emergency medicine practitioners and some interventions can be proposed to reduce stress. PMID:26060665

Defining our destiny: trainee working group consensus statement on the future of emergency surgery training in the United Kingdom.

PubMed

Sharrock, A E; Gokani, V J; Harries, R L; Pearce, L; Smith, S R; Ali, O; Chu, H; Dubois, A; Ferguson, H; Humm, G; Marsden, M; Nepogodiev, D; Venn, M; Singh, S; Swain, C; Kirkby-Bott, J

2015-01-01

The United Kingdom National Health Service treats both elective and emergency patients and seeks to provide high quality care, free at the point of delivery. Equal numbers of emergency and elective general surgical procedures are performed, yet surgical training prioritisation and organisation of NHS institutions is predicated upon elective care. The increasing ratio of emergency general surgery consultant posts compared to traditional sub-specialities has yet to be addressed. How should the capability gap be bridged to equip motivated, skilled surgeons of the future to deliver a high standard of emergency surgical care? The aim was to address both training requirements for the acquisition of necessary emergency general surgery skills, and the formation of job plans for trainee and consultant posts to meet the current and future requirements of the NHS. Twenty nine trainees and a consultant emergency general surgeon convened as a Working Group at The Association of Surgeons in Training Conference, 2015, to generate a united consensus statement to the training requirement and delivery of emergency general surgery provision by future general surgeons. Unscheduled general surgical care provision, emergency general surgery, trauma competence, training to meet NHS requirements, consultant job planning and future training challenges arose as key themes. Recommendations have been made from these themes in light of published evidence. Careful workforce planning, education, training and fellowship opportunities will provide well-trained enthusiastic individuals to meet public and societal need.

The importance of improving the quality of emergency surgery for a regional quality collaborative.

PubMed

Smith, Margaret; Hussain, Adnan; Xiao, Jane; Scheidler, William; Reddy, Haritha; Olugbade, Kola; Cummings, Dustin; Terjimanian, Michael; Krapohl, Greta; Waits, Seth A; Campbell, Darrell; Englesbe, Michael J

2013-04-01

Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.

Evaluation of the Huawei UDS cloud storage system for CERN specific data

NASA Astrophysics Data System (ADS)

Zotes Resines, M.; Heikkila, S. S.; Duellmann, D.; Adde, G.; Toebbicke, R.; Hughes, J.; Wang, L.

2014-06-01

Cloud storage is an emerging architecture aiming to provide increased scalability and access performance, compared to more traditional solutions. CERN is evaluating this promise using Huawei UDS and OpenStack SWIFT storage deployments, focusing on the needs of high-energy physics. Both deployed setups implement S3, one of the protocols that are emerging as a standard in the cloud storage market. A set of client machines is used to generate I/O load patterns to evaluate the storage system performance. The presented read and write test results indicate scalability both in metadata and data perspectives. Futher the Huawei UDS cloud storage is shown to be able to recover from a major failure of losing 16 disks. Both cloud storages are finally demonstrated to function as back-end storage systems to a filesystem, which is used to deliver high energy physics software.

Enhanced risk management by an emerging multi-agent architecture

NASA Astrophysics Data System (ADS)

Lin, Sin-Jin; Hsu, Ming-Fu

2014-07-01

Classification in imbalanced datasets has attracted much attention from researchers in the field of machine learning. Most existing techniques tend not to perform well on minority class instances when the dataset is highly skewed because they focus on minimising the forecasting error without considering the relative distribution of each class. This investigation proposes an emerging multi-agent architecture, grounded on cooperative learning, to solve the class-imbalanced classification problem. Additionally, this study deals further with the obscure nature of the multi-agent architecture and expresses comprehensive rules for auditors. The results from this study indicate that the presented model performs satisfactorily in risk management and is able to tackle a highly class-imbalanced dataset comparatively well. Furthermore, the knowledge visualised process, supported by real examples, can assist both internal and external auditors who must allocate limited detecting resources; they can take the rules as roadmaps to modify the auditing programme.

Emerging Robust Heterostructure of MoS2-rGO for High-Performance Supercapacitors.

PubMed

Saraf, Mohit; Natarajan, Kaushik; Mobin, Shaikh M

2018-05-16

The intermittent nature of renewable energy resources has led to a continuous mismatch between energy demand and supply. A possible solution to overcome this persistent problem is to design appropriate energy-storage materials. Supercapacitors based on different nanoelectrode materials have emerged as one of the promising storage devices. In this work, we investigate the supercapacitor properties of a molybdenum disulfide-reduced graphene oxide (rGO) heterostructure-based binder-free electrode, which delivered a high specific capacitance (387.6 F g -1 at 1.2 A g -1 ) and impressive cycling stability (virtually no loss up to 1000 cycles). In addition, the possible role of rGO in the composite toward synergistically enhanced supercapacitance has been highlighted. Moreover, an attempt has been made to correlate the electrochemical impedance spectroscopy studies with the voltammetric analyses. The performance exceeds that of the reported state-of-the-art structures.

Building America FY 2016 Annual Report: Building America Is Driving Real Solutions in the Race to Zero Energy Homes

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

Farrar, Sara; Rothgeb, Stacey; Polly, Ben

The U.S. Department of Energy (DOE) Building America Program enables the transformation of the U.S. housing industry to achieve energy savings through energy-efficient, high-performance homes with improved durability, comfort, and health for occupants. Building America bridges the gap between the development of emerging technologies and the adoption of codes and standards by engaging industry partners in applied research, development, and demonstration of high-performance solutions.

Impacts of high resolution data on traveler compliance levels in emergency evacuation simulations

DOE PAGES

Lu, Wei; Han, Lee D.; Liu, Cheng; ...

2016-05-05

In this article, we conducted a comparison study of evacuation assignment based on Traffic Analysis Zones (TAZ) and high resolution LandScan USA Population Cells (LPC) with detailed real world roads network. A platform for evacuation modeling built on high resolution population distribution data and activity-based microscopic traffic simulation was proposed. This platform can be extended to any cities in the world. The results indicated that evacuee compliance behavior affects evacuation efficiency with traditional TAZ assignment, but it did not significantly compromise the performance with high resolution LPC assignment. The TAZ assignment also underestimated the real travel time during evacuation. Thismore » suggests that high data resolution can improve the accuracy of traffic modeling and simulation. The evacuation manager should consider more diverse assignment during emergency evacuation to avoid congestions.« less

Potential role for psychological skills training in emergency medicine: Part 1 - Introduction and background.

PubMed

Lauria, Michael J; Rush, Stephen; Weingart, Scott D; Brooks, Jason; Gallo, Isabelle A

2016-10-01

Psychological skills training (PST) is the systematic acquisition and practice of different psychological techniques to improve cognitive and technical performance. This training consists of three phases: education, skills acquisition and practice. Some of the psychological skills developed in this training include relaxation techniques, focusing and concentration skills, positive 'self-suggestion' and visualisation exercises. Since the middle of the 20th century, PST has been successfully applied by athletes, performing artists, business executives, military personnel and other professionals in high-risk occupations. Research in these areas has demonstrated the breadth and depth of the training's effectiveness. Despite the benefits realised in other professions, medicine has only recently begun to explore certain elements of PST. The present paper reviews the history and evidence behind the concept of PST. In addition, it presents some aspects of PST that have already been incorporated into medical training as well as implications for developing more comprehensive programmes to improve delivery of emergency medical care. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Check the Head: Emergency Ultrasound Diagnosis of Fetal Anencephaly

PubMed Central

Hall, John W.; Denne, Nicolas; Minardi, Joseph J.; Williams, Debra; Balcik, BJ

2016-01-01

Background Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding. Case Report A 33-year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside US was performed. The EP noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal US. Making the diagnosis at the point of care allowed earlier detection and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, thus decreasing maternal risk. If this diagnosis would not have been recognized by the EP at the point of care, it may not have been diagnosed until the second trimester, and lower-risk maternal options would not have been available. PMID:27429697

Advancing regulatory science to bring novel medical devices for use in emergency care to market: the role of the Food and Drug Administration.

PubMed

Scully, Christopher G; Forrest, Shawn; Galeotti, Loriano; Schwartz, Suzanne B; Strauss, David G

2015-04-01

The Food and Drug Administration (FDA) performs regulatory science to provide science-based medical product regulatory decisions. This article describes the types of scientific research the FDA's Center for Devices and Radiological Health performs and highlights specific projects related to medical devices for emergency medicine. In addition, this article discusses how results from regulatory science are used by the FDA to support the regulatory process as well as how the results are communicated to the public. Regulatory science supports the FDA's mission to assure safe, effective, and high-quality medical products are available to patients. Published by Elsevier Inc.

[Applying situational leadership in emergency nursing].

PubMed

Wehbe, Grasiela; Galvão, Cristina Maria; Galvão, Maria Cristina

2005-01-01

This study aimed to identify the correspondence of opinions between nurses and nursing staff members who work at the emergency unit regarding the leadership style performed by nurses and the style nurses must adopt considering the maturity level of nursing staff members and the care provided at the unit. Situational Leadership was adopted as a theoretical reference framework. In order to achieve these goals, instruments were elaborated and applied to 24 research participants. Results demonstrated that the leadership style nurses most frequently perform was E3 (participating), and that nurses should adopt leadership style E4 (delegating) in view of the nursing staff's level of maturity, suggesting that staff members present a high level of maturity (M4).

An "Education Professions Performance Development Act": A Prospectus for Providing "Highly Qualified" and More Motivated Teachers and Leaders for America's Schools

ERIC Educational Resources Information Center

Guthrie, James W.

2005-01-01

Classroom teachers are among the few remaining employee groups whose evaluations and remuneration are generally unrelated to their performance. However, it is difficult to appraise a teacher's effectiveness by achievement of pupils because learning is not under an instructor's complete influence. New measurement techniques are emerging, however,…

Exploring Socio-Demographics, Mobility, and Living Arrangement as Risk Factors for Academic Performance among Children Experiencing Homelessness

ERIC Educational Resources Information Center

Howland, Allison; Chen, Li-Ting; Chen, Ming-E; Min, Mina

2017-01-01

Homeless children usually experience high mobility. Yet, it is not clear if the degree of mobility among homeless children is associated with their academic performance. Furthermore, an emerging body of literature is beginning to examine the impact of specific living arrangements (e.g., living with families or friends) on homeless family and child…

Illuminating the inner leadership journey by engaging intention and mindfulness as guided by caring theory.

PubMed

Pipe, Teresa Britt

2008-01-01

Sustained, high-performance nursing leadership can be effectively guided by caring theory. While much of leadership performance is manifested by external behaviors, highly effective leaders are also grounded by internal work of self-reflection and growth. This article focuses primarily on the inward journey of leadership as guided by Jean Watson's Theory of Human Caring. Key elements of the theory are interpreted within the context of the emerging, urgent, high-stakes challenges of the current healthcare environment. The links between self-nurturance and caring-healing leadership of others are explored.

Effect of motivational climate on sportspersonship among competitive youth male and female football players.

PubMed

Miller, Blake W; Roberts, Glyn C; Ommundsen, Yngvar

2004-06-01

The purpose of this study was to investigate the influence of perceived motivational climate and gender on sportspersonship behavior of competitive youth football players. Participants were 512 boy and 202 girl Norwegian youth football players (12-14 years old) competing in an international football tournament. A 2 x 2 x 2 (gender, mastery climate high and low, performance climate high and low) MANOVA produced no multivariate or interaction effects, but main effects for gender, performance climate, and mastery climate did emerge. Post hoc analyses of the simple main effects found that boys and girls were different in sportspersonship, but only in that boys were more sportspersonlike than girls on one of the four sportspersonship dimensions. Players perceiving a high mastery climate endorsed sportspersonship more than those players perceiving a low mastery climate, and players perceiving a high performance climate were less likely to endorse sportspersonship than players perceiving a low performance climate. Canonical correlation analysis revealed that a strong mastery climate was positively associated with commitment, respect for social conventions, and respect for rules and officials. A strong performance climate was negatively associated with respect and concern for social conventions and respect for rules and officials, while a positive association emerged for respect and concern for the opponent. The results of our study suggest that both boys and girls may well perceive the coach emphasizing similar criteria of success and failure and thereby a similar culture of sportspersonship, while in general a strong mastery climate leads to a higher sportspersonship orientation.

New York City's Strategy for Improving High Schools: An Overview

ERIC Educational Resources Information Center

Alliance for Excellent Education, 2010

2010-01-01

As the nation has embraced the need to graduate every student ready for college and careers, high school reform has emerged at the top of the education agenda. Many local and state leaders are implementing strategies to address low performance and close achievement gaps. As federal policymakers look ahead to opportunities to support this…

A Web-based Decision Tool to Estimate Subarachnoid Hemorrhage Risk in Emergency Department Patients

PubMed Central

Manella, Haley; Sivasankar, Shyam; Perry, Jeffrey J; Pfeil, Sam; Senyak, Josh; Shachter, Ross

2018-01-01

Subarachnoid hemorrhage (SAH) from a leaking aneurysm is a neurological emergency. SAH patients often present with headache—a common chief complaint among emergency department patients. If unrecognized, 70% of the patients with re-bleeds die and one third are left with neurological deficits. Therefore, it is critical to distinguish the signs and symptoms of SAH from benign causes of headache, perform the appropriate diagnostic tests and treat in a timely manner in order to reduce the disability and mortality associated with this condition. In patients with suspected SAH, traditional diagnostic strategies in the emergency department employ non-contrast computed tomography (CT) of the brain to detect blood in the subarachnoid space followed by lumbar puncture if there is a high clinical probability of aneurysmal bleed without any evidence of blood on CT scan. While the older generation CT scanners were less sensitive to blood detection in the subarachnoid space, recent advances in CT imaging have resulted in sensitivity approaching 100% for detection of blood in the subarachnoid space specifically within six hours of symptom onset. Therefore, the benefit of lumbar puncture is controversial when performed within the first six hours of symptom onset. Despite this, lumbar puncture is still commonly performed in the emergency department, exposing patients to unnecessary procedural risks. The objective of this research study is to develop a web-based risk calculator that estimates the risk of SAH based on time to emergency department presentation after symptom onset, physical findings and imaging characteristics with the goal of reducing unnecessary lumbar punctures in the emergency department. In this technical report, we describe the prototype calculator, the mathematical basis of the model and provide a link to the web-based prototype. In the future, we will refine the prototype, make it user-friendly to physicians, staff and patients and study its benefits in the emergency department. PMID:29568717

Emergency duties and deaths from heart disease among firefighters in the United States.

PubMed

Kales, Stefanos N; Soteriades, Elpidoforos S; Christophi, Costas A; Christiani, David C

2007-03-22

Heart disease causes 45% of the deaths that occur among U.S. firefighters while they are on duty. We examined duty-specific risks of death from coronary heart disease among on-duty U.S. firefighters from 1994 to 2004. We reviewed summaries provided by the Federal Emergency Management Agency of the deaths of all on-duty firefighters between 1994 and 2004, except for deaths associated with the September 11, 2001, terrorist attacks. Estimates of the proportions of time spent by firefighters each year performing various duties were obtained from a municipal fire department, from 17 large metropolitan fire departments, and from a national database. Odds ratios and 95% confidence intervals for death from coronary heart disease during specific duties were calculated from the ratios of the observed odds to the expected odds, with nonemergency duties as the reference category. Deaths from coronary heart disease were associated with suppressing a fire (32.1% of all such deaths), responding to an alarm (13.4%), returning from an alarm (17.4%), engaging in physical training (12.5%), responding to nonfire emergencies (9.4%), and performing nonemergency duties (15.4%). As compared with the odds of death from coronary heart disease during nonemergency duties, the odds were 12.1 to 136 times as high during fire suppression, 2.8 to 14.1 times as high during alarm response, 2.2 to 10.5 times as high during alarm return, and 2.9 to 6.6 times as high during physical training. These odds were based on three estimates of the time that firefighters spend on their duties. Certain emergency firefighting duties were associated with a risk of death from coronary heart disease that was markedly higher than the risk associated with nonemergency duties. Fire suppression was associated with the highest risk, which was approximately 10 to 100 times as high as that for nonemergency duties. Copyright 2007 Massachusetts Medical Society.

Test Characteristics of Point of Care Ultrasound for the Diagnosis of Retinal Detachment in the Emergency Department.

PubMed

Kim, Daniel J; Francispragasam, Mario; Docherty, Gavin; Silver, Byron; Prager, Ross; Lee, Donna; Maberley, David

2018-05-18

Previous studies of point of care ultrasound (POCUS) have reported high sensitivities and specificities for retinal detachment (RD). Our primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD. This was a prospective diagnostic test assessment of POCUS performed by EPs with varying ultrasound experience on a convenience sample of emergency department (ED) patients presenting with flashes or floaters in one or both eyes. After standard ED assessment, EPs performed an ocular POCUS scan targeted to detect the presence or absence of RD. After completing their ED visit, all patients were assessed by a retina specialist who was blinded to the results of the POCUS scan. We calculated sensitivity and specificity with associated exact binomial confidence intervals (CI) using the retina specialist's final diagnosis as the reference standard. A total of 30 EPs enrolled 115 patients, with median age of 60 years and 64% female. The retina specialist diagnosed RD in 16 (14%) cases. The sensitivity and specificity of POCUS for detecting RD was 75% (95% CI 48%-93%) and 94% (95% CI 87%-98%), respectively. The positive likelihood ratio was 12.4 (95% CI 5.4-28.3), and negative likelihood ratio was 0.27 (95% CI 0.11-0.62). A large heterogeneous group of EPs can perform POCUS with high specificity but only intermediate sensitivity for RD. A negative POCUS scan in the ED performed by a heterogeneous group of providers after a one-hour POCUS didactic is not sufficiently sensitive to rule out RD in a patient with new onset flashes or floaters. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Host specificity of two pollinating seed-consuming fly species is not related to soil moisture of host plant in the high Himalayas.

PubMed

Song, Bo; Stöcklin, Jürg; Gao, Yong-Qian; Peng, De-Li; Sun, Hang

2017-01-01

Studying the drivers of host specificity can contribute to our understanding of the origin and evolution of obligate pollination mutualisms. The preference-performance hypothesis predicts that host plant choice of female insects is related mainly to the performance of their offspring. Soil moisture is thought to be particularly important for the survival of larvae and pupae that inhabit soil. In the high Himalayas, Rheum nobile and R. alexandrae differ in their distribution in terms of soil moisture; that is, R. nobile typically occurs in scree with well-drained soils, R. alexandrae in wetlands. The two plant species are pollinated by their respective mutualistic seed-consuming flies, Bradysia sp1. and Bradysia sp2. We investigated whether soil moisture is important for regulating host specificity by comparing pupation and adult emergence of the two fly species using field and laboratory experiments. Laboratory experiments revealed soil moisture did have significant effects on larval and pupal performances in both fly species, but the two fly species had similar optimal soil moisture requirements for pupation and adult emergence. Moreover, a field reciprocal transfer experiment showed that there was no significant difference in adult emergence for both fly species between their native and non-native habitats. Nevertheless, Bradysia sp1., associated with R. nobile , was more tolerant to drought stress, while Bradysia sp2., associated with R. alexandrae , was more tolerant to flooding stress. These results indicate that soil moisture is unlikely to play a determining role in regulating host specificity of the two fly species. However, their pupation and adult emergence in response to extremely wet or dry soils are habitat-specific.

Emerging technologies for biotherapeutic bioanalysis from a high-throughput and multiplexing perspective: insights from an AAPS emerging technology action program committee.

PubMed

Purushothama, Shobha; Dysinger, Mark; Chen, Yao; Österlund, Karolina; Mora, Johanna; Chunyk, Allison Given; Peloquin, Russ

2018-02-01

This manuscript aims to provide insights and updates on emerging technologies from a throughput and multiplexing perspective and to update readers on changes in previously reported technologies. The technologies discussed range from nascent (ultrasensitive Cira, Intellicyt ® , Dynaxi and Captsure™) to the more established (Ella and SQIDlite™). For the nascent technologies, there was an emphasis on user interviews and reviews, where available, to help provide an unbiased view to our readers. For the Ella, a review of published user data as well as author and other user experiences are summarized. Due to their emergent nature, all the technologies described are applicable in the early drug development stage, may require an upfront investment of capital and may not perform as expected.

High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance.

PubMed

Johnsen, Bjørn Helge; Westli, Heidi Kristina; Espevik, Roar; Wisborg, Torben; Brattebø, Guttorm

2017-11-10

High quality team leadership is important for the outcome of medical emergencies. However, the behavioral marker of leadership are not well defined. The present study investigated frequency of behavioral markers of shared mental models (SMM) on quality of medical management. Training video recordings of 27 trauma teams simulating emergencies were analyzed according to team -leader's frequency of shared mental model behavioral markers. The results showed a positive correlation of quality of medical management with leaders sharing information without an explicit demand for the information ("push" of information) and with leaders communicating their situational awareness (SA) and demonstrating implicit supporting behavior. When separating the sample into higher versus lower performing teams, the higher performing teams had leaders who displayed a greater frequency of "push" of information and communication of SA and supportive behavior. No difference was found for the behavioral marker of team initiative, measured as bringing up suggestions to other teammembers. The results of this study emphasize the team leader's role in initiating and updating a team's shared mental model. Team leaders should also set expectations for acceptable interaction patterns (e.g., promoting information exchange) and create a team climate that encourages behaviors, such as mutual performance monitoring, backup behavior, and adaptability to enhance SMM.

The Challenge of Aviation Emergency and Abnormal Situations

NASA Technical Reports Server (NTRS)

Burian, Barbara K.; Barshi, Immanuel; Dismukes, Key

2005-01-01

Emergency and abnormal situations occur on flights everyday around the world. They range from minor situations readily managed to extremely serious and highly time-critical situations that deeply challenge the skills of even the most effective crews. How well crews respond to these situations is a function of several interacting sets of issues: (1) the design of non-normal procedures and checklists, (2) design of aircraft systems and automation, (3) specific aspects of the non-normal situation, such as time criticality and complexity of the situation, (4) human performance capabilities and cognitive limitations under high workload and stress, (5) design of training for non-normal situations, (6) philosophies, policies and practices within the industry, and (7) economic and regulatory constraints. Researchers and pilots working on NASA's Emergency and Abnormal Situations project are addressing these issues in a long-range study. In this paper we discuss these issues and illustrate them with examples from recent incidents and accidents.

High-beam intensity, visual performance and safety-related impacts.

DOT National Transportation Integrated Search

2015-10-01

It has been understood for many years that driving above certain speeds at night while using low beam : headlights can result in insufficient visibility to respond to hazards on the road. As new vehicle : headlighting technologies emerge, the practic...

ERCMExpress. Volume 2, Issue 2

ERIC Educational Resources Information Center

US Department of Education, 2006

2006-01-01

This issue of the Emergency Response and Crisis Management (ERCM) Technical Assistance Center's "ERCMExpress" introduces the National Clearinghouse for Educational Facilities (NCEF), a free public service that provides information on planning, designing, funding, building, improving and maintaining safe, healthy, high-performance schools. NCEF is…

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

PubMed Central

Barnett, Michael L.; Olenski, Andrew R.; Jena, Anupam B.

2017-01-01

BACKGROUND Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. METHODS We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. RESULTS Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.) PMID:28199807

Many-core graph analytics using accelerated sparse linear algebra routines

NASA Astrophysics Data System (ADS)

Kozacik, Stephen; Paolini, Aaron L.; Fox, Paul; Kelmelis, Eric

2016-05-01

Graph analytics is a key component in identifying emerging trends and threats in many real-world applications. Largescale graph analytics frameworks provide a convenient and highly-scalable platform for developing algorithms to analyze large datasets. Although conceptually scalable, these techniques exhibit poor performance on modern computational hardware. Another model of graph computation has emerged that promises improved performance and scalability by using abstract linear algebra operations as the basis for graph analysis as laid out by the GraphBLAS standard. By using sparse linear algebra as the basis, existing highly efficient algorithms can be adapted to perform computations on the graph. This approach, however, is often less intuitive to graph analytics experts, who are accustomed to vertex-centric APIs such as Giraph, GraphX, and Tinkerpop. We are developing an implementation of the high-level operations supported by these APIs in terms of linear algebra operations. This implementation is be backed by many-core implementations of the fundamental GraphBLAS operations required, and offers the advantages of both the intuitive programming model of a vertex-centric API and the performance of a sparse linear algebra implementation. This technology can reduce the number of nodes required, as well as the run-time for a graph analysis problem, enabling customers to perform more complex analysis with less hardware at lower cost. All of this can be accomplished without the requirement for the customer to make any changes to their analytics code, thanks to the compatibility with existing graph APIs.

Team training in obstetric and neonatal emergencies using highly realistic simulation in Mexico: impact on process indicators.

PubMed

Walker, Dilys; Cohen, Susanna; Fritz, Jimena; Olvera, Marisela; Lamadrid-Figueroa, Hector; Cowan, Jessica Greenberg; Hernandez, Dolores Gonzalez; Dettinger, Julia C; Fahey, Jenifer O

2014-11-20

Ineffective management of obstetric emergencies contributes significantly to maternal and neonatal morbidity and mortality in Mexico. PRONTO (Programa de Rescate Obstétrico y Neonatal: Tratamiento Óptimo y Oportuno) is a highly-realistic, low-tech simulation-based obstetric and neonatal emergency training program. A pair-matched hospital-based controlled implementation trial was undertaken in three states in Mexico, with pre/post measurement of process indicators at intervention hospitals. This report assesses the impact of PRONTO simulation training on process indicators from the pre/post study design for process indicators. Data was collected in twelve intervention facilities on process indicators, including pre/post changes in knowledge and self-efficacy of obstetric emergencies and neonatal resuscitation, achievement of strategic planning goals established during training and changes in teamwork scores. Authors performed a longitudinal fixed-effects linear regression model to estimate changes in knowledge and self-efficacy and logistic regression to assess goal achievement. A total of 450 professionals in interprofessional teams were trained. Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p <0.001- 0.009) in all domains. Teamwork scores improved and were maintained over a three month period. A mean of 58.8% strategic planning goals per team in each hospital were achieved. There was no association between high goal achievement and knowledge, self-efficacy, proportion of doctors or nurses in training, state, or teamwork score. These results suggest that PRONTO's highly realistic, locally appropriate simulation and team training in maternal and neonatal emergency care may be a promising avenue for optimizing emergency response and improving quality of facility-based obstetric and neonatal care in resource-limited settings. NCT01477554.

Innovative architecture design for high performance organic and hybrid multi-junction solar cells

NASA Astrophysics Data System (ADS)

Li, Ning; Spyropoulos, George D.; Brabec, Christoph J.

2017-08-01

The multi-junction concept is especially attractive for the photovoltaic (PV) research community owing to its potential to overcome the Schockley-Queisser limit of single-junction solar cells. Tremendous research interests are now focused on the development of high-performance absorbers and novel device architectures for emerging PV technologies, such as organic and perovskite PVs. It has been predicted that the multi-junction concept is able to boost the organic and perovskite PV technologies approaching the 20% and 30% benchmarks, respectively, showing a bright future of commercialization of the emerging PV technologies. In this contribution, we will demonstrate innovative architecture design for solution-processed, highly functional organic and hybrid multi-junction solar cells. A simple but elegant approach to fabricating organic and hybrid multi-junction solar cells will be introduced. By laminating single organic/hybrid solar cells together through an intermediate layer, the manufacturing cost and complexity of large-scale multi-junction solar cells can be significantly reduced. This smart approach to balancing the photocurrents as well as open circuit voltages in multi-junction solar cells will be demonstrated and discussed in detail.

[Oncological emergencies in the emergency department].

PubMed

Cimpoeşu, Diana; Dumea, Mihaela; Durchi, Simona; Apostoae, F; Olaru, G; Ciolan, Mioara; Popa, O; Corlade-Andrei, Mihaela

2011-01-01

to assess the profile and the characteristic of oncological patients, establishing management in patients with neoplasia presented in the emergency department (ED), the analysis of short-term movements in patients with neoplasia whilst in the ED. we performed a retrospective study on nonrandomized consecutive cases. The lot analysis included 1315 oncological patients admitted in the Emergency Department of the Clinical Emergency Hospital "St. Spiridon" Iaşi, in the period June 1st, 2009 - May 31st, 2010. 23.12% of the patients had high suspicion of neoplasia at the first visit to the ED. 67.07% of patients were in metastatic stage disease located as follows: liver metastasis 37.59%, lung metastasis 18.36%, lymph node metastasis 13, 29%. After processing the data there were found statistically significant correlations between the age of patients and the documented/suspected diagnosis of neoplasia (p = 0.01) in the sense that a neoplasia diagnosis in emergency was more frequent in people of young age. It should be mentioned that other studies rarely mention first diagnosis of neoplasia in emergency department with presence of complications. 1315 oncological patients presented in ED, almost a quarter of which presented high suspicion of neoplasia (still without histopathological confirmation) when in ED (23.12%). Most of them were aged male patients (over 65 years old), with tumors of the digestive system. A significant proportion (almost 60%) of these patients ended up in emergency due to complications and the therapy intended life support and pain management. Some of these patients were directed to further exploring and emergency outpatient therapy while 75% of patients were hospitalized after stabilization. Although we expected that the frequency of complications to be higher in patients previously diagnosed with cancer, data analysis showed no statistically significant differences (p = NS) between the rate of complications in patients previously diagnosed with neoplasia and those with high-suspicion neoplasia first diagnosed in the ED.

The Use and Efficacy of Capacity-Building Assistance for Low-Performing Districts: The Case of California's District Assistance and Intervention Teams

ERIC Educational Resources Information Center

Strunk, Katharine O.; McEachin, Andrew; Westover, Theresa N.

2014-01-01

The theory of action upon which high-stakes accountability policies are based calls for systemic reforms in educational systems that will emerge by pairing incentives for improvement with extensive and targeted technical assistance (TA) to build the capacity of low-performing schools and districts. To this end, a little discussed and often…

Prototype development and demonstration for response, emergency staging, communications, uniform management, and evacuation (R.E.S.C.U.M.E.) : R.E.S.C.U.M.E. final functional and performance requirements.

DOT National Transportation Integrated Search

2014-01-01

This document provides the high-level functional and performance requirements for the Prototype Development and Demonstration of a R.E.S.C.U.M.E. system. The requirements included in this document are based upon those that can be found in previous R....

THE EPIDEMIOLOGY OF EMERGENCY DEPARTMENT THORACOTOMY IN A STATEWIDE TRAUMA SYSTEM: DOES CENTER VOLUME MATTER?

PubMed

Dumas, Ryan P; Seamon, Mark J; Smith, Brian P; Yang, Wei; Cannon, Jeremy W; Schwab, C William; Reilly, Patrick M; Holena, Daniel N

2018-04-17

The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. We queried the Pennsylvania Trauma Outcomes Study (PTOS) registry from 2007-2015 for all EDTs performed at level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. 1,399 emergency department thoracotomies were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared to patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared to those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower volume centers. Level 3: Retrospective cohort study.

Physician leadership: influence on practice-based learning and improvement.

PubMed

Prather, Stephen E; Jones, David N

2003-01-01

In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change.

Jet engine applications for materials with nanometer-scale dimensions

NASA Technical Reports Server (NTRS)

Appleby, J. W., Jr.

1995-01-01

The performance of advanced military and commercial gas turbine engines is often linked to advances in materials technology. High performance gas turbine engines being developed require major material advances in strength, toughness, reduced density and improved temperature capability. The emerging technology of nanostructured materials has enormous potential for producing materials with significant improvements in these properties. Extraordinary properties demonstrated in the laboratory include material strengths approaching theoretical limit, ceramics that demonstrate ductility and toughness, and materials with ultra-high hardness. Nanostructured materials and coatings have the potential for meeting future gas turbine engine requirements for improved performance, reduced weight and lower fuel consumption.

Jet engine applications for materials with nanometer-scale dimensions

NASA Technical Reports Server (NTRS)

Appleby, J. W., Jr.

1995-01-01

The performance of advanced military and commercial gas turbine engines is often linked to advances in materials technology. High performance gas turbine engines being developed require major material advances in strength, toughness, reduced density and improved temperature capability. The emerging technology of nanostructured materials has enormous potential for producing materials with significant improvements in these properties. Extraordinary properties demonstrated in the laboratory include material strengths approaching theoretical limit, ceramics that demonstrate ductility and toughness, and material with ultra-high hardness. Nanostructured materials and coatings have the potential for meeting future gas turbine engine requirements for improved performance, reduced weight and lower fuel consumption.

Introduction of an accelerated diagnostic protocol in the assessment of emergency department patients with possible acute coronary syndrome: the Nambour Short Low-Intermediate Chest pain project.

PubMed

George, Terry; Ashover, Sarah; Cullen, Louise; Larsen, Peter; Gibson, Jason; Bilesky, Jennifer; Coverdale, Steven; Parsonage, William

2013-08-01

Emergency physicians can feel pressured by opposing forces of clinical reality and the need to publish successful key performance indicators in an environment of increasing demands and cost containment. This is particularly relevant to management of patients with undifferentiated chest pain and possible acute coronary syndrome. Unreliability of clinical assessment and high risk of adverse outcomes for all concerned exist, yet national guidelines are at odds with efforts to reduce ED crowding and access block. We report findings from the Nambour Short Low-Intermediate Chest pain risk trial, which safely introduced an accelerated diagnostic protocol with reduced ED length of stay and high patient acceptability. Over a 7-month period, there were no major adverse cardiac events by 30 days in 19% of undifferentiated chest pain presentations with possible acute coronary syndrome discharged after normal sensitive cardiac troponin taken 2 h after presentation and scheduled to return for outpatient exercise stress test. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Integrating team training strategies into obstetrical emergency simulation training.

PubMed

Daniel, Linda T; Simpson, Ellen K

2009-01-01

Successful management of obstetrical emergencies such as shoulder dystocia requires the coordinated efforts of a multidisciplinary team of professionals. Simulation education provides an opportunity to learn and master simple as well as complex technical skills needed in emergent situations. Team training has been shown to improve the quality of communication among team members and consequently has an enormous impact on human performance. In the healthcare environment, especially obstetrics where the stakes are high, integrating team training into simulation education can advance efforts to create and sustain a culture of safety. With over 7,100 deliveries annually, our 1,100-bed, two-hospital regional healthcare system embarked on this journey to advance the culture of safety.

The emerging High Efficiency Video Coding standard (HEVC)

NASA Astrophysics Data System (ADS)

Raja, Gulistan; Khan, Awais

2013-12-01

High definition video (HDV) is becoming popular day by day. This paper describes the performance analysis of latest upcoming video standard known as High Efficiency Video Coding (HEVC). HEVC is designed to fulfil all the requirements for future high definition videos. In this paper, three configurations (intra only, low delay and random access) of HEVC are analyzed using various 480p, 720p and 1080p high definition test video sequences. Simulation results show the superior objective and subjective quality of HEVC.

Can Embedded Annotations Help High School Students Perform Problem Solving Tasks Using a Web-Based Historical Document?

ERIC Educational Resources Information Center

Lee, John K.; Calandra, Brendan

2004-01-01

Two versions of a Web site on the United States Constitution were used by students in separate high school history classes to solve problems that emerged from four constitutional scenarios. One site contained embedded conceptual scaffolding devices in the form of textual annotations; the other did not. The results of our study demonstrated the…

Assessing high reliability practices in wildland fire management: an exploration and benchmarking of organizational culture

Treesearch

Anne E. Black; Brooke Baldauf McBride

2013-01-01

In an effort to improve organizational outcomes, including safety, in wildland fire management, researchers and practitioners have turned to a domain of research on organizational performance known as High Reliability Organizing (HRO). The HRO paradigm emerged in the late 1980s in an effort to identify commonalities among organizations that function under hazardous...

Developing Administrative Vision.

ERIC Educational Resources Information Center

Chance, Edward W.

Visionary leadership has emerged as a significant characteristic of high performing school administrators. Vision provides a sense of direction for the school and facilitates accomplishment. Administrators must move from authoritarian and managerial modes of operation to proactive leadership, and maintain a focus on the vision through turmoil and…

Pressure-induced dramatic changes in organic–inorganic halide perovskites

PubMed Central

Yang, Wenge

2017-01-01

Organic–inorganic halide perovskites have emerged as a promising family of functional materials for advanced photovoltaic and optoelectronic applications with high performances and low costs. Various chemical methods and processing approaches have been employed to modify the compositions, structures, morphologies, and electronic properties of hybrid perovskites. However, challenges still remain in terms of their stability, the use of environmentally unfriendly chemicals, and the lack of an insightful understanding into structure–property relationships. Alternatively, pressure, a fundamental thermodynamic parameter that can significantly alter the atomic and electronic structures of functional materials, has been widely utilized to further our understanding of structure–property relationships, and also to enable emergent or enhanced properties of given materials. In this perspective, we describe the recent progress of high-pressure research on hybrid perovskites, particularly regarding pressure-induced novel phenomena and pressure-enhanced properties. We discuss the effect of pressure on structures and properties, their relationships and the underlying mechanisms. Finally, we give an outlook on future research avenues in which high pressure and related alternative methods such as chemical tailoring and interfacial engineering may lead to novel hybrid perovskites uniquely suited for high-performance energy applications. PMID:29147500

Full-Scale Crash Tests and Analyses of Three High-Wing Single

NASA Technical Reports Server (NTRS)

Annett, Martin S.; Littell, Justin D.; Stimson, Chad M.; Jackson, Karen E.; Mason, Brian H.

2015-01-01

The NASA Emergency Locator Transmitter Survivability and Reliability (ELTSAR) project was initiated in 2014 to assess the crash performance standards for the next generation of ELT systems. Three Cessna 172 aircraft have been acquired to conduct crash testing at NASA Langley Research Center's Landing and Impact Research Facility. Testing is scheduled for the summer of 2015 and will simulate three crash conditions; a flare to stall while emergency landing, and two controlled flight into terrain scenarios. Instrumentation and video coverage, both onboard and external, will also provide valuable data of airframe response. Full-scale finite element analyses will be performed using two separate commercial explicit solvers. Calibration and validation of the models will be based on the airframe response under these varying crash conditions.

Interplanetary laser ranging - an emerging technology for planetary science missions

NASA Astrophysics Data System (ADS)

Dirkx, D.; Vermeersen, L. L. A.

2012-09-01

Interplanetary laser ranging (ILR) is an emerging technology for very high accuracy distance determination between Earth-based stations and spacecraft or landers at interplanetary distances. It has evolved from laser ranging to Earth-orbiting satellites, modified with active laser transceiver systems at both ends of the link instead of the passive space-based retroreflectors. It has been estimated that this technology can be used for mm- to cm-level accuracy range determination at interplanetary distances [2, 7]. Work is being performed in the ESPaCE project [6] to evaluate in detail the potential and limitations of this technology by means of bottom-up laser link simulation, allowing for a reliable performance estimate from mission architecture and hardware characteristics.

Emergency surgery for Crohn's disease.

PubMed

Smida, Malek; Miloudi, Nizar; Hefaiedh, Rania; Zaibi, Rabaa

2016-03-01

Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates. Emergency surgical indication could be frequently the first presentation of Crohn's disease.  Acute intestinal obstruction and perforation-peritonitis were the most common indications for emergent surgery in Crohn's disease in our study.

The Effects of Guided Imagery on Heart Rate Variability in Simulated Spaceflight Emergency Tasks Performers

PubMed Central

Yijing, Zhang; Xiaoping, Du; Fang, Liu; Xiaolu, Jing; Bin, Wu

2015-01-01

Objectives. The present study aimed to investigate the effects of guided imagery training on heart rate variability in individuals while performing spaceflight emergency tasks. Materials and Methods. Twenty-one student subjects were recruited for the experiment and randomly divided into two groups: imagery group (n = 11) and control group (n = 10). The imagery group received instructor-guided imagery (session 1) and self-guided imagery training (session 2) consecutively, while the control group only received conventional training. Electrocardiograms of the subjects were recorded during their performance of nine spaceflight emergency tasks after imagery training. Results. In both of the sessions, the root mean square of successive differences (RMSSD), the standard deviation of all normal NN (SDNN), the proportion of NN50 divided by the total number of NNs (PNN50), the very low frequency (VLF), the low frequency (LF), the high frequency (HF), and the total power (TP) in the imagery group were significantly higher than those in the control group. Moreover, LF/HF of the subjects after instructor-guided imagery training was lower than that after self-guided imagery training. Conclusions. Guided imagery was an effective regulator for HRV indices and could be a potential stress countermeasure in performing spaceflight tasks. PMID:26137491

Transistor analogs of emergent iono-neuronal dynamics.

PubMed

Rachmuth, Guy; Poon, Chi-Sang

2008-06-01

Neuromorphic analog metal-oxide-silicon (MOS) transistor circuits promise compact, low-power, and high-speed emulations of iono-neuronal dynamics orders-of-magnitude faster than digital simulation. However, their inherently limited input voltage dynamic range vs power consumption and silicon die area tradeoffs makes them highly sensitive to transistor mismatch due to fabrication inaccuracy, device noise, and other nonidealities. This limitation precludes robust analog very-large-scale-integration (aVLSI) circuits implementation of emergent iono-neuronal dynamics computations beyond simple spiking with limited ion channel dynamics. Here we present versatile neuromorphic analog building-block circuits that afford near-maximum voltage dynamic range operating within the low-power MOS transistor weak-inversion regime which is ideal for aVLSI implementation or implantable biomimetic device applications. The fabricated microchip allowed robust realization of dynamic iono-neuronal computations such as coincidence detection of presynaptic spikes or pre- and postsynaptic activities. As a critical performance benchmark, the high-speed and highly interactive iono-neuronal simulation capability on-chip enabled our prompt discovery of a minimal model of chaotic pacemaker bursting, an emergent iono-neuronal behavior of fundamental biological significance which has hitherto defied experimental testing or computational exploration via conventional digital or analog simulations. These compact and power-efficient transistor analogs of emergent iono-neuronal dynamics open new avenues for next-generation neuromorphic, neuroprosthetic, and brain-machine interface applications.

Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies.

PubMed

Dean, Anthony J; Breyer, Michael J; Ku, Bon S; Mills, Angela M; Pines, Jesse M

2010-02-01

Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in high-volume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Feasibility of dynamic cardiac ultrasound transmission via mobile phone for basic emergency teleconsultation.

PubMed

Lim, Tae Ho; Choi, Hyuk Joong; Kang, Bo Seung

2010-01-01

We assessed the feasibility of using a camcorder mobile phone for teleconsulting about cardiac echocardiography. The diagnostic performance of evaluating left ventricle (LV) systolic function was measured by three emergency medicine physicians. A total of 138 short echocardiography video sequences (from 70 subjects) was selected from previous emergency room ultrasound examinations. The measurement of LV ejection fraction based on the transmitted video displayed on a mobile phone was compared with the original video displayed on the LCD monitor of the ultrasound machine. The image quality was evaluated using the double stimulation impairment scale (DSIS). All observers showed high sensitivity. There was an improvement in specificity with the observer's increasing experience of cardiac ultrasound. Although the image quality of video on the mobile phone was lower than that of the original, a receiver operating characteristic (ROC) analysis indicated that there was no significant difference in diagnostic performance. Immediate basic teleconsulting of echocardiography movies is possible using current commercially-available mobile phone systems.

Thalamic Amnesia Mimicking Transient Global Amnesia.

PubMed

Giannantoni, Nadia M; Lacidogna, Giordano; Broccolini, Aldobrando; Pilato, Fabio; Profice, Paolo; Morosetti, Roberta; Caliandro, Pietro; Gambassi, Giovanni; Della Marca, Giacomo; Frisullo, Giovanni

2015-06-01

Transient global amnesia is a benign syndrome and one of the most frequent discharges from the emergency department that can hardly be distinguished from other mimicking diseases. No consensus in the evaluation of transient global amnesia has yet been found in the emergency setting. We describe a 69-year-old woman who presented to our emergency department with an abrupt onset of anterograde amnesia, preceded by a similar amnesic episode misinterpreted as transient global amnesia. Neuroradiologic, neuropsychological, and neurophysiological evaluations supported the diagnosis of vascular thalamic amnesia. We report a patient who clinically fulfilled transient global amnesia's criteria and in whom nevertheless was disclosed a thalamic ischemic lesion on neuroimaging.This case report highlights the importance of performing neuroradiologic screening in the emergency department even when clinical history and physical findings are highly suggestive for transient global amnesia.

See one, do one, teach one: advanced technology in medical education.

PubMed

Vozenilek, John; Huff, J Stephen; Reznek, Martin; Gordon, James A

2004-11-01

The concept of "learning by doing" has become less acceptable, particularly when invasive procedures and high-risk care are required. Restrictions on medical educators have prompted them to seek alternative methods to teach medical knowledge and gain procedural experience. Fortunately, the last decade has seen an explosion of the number of tools available to enhance medical education: web-based education, virtual reality, and high fidelity patient simulation. This paper presents some of the consensus statements in regard to these tools agreed upon by members of the Educational Technology Section of the 2004 AEM Consensus Conference for Informatics and Technology in Emergency Department Health Care, held in Orlando, Florida. Web-based teaching: 1) Every ED should have access to medical educational materials via the Internet, computer-based training, and other effective education methods for point-of-service information, continuing medical education, and training. 2) Real-time automated tools should be integrated into Emergency Department Information Systems [EDIS] for contemporaneous education. Virtual reality [VR]: 1) Emergency physicians and emergency medicine societies should become more involved in VR development and assessment. 2) Nationally accepted protocols for the proper assessment of VR applications should be adopted and large multi-center groups should be formed to perform these studies. High-fidelity simulation: Emergency medicine residency programs should consider the use of high-fidelity patient simulators to enhance the teaching and evaluation of core competencies among trainees. Across specialties, patient simulation, virtual reality, and the Web will soon enable medical students and residents to... see one, simulate many, do one competently, and teach everyone.

Organizational factors affecting length of stay in the emergency department: initial observational study.

PubMed

Bashkin, Osnat; Caspi, Sigalit; Haligoa, Rachel; Mizrahi, Sari; Stalnikowicz, Ruth

2015-01-01

Length of stay (LOS) is considered a key measure of emergency department throughput, and from the perspective of the patient, it is perceived as a measure of healthcare service quality. Prolonged LOS can be caused by various internal and external factors. This study examined LOS in the emergency department and explored the main factors that influence LOS and cause delay in patient care. Observations of 105 patients were performed over a 3-month period at the emergency room of a community urban hospital. Observers monitored patients from the moment of entrance to the department until discharge or admission to another hospital ward. Analysis revealed a general average total emergency department LOS of 438 min. Significant differences in average LOS were found between admitted patients (Mean = 544 min, SD = 323 min) and discharged patients (Mean = 291 min, SD = 286 min). In addition, nurse and physician change of shifts and admissions to hospital wards were found to be significant factors associated with LOS. Using an Ishikawa causal diagram, we explored various latent organizational factors that may prolong this time. The study identified several factors that are associated with high average emergency department LOS. High LOS may lead to increases in expenditures and may have implications for patient safety, whereas certain organizational changes, communication improvement, and time management may have a positive effect on it. Interdisciplinary methods can be used to explore factors causing prolonged emergency department LOS and contribute to a better understanding of them.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

International migration as a determinant of emergency caesarean.

PubMed

Merry, Lisa; Semenic, Sonia; Gyorkos, Theresa W; Fraser, William; Small, Rhonda; Gagnon, Anita J

2016-10-01

High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The Emergence Of The National Research And Education Network (NREN) And Its Implications For American Telecommunications

NASA Astrophysics Data System (ADS)

Maloff, Joel H.

1990-01-01

"The nation which most completely assimilates high performance computing into its economy will very likely emerge as the dominant intellectual, economic, and technological force in the next century", Senator Albert Gore, Jr., May 18, 1989, while introducing Senate Bill 1067, "The National High Performance Computer Technology Act of 1989". A national network designed to link supercomputers, particle accelerators, researchers, educators, government, and industry is beginning to emerge. The degree to which the United States can mobilize the resources inherent within our academic, industrial and government sectors towards the establishment of such a network infrastructure will have direct bearing on the economic and political stature of this country in the next century. This program will have significant impact on all forms of information transfer, and peripheral benefits to all walks of life similar to those experienced from the moon landing program of the 1960's. The key to our success is the involvement of scientists, librarians, network designers, and bureaucrats in the planning stages. Collectively, the resources resident within the United States are awesome; individually, their impact is somewhat more limited. The engineers, technicians, business people, and educators participating in this conference have a vital role to play in the success of the National Research and Education Network (NREN).

Optical and thermal performance of bladed receivers

NASA Astrophysics Data System (ADS)

Pye, John; Coventry, Joe; Ho, Clifford; Yellowhair, Julius; Nock, Ian; Wang, Ye; Abbasi, Ehsan; Christian, Joshua; Ortega, Jesus; Hughes, Graham

2017-06-01

Bladed receivers use conventional receiver tube-banks rearranged into bladed/finned structures, and offer better light trapping, reduced radiative and convective losses, and reduced tube mass, based on the presented optical and thermal analysis. Optimising for optical performance, deep blades emerge. Considering thermal losses leads to shallower blades. Horizontal blades perform better, in both windy and no-wind conditions, than vertical blades, at the scales considered so far. Air curtains offer options to further reduce convective losses; high flux on blade-tips is still a concern.

A review of advanced high performance, insensitive and thermally stable energetic materials emerging for military and space applications.

PubMed

Sikder, A K; Sikder, Nirmala

2004-08-09

Energetic materials used extensively both for civil and military applications. There are continuous research programmes worldwide to develop new materials with higher performance and enhanced insensitivity to thermal or shock insults than the existing ones in order to meet the requirements of future military and space applications. This review concentrates on recent advances in syntheses, potential formulations and space applications of potential compounds with respect to safety, performance and stability.

The bench scientist's guide to RNA-Seq analysis

USDA-ARS?s Scientific Manuscript database

RNA sequencing (RNA-Seq) is emerging as a highly accurate method to quantify transcript abundance. However, analyses of the large data sets obtained by sequencing the entire transcriptome of organisms have generally been performed by bioinformatic specialists. Here we outline a methods strategy desi...

Factors Associated with Short-Term Mortality After Surgical Oncologic Emergencies.

PubMed

Bosscher, Marianne R F; Bastiaannet, Esther; van Leeuwen, Barbara L; Hoekstra, Harald J

2016-06-01

The clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies. This was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality. During the study period, 207 patients experienced surgical oncologic emergencies-101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19-92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002). Defining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.

A retrospective review of vital signs and clinical outcomes of febrile infants younger than 3 months old presenting to the emergency department

PubMed Central

Chong, Shu-Ling; Ong, Gene Yong-Kwang; Chin, Wendy Yi Wen; Chua, John Mingzhou; Nair, Praseetha; Ong, Alicia Shu Zhen; Ng, Kee Chong; Maconochie, Ian

2018-01-01

Objectives Febrile infants younger than 3 months old present a diagnostic dilemma to the emergency physician. We aim to describe a large population of febrile infants less than 3 months old presenting to a pediatric emergency department (ED) and to assess the performance of current heart rate guidelines in the prediction of serious infections (SI). Materials and methods We performed a retrospective review of febrile infants younger than 3 months old, between March 2015 and Feb 2016, in a large tertiary pediatric ED. We documented the primary outcome of SI for each infant, as well as the clinical findings, vital signs, and Severity Index Score (SIS). We assessed the performance of the Paediatric Canadian Triage and Acuity Scale (PaedCTAS), Advanced Pediatric Life Support (APLS) guidelines and Fleming normal reference values, using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operating characteristics curve (AUC). Results 1057 infants were analyzed, with 326 (30.6%) infants diagnosed with SI. High temperature, tachycardia, and low SIS score were significantly associated with SI. Item analysis showed that the SIS performance was driven by the presence of mottling (p = 0.003) and high temperature (p<0.001). The APLS guideline had the highest sensitivity (66.0%, 95% CI 60.5–71.1%), NPV (73.3%, 95% CI 69.7–76.5%) and AUC (0.538), while the PaedCTAS (2 standard deviation from normal) had the highest specificity (98.5%, 95% CI 97.3–99.3%) and PPV (55.2%, 95% CI 32.7–71.0%). Conclusions Current guidelines on infantile heart rates have a variable performance. In our study, the APLS heart rate guidelines performed with the highest sensitivity, but no individual guideline predicted for SIs satisfactorily. PMID:29304160

Solution Processed Metal Oxide High-κ Dielectrics for Emerging Transistors and Circuits.

PubMed

Liu, Ao; Zhu, Huihui; Sun, Huabin; Xu, Yong; Noh, Yong-Young

2018-06-14

The electronic functionalities of metal oxides comprise conductors, semiconductors, and insulators. Metal oxides have attracted great interest for construction of large-area electronics, particularly thin-film transistors (TFTs), for their high optical transparency, excellent chemical and thermal stability, and mechanical tolerance. High-permittivity (κ) oxide dielectrics are a key component for achieving low-voltage and high-performance TFTs. With the expanding integration of complementary metal oxide semiconductor transistors, the replacement of SiO 2 with high-κ oxide dielectrics has become urgently required, because their provided thicker layers suppress quantum mechanical tunneling. Toward low-cost devices, tremendous efforts have been devoted to vacuum-free, solution processable fabrication, such as spin coating, spray pyrolysis, and printing techniques. This review focuses on recent progress in solution processed high-κ oxide dielectrics and their applications to emerging TFTs. First, the history, basics, theories, and leakage current mechanisms of high-κ oxide dielectrics are presented, and the underlying mechanism for mobility enhancement over conventional SiO 2 is outlined. Recent achievements of solution-processed high-κ oxide materials and their applications in TFTs are summarized and traditional coating methods and emerging printing techniques are introduced. Finally, low temperature approaches, e.g., ecofriendly water-induced, self-combustion reaction, and energy-assisted post treatments, for the realization of flexible electronics and circuits are discussed. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[Series: Medical Applications of the PHITS Code (2): Acceleration by Parallel Computing].

PubMed

Furuta, Takuya; Sato, Tatsuhiko

2015-01-01

Time-consuming Monte Carlo dose calculation becomes feasible owing to the development of computer technology. However, the recent development is due to emergence of the multi-core high performance computers. Therefore, parallel computing becomes a key to achieve good performance of software programs. A Monte Carlo simulation code PHITS contains two parallel computing functions, the distributed-memory parallelization using protocols of message passing interface (MPI) and the shared-memory parallelization using open multi-processing (OpenMP) directives. Users can choose the two functions according to their needs. This paper gives the explanation of the two functions with their advantages and disadvantages. Some test applications are also provided to show their performance using a typical multi-core high performance workstation.

Achieving excellence in community health centers: implications for health reform.

PubMed

Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

2012-02-01

Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

GPU-based High-Performance Computing for Radiation Therapy

PubMed Central

Jia, Xun; Ziegenhein, Peter; Jiang, Steve B.

2014-01-01

Recent developments in radiotherapy therapy demand high computation powers to solve challenging problems in a timely fashion in a clinical environment. Graphics processing unit (GPU), as an emerging high-performance computing platform, has been introduced to radiotherapy. It is particularly attractive due to its high computational power, small size, and low cost for facility deployment and maintenance. Over the past a few years, GPU-based high-performance computing in radiotherapy has experienced rapid developments. A tremendous amount of studies have been conducted, in which large acceleration factors compared with the conventional CPU platform have been observed. In this article, we will first give a brief introduction to the GPU hardware structure and programming model. We will then review the current applications of GPU in major imaging-related and therapy-related problems encountered in radiotherapy. A comparison of GPU with other platforms will also be presented. PMID:24486639

Towards Building a High Performance Spatial Query System for Large Scale Medical Imaging Data.

PubMed

Aji, Ablimit; Wang, Fusheng; Saltz, Joel H

2012-11-06

Support of high performance queries on large volumes of scientific spatial data is becoming increasingly important in many applications. This growth is driven by not only geospatial problems in numerous fields, but also emerging scientific applications that are increasingly data- and compute-intensive. For example, digital pathology imaging has become an emerging field during the past decade, where examination of high resolution images of human tissue specimens enables more effective diagnosis, prediction and treatment of diseases. Systematic analysis of large-scale pathology images generates tremendous amounts of spatially derived quantifications of micro-anatomic objects, such as nuclei, blood vessels, and tissue regions. Analytical pathology imaging provides high potential to support image based computer aided diagnosis. One major requirement for this is effective querying of such enormous amount of data with fast response, which is faced with two major challenges: the "big data" challenge and the high computation complexity. In this paper, we present our work towards building a high performance spatial query system for querying massive spatial data on MapReduce. Our framework takes an on demand index building approach for processing spatial queries and a partition-merge approach for building parallel spatial query pipelines, which fits nicely with the computing model of MapReduce. We demonstrate our framework on supporting multi-way spatial joins for algorithm evaluation and nearest neighbor queries for microanatomic objects. To reduce query response time, we propose cost based query optimization to mitigate the effect of data skew. Our experiments show that the framework can efficiently support complex analytical spatial queries on MapReduce.

Towards Building a High Performance Spatial Query System for Large Scale Medical Imaging Data

PubMed Central

Aji, Ablimit; Wang, Fusheng; Saltz, Joel H.

2013-01-01

Support of high performance queries on large volumes of scientific spatial data is becoming increasingly important in many applications. This growth is driven by not only geospatial problems in numerous fields, but also emerging scientific applications that are increasingly data- and compute-intensive. For example, digital pathology imaging has become an emerging field during the past decade, where examination of high resolution images of human tissue specimens enables more effective diagnosis, prediction and treatment of diseases. Systematic analysis of large-scale pathology images generates tremendous amounts of spatially derived quantifications of micro-anatomic objects, such as nuclei, blood vessels, and tissue regions. Analytical pathology imaging provides high potential to support image based computer aided diagnosis. One major requirement for this is effective querying of such enormous amount of data with fast response, which is faced with two major challenges: the “big data” challenge and the high computation complexity. In this paper, we present our work towards building a high performance spatial query system for querying massive spatial data on MapReduce. Our framework takes an on demand index building approach for processing spatial queries and a partition-merge approach for building parallel spatial query pipelines, which fits nicely with the computing model of MapReduce. We demonstrate our framework on supporting multi-way spatial joins for algorithm evaluation and nearest neighbor queries for microanatomic objects. To reduce query response time, we propose cost based query optimization to mitigate the effect of data skew. Our experiments show that the framework can efficiently support complex analytical spatial queries on MapReduce. PMID:24501719

A Conceptual Framework to Measure Systems’ Performance during Emergency Preparedness Exercises

PubMed Central

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D.

2014-01-01

Large-scale public health emergencies require a sophisticated, coordinated response involving multiple entities to protect health and minimize suffering. However, the rarity of such emergencies presents a barrier to gathering observational data about the effectiveness of the public health response before such events occur. For this reason, public health practitioners increasingly have relied on simulated emergencies, known as “exercises” as proxies to test their emergency capabilities. However, the formal evaluation of performance in these exercises, historically has been inconsistent, and there is little research to describe how data acquired from simulated emergencies actually support conclusions about the quality of the public health emergency response system. Over the past six years, we have designed and evaluated more than seventy public health emergency exercises, collaborating with public health agencies, hospitals and others to test a wide variety of systems and their capabilities. Using the data and experience that we gathered, we have developed a conceptual framework that describes the essential elements necessary to consider when applying performance measurement science to public health emergency exercises. We suggest that this framework may assist practitioners and researchers who wish to better measure performance in exercises and to improve public health emergency preparedness. PMID:25233015

Psychological safety: The key to high performance in high stress, potentially traumatic environments

Treesearch

James Saveland

2011-01-01

Safety is typically talked about in a context of the absence of injury. The field of resilience engineering has been advocating that we think about safety differently, by taking a systems view and begin to see how people create safety in unsafe systems by managing risk. There is growing recognition that safety is an emergent behavior of our complex system of human...

76 FR 8758 - Privacy Act of 1974; Department of Homeland Security Federal Emergency Management Agency-002...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-15

... screen activity in the National Emergency Management Information System for both call-related customer... desktop screen as they perform work in National Emergency Management Information System (NEMIS); (3) Avaya...), Enterprise Performance Information Management Section, Federal Emergency Management Agency, Texas National...

Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke

PubMed Central

Pahwa, Harvinder Singh; Kumar, Awanish; Srivastava, Rohit; Rai, Anurag

2012-01-01

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful. PMID:22854240

Trans-anal barotrauma by compressed air leading to sigmoid perforation due to a dangerous practical joke.

PubMed

Pahwa, Harvinder Singh; Kumar, Awanish; Srivastava, Rohit; Rai, Anurag

2012-08-01

To present a case report of trans-anal barotrauma by high-pressure compressed air jet as a dangerous practical joke, that is, playful insufflation of high-pressure air jet through the anal orifice resulting in sigmoid perforation. The patient presented to emergency a day later with complaints of severe pain in the abdomen and abdominal distension following insufflation of high-pressure air jet through the anus. On examination, he had signs suggestive of perforation peritonitis and x-ray of the abdomen showed gas under the diaphragm. An emergency exploratory laparotomy was performed which revealed a 4-cm perforation in the sigmoid colon. Resection of the segment containing perforation along with the surrounding devitalised part was done with double-barrel colostomy. Reversal of colostomy was done after 8 weeks. Follow-up was uneventful.

Bilateral blindness following anterior nasal packing in a case of nasopharyngeal angiofibroma.

PubMed

Sahoo, A K; Preetam, C; Kumar, R; Samal, D K

2016-11-01

Epistaxis is the most common ENT emergency encountered in the Emergency Department. Most cases can be managed by simple anterior nasal packing. This is usually a safe and very effective option in an emergency situation, requiring minimal expertise and infrastructure. This paper describes a rare instance of a serious complication following anterior nasal packing in a case of nasopharyngeal angiofibroma. A 27-year-old man diagnosed with nasopharyngeal angiofibroma presented to the Emergency Department with bilateral epistaxis. The patient was stabilised and anterior nasal packing was performed, which controlled the bleeding. Three hours later, the patient developed complete blindness in both eyes. Aggressive medical management was initiated immediately, but failed to restore the patient's vision. Anterior nasal packing is a simple and minimally invasive procedure practised regularly in an Emergency Department setting. However, it can occasionally lead to serious complications such as blindness. Thus, obtaining informed consent is essential to avoid medico-legal consequences in high-risk cases.

Impact of high-performance work systems on individual- and branch-level performance: test of a multilevel model of intermediate linkages.

PubMed

Aryee, Samuel; Walumbwa, Fred O; Seidu, Emmanuel Y M; Otaye, Lilian E

2012-03-01

We proposed and tested a multilevel model, underpinned by empowerment theory, that examines the processes linking high-performance work systems (HPWS) and performance outcomes at the individual and organizational levels of analyses. Data were obtained from 37 branches of 2 banking institutions in Ghana. Results of hierarchical regression analysis revealed that branch-level HPWS relates to empowerment climate. Additionally, results of hierarchical linear modeling that examined the hypothesized cross-level relationships revealed 3 salient findings. First, experienced HPWS and empowerment climate partially mediate the influence of branch-level HPWS on psychological empowerment. Second, psychological empowerment partially mediates the influence of empowerment climate and experienced HPWS on service performance. Third, service orientation moderates the psychological empowerment-service performance relationship such that the relationship is stronger for those high rather than low in service orientation. Last, ordinary least squares regression results revealed that branch-level HPWS influences branch-level market performance through cross-level and individual-level influences on service performance that emerges at the branch level as aggregated service performance.

High-Performance Buildings – Value, Messaging, Financial and Policy Mechanisms

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

McCabe, Molly

At the request of the Pacific Northwest National Laboratory, an in-depth analysis of the rapidly evolving state of real estate investments, high-performance building technology, and interest in efficiency was conducted by HaydenTanner, LLC, for the U.S. Department of Energy (DOE) Building Technologies Program. The analysis objectives were • to evaluate the link between high-performance buildings and their market value • to identify core messaging to motivate owners, investors, financiers, and others in the real estate sector to appropriately value and deploy high-performance strategies and technologies across new and existing buildings • to summarize financial mechanisms that facilitate increased investment inmore » these buildings. To meet these objectives, work consisted of a literature review of relevant writings, examination of existing and emergent financial and policy mechanisms, interviews with industry stakeholders, and an evaluation of the value implications through financial modeling. This report documents the analysis methodology and findings, conclusion and recommendations. Its intent is to support and inform the DOE Building Technologies Program on policy and program planning for the financing of high-performance new buildings and building retrofit projects.« less

BNLs Synchrotron-radiation Research Hub for Characterizing Detection Materials and Devices for the NA-22 Community

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

Camarda, G. S.; Bolotnikov, A. E.; Cui, Y.

The goal of this project is to obtain and characterize scintillators, emerging- and commercial-compoundsemiconductor radiation- detection materials and devices provided by vendors and research organizations. The focus of our proposed research is to clarify the role of the deleterious defects and impurities responsible for the detectors' non-uniformity in scintillating crystals, commercial semiconductor radiation-detector materials, and in emerging R&D ones. Some benefits of this project addresses the need for fabricating high-performance scintillators and compound-semiconductor radiation-detectors with the proven potential for large-scale manufacturing. The findings help researchers to resolve the problems of non-uniformities in scintillating crystals, commercial semiconductor radiation-detector materials, and inmore » emerging R&D ones.« less

Hand ultrasound: a high-fidelity simulation of lung sliding.

PubMed

Shokoohi, Hamid; Boniface, Keith

2012-09-01

Simulation training has been effectively used to integrate didactic knowledge and technical skills in emergency and critical care medicine. In this article, we introduce a novel model of simulating lung ultrasound and the features of lung sliding and pneumothorax by performing a hand ultrasound. The simulation model involves scanning the palmar aspect of the hand to create normal lung sliding in varying modes of scanning and to mimic ultrasound features of pneumothorax, including "stratosphere/barcode sign" and "lung point." The simple, reproducible, and readily available simulation model we describe demonstrates a high-fidelity simulation surrogate that can be used to rapidly illustrate the signs of normal and abnormal lung sliding at the bedside. © 2012 by the Society for Academic Emergency Medicine.

Emerging Avenues for Utilization of Exotic Germplasm.

PubMed

Wang, Cuiling; Hu, Songlin; Gardner, Candice; Lübberstedt, Thomas

2017-07-01

Breeders have been successful in increasing crop performance by exploiting genetic diversity over time. However, the reported annual yield increases are not sufficient in view of rapid human population growth and global environmental changes. Exotic germplasm possesses high levels of genetic diversity for valuable traits. However, only a small fraction of naturally occurring genetic diversity is utilized. Moreover, the yield gap between elite and exotic germplasm widens, which increases the effort needed to use exotic germplasm and to identify beneficial alleles and for their introgression. The advent of high-throughput genotyping and phenotyping technologies together with emerging biotechnologies provide new opportunities to explore exotic genetic variation. This review will summarize potential challenges for utilization of exotic germplasm and provide solutions. Copyright © 2017 Elsevier Ltd. All rights reserved.

External evaluation of the Dimension Vista 1500® intelligent lab system.

PubMed

Bruneel, Arnaud; Dehoux, Monique; Barnier, Anne; Boutten, Anne

2012-09-01

Dimension Vista® analyzer combines four technologies (photometry, nephelometry, V-LYTE® integrated multisensor potentiometry, and LOCI® chemiluminescence) into one high-throughput system. We assessed analytical performance of assays routinely performed in our emergency laboratory according to the VALTEC protocol, and practicability. Precision was good for most parameters. Analytical domain was large and suitable for undiluted analysis in most clinical settings encountered in our hospital. Data were comparable and correlated to our routine analyzers (Roche Modular DP®, Abbott AXSYM®, Siemens Dimension® RxL, and BN ProSpec®). Performance of nephelometric and LOCI modules was excellent. Functional sensitivity of high-sensitivity C-reactive protein and cardiac troponin I were 0.165 mg/l and 0.03 ng/ml, respectively (coefficient of variation; CV < 10%). The influence of interfering substances (i.e., hemoglobin, bilirubin, or lipids) was moderate, and Dimension Vista® specifically alerted for interference according to HIL (hemolysis, icterus, lipemia) indices. Good instrument performance and full functionality (no reagent or sample carryover in the conditions evaluated, effective sample-volume detection, and clot detection) were confirmed. Simulated routine testing demonstrated excellent practicability, throughput, ease of use of software and security. Performance and practicability of Dimension Vista® are highly suitable for both routine and emergency use. Since no volume detection and thus no warning is available on limited sample racks, pediatric samples require special caution to the Siemens protocol to be analyzed in secured conditions. Our experience in routine practice is also discussed, i.e., the impact of daily workload, "manual" steps resulting from dilutions and pediatric samples, maintenances, flex hydration on instrument's performance on throughput and turnaround time. © 2012 Wiley Periodicals, Inc.

[New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue].

PubMed

Gałazkowski, Robert

2010-01-01

In Poland, two types of medical services are accomplished by the Medical Air Rescue (MAR) operating all over the country: emergency transport from the incident scene to hospital and inter-hospital transport. Helicopters or planes are used for this purpose. In 2009, helicopters performed 4359 flights to incidents and 1537 inter-hospital transports whereas planes performed 589 inter-hospital ambulance and 196 rescue flights. MAR operates from 17 bases of the Helicopter Emergency Medical Service (HEMS) and one airbase. Helicopters are mainly used when medical transport is emergent, within the operational region of a given base whereas planes when the distance between the present and target airports exceeds 250 km. In 2008, new modern aircraft were introduced to HEMS-helicopters EC 135. They fulfil all requirements of air transport regulations and are adjusted to visual (VFR) and instrumental (IFR) flights rules, at day and night. The medical cabin of EC 135 is ergonomic and functional considering the majority of rescue activities under life-saving circumstances. It is equipped with ventilator, defibrillator, infusion pumps etc. Defibrillators have 12-lead ECG, E(T)CO2, SpO2, NIBP, and IBP modules. Transport ventilators can work in a variety of ventilation modes including CMV, SIMV, SVV, BILEVEL, PCV, ASB, PPV and CPAP. The purchase of helicopters with modern avionic and medical configuration ensures high quality services of MAR for many years to come.

[Surgical treatment of colonic and rectal tumors].

PubMed

Verushkin, I I; Ratmanov, A M; Kotomin, S V; Sharnov, V A; Verushkina, N I

1996-01-01

The study included three groups of patients with rectal and colonic tumors operated on under emergency and routine conditions. The percentage of emergency operations proved rather high, surgery being performed under both hospital and field conditions. Causes for calls have been evaluated and extent of surgery versus operating conditions and immediate results in each group assessed. Operating under hospital conditions is recommended for carrying out procedures like that of Hartman involving obligatory removal of tumor and verification of diagnosis. Reconstructive surgery should be performed in specialized wards of a regional clinic. Higher expertise of rural surgeons as well as increased competence of general practitioners in oncopathology, timely inclusion of oncologists into on-call teams of doctors and hospitalization of patients into specialized wards contribute to higher effectiveness of treatment of bowel pathologies.

Portable emergency telemedicine system over wireless broadband and 3G networks.

PubMed

Hong, SungHye; Kim, SangYong; Kim, JungChae; Lim, DongKyu; Jung, SeokMyung; Kim, DongKeun; Yoo, Sun K

2009-01-01

The telemedicine system aims at monitoring patients remotely without limit in time and space. However the existing telemedicine systems exchange medical information simply in a specified location. Due to increasing speed in processing data and expanding bandwidth of wireless networks, it is possible to perform telemedicine services on personal digital assistants (PDA). In this paper, a telemedicine system on PDA was developed using wideband mobile networks such as Wi-Fi, HSDPA, and WiBro for high speed bandwidths. This system enables to utilize and exchange variety and reliable patient information of video, biosignals, chatting messages, and triage data. By measuring bandwidths of individual data of the system over wireless networks, and evaluating the performance of this system using PDA, we demonstrated the feasibility of the designed portable emergency telemedicine system.

Emergency medicine in modern Europe.

PubMed

Fleischmann, Thomas; Fulde, Gordian

2007-08-01

Emergency medicine in the highly advanced world is traditionally performed in two different ways. The first is the well-known Anglo-American system with skilled EDs, and a pre-hospital emergency medical service utilizing paramedics. The second is the so-called Franco-German system, with a highly developed pre-hospital emergency physician service, but only a basic organization of hospital-based emergency medicine. This gap is now closing fast because of the rapid advancement of hospital-based emergency medicine in Europe. Four criteria might be used to measure this: the recognition as a specialty, the specialist training programme, the professional organization of emergency physicians and the presence of academic centres in Europe. Eleven of the 27 European countries recognize hospital-based emergency medicine as a specialty already. These include Belgium, Czech Republic, Estonia, Hungary, Ireland, Italy, Malta, Poland, Romania, Slovenia and the United Kingdom. Other nations are striving to do so, for example Sweden, France, Germany and Greece. There is no doubt that emergency medicine is gaining momentum and other countries will follow. Training for the specialty of emergency medicine is advanced already. Several curricula presently exist in the respective European countries. A task force, governed by the European Society for Emergency Medicine has been working hard to create a model curriculum for all of Europe, which is expected to be published in 2007. This comprises a 5-year specialty training, with three of them spent in an ED. The curriculum follows a symptom-oriented approach to emergency medicine, and includes a skilled description of the key competencies of the future trained emergency physicians. Given the century-long history of the pre-hospital emergency physician service in some European countries, a number of professional bodies exist representing pre-hospital emergency doctors. Within the last few years, ED physicians followed suit forming organizations of their own. In some countries, the next step of amalgamation has occurred, with the merger of EMS and ED emergency physician organizations, although no country has abolished the pre-hospital emergency physician service. The last milestone, the development of academic emergency centres, has only just started. This process will take some time. The present paper describes the present and future of emergency medicine in some European countries using these criteria.

Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism.

PubMed

Dresden, Scott; Mitchell, Patricia; Rahimi, Layla; Leo, Megan; Rubin-Smith, Julia; Bibi, Salma; White, Laura; Langlois, Breanne; Sullivan, Alison; Carmody, Kristin

2014-01-01

The objective of this study was to determine the diagnostic performance of right ventricular dilatation identified by emergency physicians on bedside echocardiography in patients with a suspected or confirmed pulmonary embolism. The secondary objective included an exploratory analysis of the predictive value of a subgroup of findings associated with advanced right ventricular dysfunction (right ventricular hypokinesis, paradoxical septal motion, McConnell's sign). This was a prospective observational study using a convenience sample of patients with suspected (moderate to high pretest probability) or confirmed pulmonary embolism. Participants had bedside echocardiography evaluating for right ventricular dilatation (defined as right ventricular to left ventricular ratio greater than 1:1) and right ventricular dysfunction (right ventricular hypokinesis, paradoxical septal motion, or McConnell's sign). The patient's medical records were reviewed for the final reading on all imaging, disposition, hospital length of stay, 30-day inhospital mortality, and discharge diagnosis. Thirty of 146 patients had a pulmonary embolism. Right ventricular dilatation on echocardiography had a sensitivity of 50% (95% confidence interval [CI] 32% to 68%), a specificity of 98% (95% CI 95% to 100%), a positive predictive value of 88% (95% CI 66% to 100%), and a negative predictive value of 88% (95% CI 83% to 94%). Positive and negative likelihood ratios were determined to be 29 (95% CI 6.1% to 64%) and 0.51 (95% CI 0.4% to 0.7%), respectively. Ten of 11 patients with right ventricular hypokinesis had a pulmonary embolism. All 6 patients with McConnell's sign and all 8 patients with paradoxical septal motion had a diagnosis of pulmonary embolism. There was a 96% observed agreement between coinvestigators and principal investigator interpretation of images obtained and recorded. Right ventricular dilatation and right ventricular dysfunction identified on emergency physician performed echocardiography were found to be highly specific for pulmonary embolism but had poor sensitivity. Bedside echocardiography is a useful tool that can be incorporated into the algorithm of patients with a moderate to high pretest probability of pulmonary embolism. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Scalable Emergency Response System for Oceangoing Assets. Final Summary Report

DTIC Science & Technology

2009-01-20

Developed for platform defense of submarines and surface ships at sea and in port, the iRobot High Speed UUV enables rapid transit with respect to a ... high level decontamination, resulting in a return to port Decision Making Option C is to sealift via decontamination vessel contingent, and perform a ...the world aboard a prepared LCAC.48 A high - speed , over- 47 One Marine’s View. Retrieved from http://www.onemarinesview.com/one_marines_view/2006/09

Cost-minimization analysis of phenytoin and fosphenytoin in the emergency department.

PubMed

Touchette, D R; Rhoney, D H

2000-08-01

To determine the value of fosphenytoin compared with phenytoin for treating patients admitted to an emergency department following a seizure. Cost-minimization analysis performed from a hospital perspective. Hospital emergency department. Two hundred fifty-six patients participating in a comparative clinical trial. Estimation of adverse event rates and resource use. In our base case, phenytoin was the preferred option, with an expected total treatment cost of $5.39 compared with $110.14 for fosphenytoin. One-way sensitivity analyses showed that the frequency and cost of treating purple glove syndrome (PGS) possibly could affect the decision. Monte Carlo simulation showed phenytoin to be the preferred option 97.3% of the time. When variable costs of care are used to calculate the value of phenytoin compared with fosphenytoin in the emergency department, phenytoin is preferred. The decision to administer phenytoin was very robust and changed only when both the frequency and cost of PGS was high.

Applying lessons from commercial aviation safety and operations to resuscitation.

PubMed

Ornato, Joseph P; Peberdy, Mary Ann

2014-02-01

Both commercial aviation and resuscitation are complex activities in which team members must respond to unexpected emergencies in a consistent, high quality manner. Lives are at stake in both activities and the two disciplines have similar leadership structures, standard setting processes, training methods, and operational tools. Commercial aviation crews operate with remarkable consistency and safety, while resuscitation team performance and outcomes are highly variable. This commentary provides the perspective of two physician-pilots showing how commercial aviation training, operations, and safety principles can be adapted to resuscitation team training and performance. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Audit of primary care electrocardiograms sent as emergency to a telehealth service - the Telehealth Network of Minas Gerais, Brazil.

PubMed

Marcolino, Milena S; Carvalho, Bárbara C; Lucena, Aline M; França, Ana Luiza N; Pessoa, Cristiane G; Neves, Daniel S; Alkmim, Maria Beatriz M

2015-01-01

The Telehealth Network of Minas Gerais (TNMG) is a public telehealth service in Brazil that has performed electrocardiogram (ECG) analysis since 2005. From February to March 2014, 28% of ECGs were classified as "emergency" by the primary care tele-health sites. This quasi-experimental study aimed to investigate the reasons behind the high number of emergency ECGs being sent in, the implementation of corrective actions, and an assessment of the impact of these actions. In the 1st phase, primary care units that sent >70% of ECGs as emergency from February to March 2014 were selected. The 2nd phase consisted of the intervention. In the 3rd phase, the proportion of ECGs sent as an emergency during the 1st and 2nd months post intervention were assessed. Of the 63 cities selected during the 1st phase, 50% of the practitioners did not know the proper definition of emergency. After the intervention, 67% of the cities had a significant reduction in the proportion of ECGs sent as an emergency during the 1st month, and 17% had a significant reduction during the 2nd month.

Stress and Simulation in Pilot Training. Final Report, May 1977 Through December 1977.

ERIC Educational Resources Information Center

Krahenbuhl, Gary S.; And Others

Research was conducted on pilot stress during simulated emergency flight conditions. Catecholamine (adrenaline and non-adrenaline) secretion for twenty United States Air Force student pilots and thirteen instructor pilots was determined during daily activities, during simulated flights performed in high realism simulators, and during actual…

Seismic evaluation of I-24 bridges and embankments in Western Kentucky : summary report.

DOT National Transportation Integrated Search

2006-09-01

I-24 is considered as one of the high priority and emergency routes in the region. Hence, it is essential that I-24 remains functional and operational after an earthquake event. The objective of this study is to perform seismic evaluation and risk as...

The Preschool Transition into Primary Grades: Is Curriculum a Factor? Developmentally Appropriate Practice.

ERIC Educational Resources Information Center

Greenberg, Sylvia

2002-01-01

Compared the California State Framework and Head Start Performance Standards for common expectations for early childhood education curriculum. Explored relationship of curriculum and the learning styles of preschool children. Found that High/Scope and Emergent Curricula were most compatible with California framework's objective of meeting the…

Intrajudge Consistency Using the Angoff Standard-Setting Method.

ERIC Educational Resources Information Center

Plake, Barbara S.; Impara, James C.

This study investigated the intrajudge consistency of Angoff-based item performance estimates. The examination used was a certification examination in an emergency medicine specialty. Ten expert panelists rated the same 24 items twice during an operational standard setting study. Results indicate that the panelists were highly consistent, in terms…

Do Fathers' Home Reading Practices at Age 2 Predict Child Language and Literacy at Age 4?

PubMed

Quach, Jon; Sarkadi, Anna; Napiza, Natasha; Wake, Melissa; Loughman, Amy; Goldfeld, Sharon

2018-03-01

Maternal shared reading practices predict emergent literacy, but fathers' contributions are less certain. We examined whether fathers' shared home reading activities at 2 years predict language and emergent literacy at age 4 years, when controlling for maternal contributions; and whether this differentially benefits these outcomes in disadvantaged children. Two-parent families were recruited from 5 relatively disadvantaged communities for the universal Let's Read literacy promotion population-based trial (ISRCTN 04602902) in Melbourne, Australia. For exposure at 2 years, home reading practices were recorded via self-reported maternal and paternal StimQ-Toddler questionnaires and dichotomized at study median (high vs low). At 4 years, outcomes assessed included receptive and expressive language (Clinical Evaluation of Language Fundamentals 4) and emergent literacy (Sunderland Phonological Awareness Test-Revised). Linear regression, adjusted for mothers' home reading, was performed to assess 2-year-old vocabulary and communication skills and family disadvantage. Interaction of disadvantage (yes vs no) with high home reading by fathers and at least one parent was assessed. Data were available for 405 families (64.3%). High father reading at 2 years (reference: low) predicted better expressive (mean difference, 4.7; 95% confidence interval, 1.5 to 8.0) and receptive (mean difference, 5.0; 95% confidence interval, 1.8 to 8.2) language at 4 years (both P < .001), but not emergent literacy skills. Similar patterns were observed in families with at least one parent with high home reading. Fathers' reading did not differentially benefit outcomes in disadvantaged children. Fathers' involvement in reading at 2 years predicted better language but not emergent literacy at 4 years, and it did not protect against adverse effects of socioeconomic disadvantage. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Population demography of alpine butterflies: Boloria pales and Boloria napaea (Lepidoptera: Nymphalidae) and their specific adaptations to high mountain environments

NASA Astrophysics Data System (ADS)

Ehl, Stefan; Ebertshäuser, Marlene; Gros, Patrick; Schmitt, Thomas

2017-11-01

High mountain ecosystems are extreme habitats, and adaptation strategies to this ecosystem are still poorly understood in most groups. To unravel such strategies, we performed a MRR study in the Hohe Tauern National Park (Salzburg, Austria) with two nymphalid butterfly species, Boloria pales and B. napaea. We analysed their population structure over one flight period by studying the development of population size and wing wear. B. pales had more individuals and a higher survival probability than B. napaea; the sensitivity to extreme weather conditions or other external influences was higher in B. napaea. We only observed proterandry in B. pales. Imagines of both species survived under snow for at least some days. Additionally, we observed a kind of risk-spreading, in that individuals of both species, and especially B. pales, have regularly emerged throughout the flight period. This emergence pattern divided the population's age structure into three phases: an initial phase with decreasing wing quality (emergence > mortality), followed by an equilibrium phase with mostly constant average wing condition (emergence = mortality) and a final ageing phase with strongly deteriorating wing condition (mortality » emergence). Consequently, neither species would likely become extinct because of particularly unsuitable weather conditions during a single flight period. The observed differences between the two species suggest a better regional adaptation of B. pales, which is restricted to high mountain systems of Europe. In contrast, the arctic-alpine B. napaea might be best adapted to conditions in the Arctic and not the more southern high mountain systems. However, this needs to be examined during future research in the Arctic.

Current UK practice in emergency laparotomy

PubMed Central

Barrow, E; Varley, S; Pichel, AC; Peden, CJ; Saunders, DI; Murray, D

2013-01-01

Introduction Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Methods Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Results Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. Conclusions This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study. PMID:24165345

Current UK practice in emergency laparotomy.

PubMed

Barrow, E; Anderson, I D; Varley, S; Pichel, A C; Peden, C J; Saunders, D I; Murray, D

2013-11-01

Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

Network protocols for real-time applications

NASA Technical Reports Server (NTRS)

Johnson, Marjory J.

1987-01-01

The Fiber Distributed Data Interface (FDDI) and the SAE AE-9B High Speed Ring Bus (HSRB) are emerging standards for high-performance token ring local area networks. FDDI was designed to be a general-purpose high-performance network. HSRB was designed specifically for military real-time applications. A workshop was conducted at NASA Ames Research Center in January, 1987 to compare and contrast these protocols with respect to their ability to support real-time applications. This report summarizes workshop presentations and includes an independent comparison of the two protocols. A conclusion reached at the workshop was that current protocols for the upper layers of the Open Systems Interconnection (OSI) network model are inadequate for real-time applications.

Two-Dimensional-Material Membranes: A New Family of High-Performance Separation Membranes.

PubMed

Liu, Gongping; Jin, Wanqin; Xu, Nanping

2016-10-17

Two-dimensional (2D) materials of atomic thickness have emerged as nano-building blocks to develop high-performance separation membranes that feature unique nanopores and/or nanochannels. These 2D-material membranes exhibit extraordinary permeation properties, opening a new avenue to ultra-fast and highly selective membranes for water and gas separation. Summarized in this Minireview are the latest ground-breaking studies in 2D-material membranes as nanosheet and laminar membranes, with a focus on starting materials, nanostructures, and transport properties. Challenges and future directions of 2D-material membranes for wide implementation are discussed briefly. © 2016 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Effects of Time of Day and Sleep Deprivation on Motorcycle-Driving Performance

PubMed Central

Bougard, Clément; Espié, Stéphane; Larnaudie, Bruno; Moussay, Sébastien; Davenne, Damien

2012-01-01

The aim of this study was to investigate whether motorcycle handling capabilities – measured by means of the efficiency of emergency manoeuvres – were dependent on prior sleep deprivation and time of day. Twelve male participants voluntarily took part in four test sessions, starting at 6 a.m., 10 a.m., 2 p.m., and 6 p.m., following a night either with or without sleep. Each test session comprised temperature and sleepiness measurements, before three different types of motorcycling tests were initiated: (1) stability in straight ahead riding at low speed (in “slow motion” mode and in “brakes and clutch” mode), (2) emergency braking and (3) crash avoidance tasks performed at 20 kph and 40 kph. The results indicate that motorcycle control at low speed depends on time of day, with an improvement in performance throughout the day. Emergency braking performance is affected at both speeds by time of day, with poorer performance (longer total stopping distance, reaction time and braking distance) in the morning, and also by sleep deprivation, from measurements obtained at 40 kph (incorrect initial speed). Except for a tendency observed after the sleepless night to deviate from the initial speed, it seems that crash avoidance capabilities are quite unaffected by the two disturbance factors. Consequently, some motorcycle handling capabilities (stability at low speed and emergency braking) change in the same way as the diurnal fluctuation observed in body temperature and sleepiness, whereas for others (crash avoidance) the participants were able to maintain their initial performance level despite the high levels of sleepiness recorded after a sleepless night. Motorcycle riders have to be aware that their handling capabilities are limited in the early morning and/or after sleep deprivation. Both these situations can increase the risk of falls and of being involved in a road accident. PMID:22761881

Analytical Validation of a Portable Mass Spectrometer Featuring Interchangeable, Ambient Ionization Sources for High Throughput Forensic Evidence Screening

NASA Astrophysics Data System (ADS)

Lawton, Zachary E.; Traub, Angelica; Fatigante, William L.; Mancias, Jose; O'Leary, Adam E.; Hall, Seth E.; Wieland, Jamie R.; Oberacher, Herbert; Gizzi, Michael C.; Mulligan, Christopher C.

2017-06-01

Forensic evidentiary backlogs are indicative of the growing need for cost-effective, high-throughput instrumental methods. One such emerging technology that shows high promise in meeting this demand while also allowing on-site forensic investigation is portable mass spectrometric (MS) instrumentation, particularly that which enables the coupling to ambient ionization techniques. While the benefits of rapid, on-site screening of contraband can be anticipated, the inherent legal implications of field-collected data necessitates that the analytical performance of technology employed be commensurate with accepted techniques. To this end, comprehensive analytical validation studies are required before broad incorporation by forensic practitioners can be considered, and are the focus of this work. Pertinent performance characteristics such as throughput, selectivity, accuracy/precision, method robustness, and ruggedness have been investigated. Reliability in the form of false positive/negative response rates is also assessed, examining the effect of variables such as user training and experience level. To provide flexibility toward broad chemical evidence analysis, a suite of rapidly-interchangeable ion sources has been developed and characterized through the analysis of common illicit chemicals and emerging threats like substituted phenethylamines. [Figure not available: see fulltext.

The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism.

PubMed

Turan, Onur; Turgut, Deniz; Gunay, Turkan; Yilmaz, Erkan; Turan, Ayse; Akkoclu, Atila

2017-01-01

Pulmonary thromboembolism (PE) is a major disease in respiratory emergencies. Thoracic CT angiography (CTA) is an important method of visualizing PE. Because of the high radiation and contrast exposure, the method should be performed selectively in patients in whom PE is suspected. The aim of the study was to identify the role of clinical scoring systems utilizing CTA results to diagnose PE. The study investigated 196 patients referred to the hospital emergency service in whom PE was suspected and CTA performed. They were evaluated by empirical, Wells, Geneva and Miniati assessments and classified as low, intermediate and high clinical probability. They were also classified according to serum D-dimer levels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated according to CTA findings. Empirical scoring was found to have the highest sensitivity, while the Wells system had the highest specificity. When low D-dimer levels and "low probabilty" were evaluated together for each scoring system, the sensitivity was found to be 100% for all methods. Wells scoring with a cut-off score of 4 had the highest specificity (56.1%). Clinical scoring systems may be guides for patients in whom PE is suspected in the emergency department. The empirical and Wells scoring systems are effective methods for patient selection. Adding evaluation of D-dimer serum levels to the clinical scores could identify patients in whom CTA should be performed. Since CTA can only be used conservatively, the use of clinical scoring systems in conjunction with D-dimer levels can be a useful guide for patient selection.

Applications of high average power nonlinear optics

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

Velsko, S.P.; Krupke, W.F.

1996-02-05

Nonlinear optical frequency convertors (harmonic generators and optical parametric oscillators are reviewed with an emphasis on high average power performance and limitations. NLO materials issues and NLO device designs are discussed in reference to several emerging scientific, military and industrial commercial applications requiring {approx} 100 watt average power level in the visible and infrared spectral regions. Research efforts required to enable practical {approx} 100 watt class NLO based laser systems are identified.

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.

High resolution tsunami modelling for the evaluation of potential risk areas in Setúbal (Portugal)

NASA Astrophysics Data System (ADS)

Ribeiro, J.; Silva, A.; Leitão, P.

2011-08-01

The use of high resolution hydrodynamic modelling to simulate the potential effects of tsunami events can provide relevant information about the most probable inundation areas. Moreover, the consideration of complementary data such as the type of buildings, location of priority equipment, type of roads, enables mapping of the most vulnerable zones, computing of the expected damage on man-made structures, constrain of the definition of rescue areas and escape routes, adaptation of emergency plans and proper evaluation of the vulnerability associated with different areas and/or equipment. Such an approach was used to evaluate the specific risks associated with a potential occurrence of a tsunami event in the region of Setúbal (Portugal), which was one of the areas most seriously affected by the 1755 tsunami. In order to perform an evaluation of the hazard associated with the occurrence of a similar event, high resolution wave propagation simulations were performed considering different potential earthquake sources with different magnitudes. Based on these simulations, detailed inundation maps associated with the different events were produced. These results were combined with the available information on the vulnerability of the local infrastructures (building types, roads and streets characteristics, priority buildings) in order to impose restrictions in the production of high-scale potential damage maps, escape routes and emergency routes maps.

Codified Hashtags for Weather Warning on Twitter: an Italian Case Study

PubMed Central

Grasso, Valentina; Crisci, Alfonso

2016-01-01

Introduction: During emergencies increasing numbers of messages are shared through social media platforms becoming a primary source of information for lay people and emergency managers. For Twitter codified hashtagging is emerging as a practical way to coordinate messages during emergencies and quickly identify relevant information. This paper considers a case study on the use of codified hashtags concerning weather warning in Italy in three different regions. Methods: From November 3rd to December 2nd 2014, tweets identified by the 3 codified hashtags #allertameteoTOS, #allertameteoLIG and #allertameteoPIE were retrieved, collecting a total of 35,558 tweets published by 7361 unique tweets authors, with the aim to assess if codified hashtags could represent an effective way to align formal and informal sources of information during weather related emergencies. An auxiliary R-package was built to lead the analytics used in this study. Authors performed a manual coding of users, hashtags and content of messages of all Twitter data considered. Results: Content analysis showed that tweets were overwhelmingly related to situational updates, with a high percentage containing geo-location information. Communication patterns of different user types were discussed for the three contexts. In accordance with previous studies, individuals showed an active participation primarily functioning as information hub during the emergency. Discussion: In the proposed cases codified hashtags have proven to be an effective tool to convey useful information on Twitter by formal and informal sources. Where institutions supported the use of the predefined hashtag in communication activities, like in Tuscany, messages were very focused, with more than 90% of tweets being situational updates. In this perspective, use of codified hashtags may potentially improve the performance of systems for automatic information retrieval and processing during disasters. Keywords: social media, emergency management, Twitter, severe weather PMID:27500010

Assessment of the Temperament, Motivation, and Capability of a School System District for Emergency Management/Crisis Performance

ERIC Educational Resources Information Center

Hoff, Larry A.

2009-01-01

This study was a cross-sectional study of leadership and staff of a public school system in Georgia concerning their temperament type, emergency management motivation and emergency management knowledge in relation to Emergency Management/Crisis performance (ERCM). The study consisted of an inclusive questionnaire that contains questions on four…

Patient outcome of emergency laparotomy improved with increasing "number of surgeons on-call" in a university hospital: Audit loop.

PubMed

Hussain, Anwar; Mahmood, Fahad; Teng, Chui; Jafferbhoy, Sadaf; Luke, David; Tsiamis, Achilleas

2017-11-01

Emergency laparotomy is a commonly performed high-mortality surgical procedure. The National Emergency Laparotomy Network (NELA) published an average mortality rate of 11.1% and a median length of stay equivalent to 16.3 days in patients undergoing emergency laparotomy. This study presents a completed audit loop after implementing the change of increasing the number of on-call surgeons in the general surgery rota of a university hospital. The aim of this study was to evaluate the outcomes of emergency laparotomy in a single UK tertiary centre after addition of one more consultant in the daily on-call rota. This is a retrospective study involving patients who underwent emergency laparotomy between March to May 2013 (first audit) and June to August 2015 (second audit). The study parameters stayed the same. The adult patients undergoing emergency laparotomy under the general surgical take were included. Appendicectomy, cholecystectomy and simple inguinal hernia repair patients were excluded. Data was collected on patient demographics, ASA, morbidity, 30-day mortality and length of hospital stay. Statistical analysis including logistic regression was performed using SPSS. During the second 3-month period, 123 patients underwent laparotomy compared to 84 in the first audit. Median age was 65(23-93) years. 56.01% cases were ASA III or above in the re-audit compared to 41.9% in the initial audit. 38% patients had bowel anastomosis compared to 35.7% in the re-audit with 4.2% leak rate in the re-audit compared to 16.6% in the first audit. 30-day mortality was 10.50% in the re-audit compared to 21% and median length of hospital stay 11 days in the re-audit compared to 16 days. The lower ASA grade was significantly associated with increased likelihood of being alive, as was being female, younger age and not requiring ITU admission post-operatively. However, having a second on-call consultant was 2.231 times more likely to increase the chances of patients not dying (p = 0.031). Our audit-loop suggests that adding a second consultant to the daily on-call rota significantly reduces postoperative mortality and morbidity. Age, ASA and ITU admission are other independent factors affecting patient outcomes. We suggest this change be applied to other high volume centres across the country to improve the outcomes after emergency laparotomy.

44 CFR 206.204 - Project performance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Project performance. 206.204 Section 206.204 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Public Assistance Project Administration...

Neural activity in the hippocampus predicts individual visual short-term memory capacity.

PubMed

von Allmen, David Yoh; Wurmitzer, Karoline; Martin, Ernst; Klaver, Peter

2013-07-01

Although the hippocampus had been traditionally thought to be exclusively involved in long-term memory, recent studies raised controversial explanations why hippocampal activity emerged during short-term memory tasks. For example, it has been argued that long-term memory processes might contribute to performance within a short-term memory paradigm when memory capacity has been exceeded. It is still unclear, though, whether neural activity in the hippocampus predicts visual short-term memory (VSTM) performance. To investigate this question, we measured BOLD activity in 21 healthy adults (age range 19-27 yr, nine males) while they performed a match-to-sample task requiring processing of object-location associations (delay period  =  900 ms; set size conditions 1, 2, 4, and 6). Based on individual memory capacity (estimated by Cowan's K-formula), two performance groups were formed (high and low performers). Within whole brain analyses, we found a robust main effect of "set size" in the posterior parietal cortex (PPC). In line with a "set size × group" interaction in the hippocampus, a subsequent Finite Impulse Response (FIR) analysis revealed divergent hippocampal activation patterns between performance groups: Low performers (mean capacity  =  3.63) elicited increased neural activity at set size two, followed by a drop in activity at set sizes four and six, whereas high performers (mean capacity  =  5.19) showed an incremental activity increase with larger set size (maximal activation at set size six). Our data demonstrated that performance-related neural activity in the hippocampus emerged below capacity limit. In conclusion, we suggest that hippocampal activity reflected successful processing of object-location associations in VSTM. Neural activity in the PPC might have been involved in attentional updating. Copyright © 2013 Wiley Periodicals, Inc.

Emergency department revisits for patients with kidney stones in California.

PubMed

Scales, Charles D; Lin, Li; Saigal, Christopher S; Bennett, Carol J; Ponce, Ninez A; Mangione, Carol M; Litwin, Mark S

2015-04-01

Kidney stones affect nearly one in 11 persons in the United States, and among those experiencing symptoms, emergency care is common. In this population, little is known about the incidence of and factors associated with repeat emergency department (ED) visits. The objective was to identify associations between potentially mutable factors and the risk of an ED revisit for patients with kidney stones in a large, all-payer cohort. This was a retrospective cohort study of all patients in California initially treated and released from EDs for kidney stones between February 2008 and November 2009. A multivariable regression model was created to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of repeat ED visits. The primary outcome was a second ED visit within 30 days of the initial discharge from emergent care. Among 128,564 patients discharged from emergent care, 13,684 (11%) had at least one additional emergent visit for treatment of their kidney stone. In these patients, nearly one in three required hospitalization or an urgent temporizing procedure at the second visit. On multivariable analysis, the risk of an ED revisit was associated with insurance status (e.g., Medicaid vs. private insurance; odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.43 to 1.61; p < 0.001). Greater access to urologic care was associated with lower odds of an ED revisit (highest quartile OR = 0.88, 95% CI = 0.80 to 0.97; p < 0.01 vs. lowest quartile). In exploratory models, performance of a complete blood count was associated with a decreased odds of revisit (OR = 0.86, 95% CI = 0.75 to 0.97; p = 0.02). Repeat high-acuity care affects one in nine patients discharged from initial emergent evaluations for kidney stones. Access to urologic care and processes of care are associated with lower risk of repeat emergent encounters. Efforts are indicated to identify preventable causes of ED revisits for kidney stone patients and design interventions to reduce the risk of high-cost, high-acuity, repeat care. © 2015 by the Society for Academic Emergency Medicine.

We still need to operate at night!

PubMed Central

Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

2007-01-01

Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

Performance analysis of medical video streaming over mobile WiMAX.

PubMed

Alinejad, Ali; Philip, N; Istepanian, R H

2010-01-01

Wireless medical ultrasound streaming is considered one of the emerging application within the broadband mobile healthcare domain. These applications are considered as bandwidth demanding services that required high data rates with acceptable diagnostic quality of the transmitted medical images. In this paper, we present the performance analysis of a medical ultrasound video streaming acquired via special robotic ultrasonography system over emulated WiMAX wireless network. The experimental set-up of this application is described together with the performance of the relevant medical quality of service (m-QoS) metrics.

An Assessment of the Influence of Emerging Social and Economic Trends on the People and Management of the Coast Guard. Volume I.

DTIC Science & Technology

1979-12-01

the trend projections derived from the cross- impact analysis described above and the weighted areas of concern components. In order to perform this... performed on shore rather than by the crew at sea. This will 60 TABLE 4-4. IMPACTS OF HIGH PROBABILITY EVENTS ON MANPOWER MANAGDENT Ca4PONqfS... impacts would include the operating economics produced by the performance of ship maintenance by shore facilities rather than crews and the reduction of

Ultrasonography versus computed tomography for suspected nephrolithiasis.

PubMed

Smith-Bindman, Rebecca; Aubin, Chandra; Bailitz, John; Bengiamin, Rimon N; Camargo, Carlos A; Corbo, Jill; Dean, Anthony J; Goldstein, Ruth B; Griffey, Richard T; Jay, Gregory D; Kang, Tarina L; Kriesel, Dana R; Ma, O John; Mallin, Michael; Manson, William; Melnikow, Joy; Miglioretti, Diana L; Miller, Sara K; Mills, Lisa D; Miner, James R; Moghadassi, Michelle; Noble, Vicki E; Press, Gregory M; Stoller, Marshall L; Valencia, Victoria E; Wang, Jessica; Wang, Ralph C; Cummings, Steven R

2014-09-18

There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography. In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses with complications that could be related to missed or delayed diagnosis and the 6-month cumulative radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events (deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with higher scores indicating more severe pain), return emergency department visits, hospitalizations, and diagnostic accuracy. A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893 to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group (P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to CT (P=0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By 7 days, the average pain score was 2.0 in each group (P=0.84). Return emergency department visits, hospitalizations, and diagnostic accuracy did not differ significantly among the groups. Initial ultrasonography was associated with lower cumulative radiation exposure than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse events, pain scores, return emergency department visits, or hospitalizations. (Funded by the Agency for Healthcare Research and Quality.).

Overview and major characteristics of future aeronautical and space systems

NASA Technical Reports Server (NTRS)

Venneri, Samuel L.; Noor, Ahmed K.

1992-01-01

A systematic projection is made of prospective materials and structural systems' performance requirements in light of emerging applications. The applications encompass high-speed/long-range rotorcraft, advanced subsonic commercial aircraft, high speed (supersonic) commercial transports, hypersonic aircraft and missiles, extremely high-altitude cruise aircraft and missiles, and aerospace craft and launch vehicles. A tabulation is presented of the materials/structures/dynamics requirements associated with future aerospace systems, as well as the further development needs foreseen in each such case.

The impact of bowl size, program setup, and blood hematocrit on the performance of a discontinuous autotransfusion system.

PubMed

Seyfried, Timo F; Gruber, Michael; Streithoff, Fabian; Mandle, Robert J; Pawlik, Michael T; Busse, Hendrik; Hansen, Ernil

2017-03-01

Cell salvage is an essential element in the concept of blood management. Modern devices provide different bowl sizes and sensor-directed programs to optimally adjust to varying clinical situations. In an experimental performance study, the discontinuous autotransfusion device XTRA (LivaNova/Sorin) was evaluated using fresh donor blood anticoagulated with heparin 5 U/mL and adjusted to a hematocrit of 10% or 25%, representing orthopedic or cardiac surgery. Test blood was processed with the autotransfusion device XTRA in four different bowls (55 mL, 125 mL, 175 mL, and 225 mL) and in three different program modes (a standard program, an optimized program, and an emergency program). Processing speed increased with bowl size and with the emergency program (range, 6.4-29.8 mL red blood cells [RBCs]/min). The RBC recovery rate exceeded 90% for all bowls and programs except the 55-mL bowl with the emergency program. Plasma elimination exceeded 95% for all bowls and programs except the 225-mL bowl with the emergency and standard programs. Maximal RBC recovery (range, 94.7%-97.6%) and plasma elimination (range, 98.7%-99.5%) were obtained with the medium-sized bowls (125 mL and 175 mL) and the optimized program. Elimination rates for potassium or plasma free hemoglobin were consistently lower than for protein or albumin and were highest for heparin. Increased hematocrit and RBC recovery rates are obtained with the optimized program Popt with the discontinuous autotransfusion device. The emergency program Pem speeds up the process but leads to RBC loss and reduced plasma elimination rates; therefore, it should be restricted to emergency situations. All four different sized bowls have high performance. Plasma elimination is represented best by protein or albumin elimination rates. © 2017 AABB.

Ultrafast optical ranging using microresonator soliton frequency combs

NASA Astrophysics Data System (ADS)

Trocha, P.; Karpov, M.; Ganin, D.; Pfeiffer, M. H. P.; Kordts, A.; Wolf, S.; Krockenberger, J.; Marin-Palomo, P.; Weimann, C.; Randel, S.; Freude, W.; Kippenberg, T. J.; Koos, C.

2018-02-01

Light detection and ranging is widely used in science and industry. Over the past decade, optical frequency combs were shown to offer advantages in optical ranging, enabling fast distance acquisition with high accuracy. Driven by emerging high-volume applications such as industrial sensing, drone navigation, or autonomous driving, there is now a growing demand for compact ranging systems. Here, we show that soliton Kerr comb generation in integrated silicon nitride microresonators provides a route to high-performance chip-scale ranging systems. We demonstrate dual-comb distance measurements with Allan deviations down to 12 nanometers at averaging times of 13 microseconds along with ultrafast ranging at acquisition rates of 100 megahertz, allowing for in-flight sampling of gun projectiles moving at 150 meters per second. Combining integrated soliton-comb ranging systems with chip-scale nanophotonic phased arrays could enable compact ultrafast ranging systems for emerging mass applications.

Exploring the Behaviour of Emerging Contaminants in the Water Cycle using the Capabilities of High Resolution Mass Spectrometry.

PubMed

Hollender, Juliane; Bourgin, Marc; Fenner, Kathrin B; Longrée, Philipp; Mcardell, Christa S; Moschet, Christoph; Ruff, Matthias; Schymanski, Emma L; Singer, Heinz P

2014-11-01

To characterize a broad range of organic contaminants and their transformation products (TPs) as well as their loads, input pathways and fate in the water cycle, the Department of Environmental Chemistry (Uchem) at Eawag applies and develops high-performance liquid chromatography (LC) methods combined with high-resolution tandem mass spectrometry (HRMS/MS). In this article, the background and state-of-the-art of LC-HRMS/MS for detection of i) known targets, ii) suspected compounds like TPs, and iii) unknown emerging compounds are introduced briefly. Examples for each approach are taken from recent research projects conducted within the department. These include the detection of trace organic contaminants and their TPs in wastewater, pesticides and their TPs in surface water, identification of new TPs in laboratory degradation studies and ozonation experiments and finally the screening for unknown compounds in the catchment of the river Rhine.

Emergency Physician Utilization of Alcohol/Substance Screening, Brief Advice and Discharge: A 10-Year Comparison.

PubMed

Broderick, Kerryann B; Kaplan, Bonnie; Martini, Dyllon; Caruso, Emily

2015-10-01

In 2007, of the 130 million emergency department (ED) visits, ∼ 38 million were due to injury, and of those, 1.9 million involved alcohol. The emergency department is a pivotal place to implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) due to the high number of patients presenting with alcohol/substance abuse risk factors or related injuries. This study compares two surveys, approximately 11 years apart, of emergency physicians nationwide which assesses the use of validated screening tools, the availability of community resources for alcohol/substance abuse treatment, and the prevailing attitudes of emergency physicians regarding Screening and Brief Intervention for alcohol/substance abuse. We performed cross-sectional anonymous surveys of 1500 emergency physicians drawn from American College of Emergency Physicians members. The survey results were compared for time interval change. The two surveys had comparable response rates. The median percentage of patients screened for alcohol/substance abuse in 1999 was 15%, vs. 20% in 2010. In 2010, 26% of emergency physicians had a formal screening tool, and the majority used Cut-down, Annoyed, Guilty, Eye-opener (85%). In 2010, a statistically significant increase in the number of emergency physicians said they would "always" or "almost always" use discharge instructions that were specific for alcohol/substance abuse, if available, vs. 1999. Few emergency physicians screen for alcohol/substance abuse despite evidence that screening and brief intervention is effective. Emergency physicians are receptive to the use of discharge material. Copyright © 2015 Elsevier Inc. All rights reserved.

Process mapping as a framework for performance improvement in emergency general surgery.

PubMed

DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

2017-12-01

Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

Process mapping as a framework for performance improvement in emergency general surgery.

PubMed

DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

2018-02-01

Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

Vertically Aligned Co9 S8 Nanotube Arrays onto Graphene Papers as High-Performance Flexible Electrodes for Supercapacitors.

PubMed

Xiong, Dongbin; Li, Xifei; Bai, Zhimin; Li, Jianwei; Han, Yan; Li, Dejun

2018-02-16

Paper-like electrodes are emerging as a new category of advanced electrodes for flexible supercapacitors (SCs). Graphene, a promising two-dimensional material with high conductivity, can be easily processed into papers. Here, we report a rational design of flexible architecture with Co 9 S 8 nanotube arrays (NAs) grown onto graphene paper (GP) via a facile two-step hydrothermal method. When employed as flexible free-standing electrode for SCs, the proposed architectured Co 9 S 8 /GPs exhibits superior electrochemical performance with ultrahigh capacitance and outstanding rate capability (469 F g -1 at 10 A g -1 ). These results demonstrate that the new nanostructured Co 9 S 8 /GPs can be potentially applied in high performance flexible supercapacitors. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

PubMed

Işıl, Rıza Gürhan; Yazıcı, Pınar; Demir, Uygar; Kaya, Cemal; Bostancı, Özgür; İdiz, Ufuk Oğuz; Işıl, Canan Tülay; Demircioğlu, Mahmut Kaan; Mihmanlı, Mehmet

2017-03-01

Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

A method for using unmanned aerial vehicles for emergency investigation of single geo-hazards and sample applications of this method

NASA Astrophysics Data System (ADS)

Huang, Haifeng; Long, Jingjing; Yi, Wu; Yi, Qinglin; Zhang, Guodong; Lei, Bangjun

2017-11-01

In recent years, unmanned aerial vehicles (UAVs) have become widely used in emergency investigations of major natural hazards over large areas; however, UAVs are less commonly employed to investigate single geo-hazards. Based on a number of successful investigations in the Three Gorges Reservoir area, China, a complete UAV-based method for performing emergency investigations of single geo-hazards is described. First, a customized UAV system that consists of a multi-rotor UAV subsystem, an aerial photography subsystem, a ground control subsystem and a ground surveillance subsystem is described in detail. The implementation process, which includes four steps, i.e., indoor preparation, site investigation, on-site fast processing and application, and indoor comprehensive processing and application, is then elaborated, and two investigation schemes, automatic and manual, that are used in the site investigation step are put forward. Moreover, some key techniques and methods - e.g., the layout and measurement of ground control points (GCPs), route planning, flight control and image collection, and the Structure from Motion (SfM) photogrammetry processing - are explained. Finally, three applications are given. Experience has shown that using UAVs for emergency investigation of single geo-hazards greatly reduces the time, intensity and risks associated with on-site work and provides valuable, high-accuracy, high-resolution information that supports emergency responses.

Transient rotordynamic analysis for the space-shuttle main engine high-pressure oxygen turbopump

NASA Technical Reports Server (NTRS)

Childs, D. W.

1974-01-01

A simulation study was conducted to examine the transient rotordynamics of the space shuttle main engine (SSME) high pressure oxygen turbopump (HPOTP) with the objective of identifying, anticipating, and avoiding rotordynamic problem areas. Simulations were performed for steady state operations at emergency power levels and for critical speed transitions. No problems are indicated in steady state operation of the HPOTP emergency power levels, although the results indicated that a rubbing condition will be experienced during critical speed transition at shutdown, particularly involving rotor deceleration rate and imbalance distribution rubbing at the turbine floating-ring seals. The condition is correctable by either reducing the imbalance at the HPOTP hot gas turbine wheels, or by a more rapid deceleration of the rotor through it critical speed.

Analysis of Effect of Zn(O,S) Buffer Layer Properties on CZTS Solar Cell Performance Using AMPS

NASA Astrophysics Data System (ADS)

Lin, Ling-Yan; Qiu, Yu; Zhang, Yu; Zhang, Hao

2016-10-01

Not Available Supported by the Guiding Project of Strategic Emerging Industries of Fujian Provincial Department of Science and Technology under Grant No 2015H0010, the Opening Project of State Key Laboratory of High Performance Ceramics and Superfine Microstructure of Shanghai Institute of Ceramics of Chinese Academy of Sciences under Grant No SKL201404SIC, and the Natural Science Foundation of Fujian Province under Grant No 2016J01751.

Mobile high-performance computing (HPC) for synthetic aperture radar signal processing

NASA Astrophysics Data System (ADS)

Misko, Joshua; Kim, Youngsoo; Qi, Chenchen; Sirkeci, Birsen

2018-04-01

The importance of mobile high-performance computing has emerged in numerous battlespace applications at the tactical edge in hostile environments. Energy efficient computing power is a key enabler for diverse areas ranging from real-time big data analytics and atmospheric science to network science. However, the design of tactical mobile data centers is dominated by power, thermal, and physical constraints. Presently, it is very unlikely to achieve required computing processing power by aggregating emerging heterogeneous many-core processing platforms consisting of CPU, Field Programmable Gate Arrays and Graphic Processor cores constrained by power and performance. To address these challenges, we performed a Synthetic Aperture Radar case study for Automatic Target Recognition (ATR) using Deep Neural Networks (DNNs). However, these DNN models are typically trained using GPUs with gigabytes of external memories and massively used 32-bit floating point operations. As a result, DNNs do not run efficiently on hardware appropriate for low power or mobile applications. To address this limitation, we proposed for compressing DNN models for ATR suited to deployment on resource constrained hardware. This proposed compression framework utilizes promising DNN compression techniques including pruning and weight quantization while also focusing on processor features common to modern low-power devices. Following this methodology as a guideline produced a DNN for ATR tuned to maximize classification throughput, minimize power consumption, and minimize memory footprint on a low-power device.

Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype?

PubMed

Pinckaers, Philippe J M; Churchward-Venne, Tyler A; Bailey, David; van Loon, Luc J C

2017-03-01

Elite athletes and coaches are in a constant search for training methods and nutritional strategies to support training and recovery efforts that may ultimately maximize athletes' performance. Recently, there has been a re-emerging interest in the role of ketone bodies in exercise metabolism, with considerable media speculation about ketone body supplements being routinely used by professional cyclists. Ketone bodies can serve as an important energy substrate under certain conditions, such as starvation, and can modulate carbohydrate and lipid metabolism. Dietary strategies to increase endogenous ketone body availability (i.e., a ketogenic diet) require a diet high in lipids and low in carbohydrates for ~4 days to induce nutritional ketosis. However, a high fat, low carbohydrate ketogenic diet may impair exercise performance via reducing the capacity to utilize carbohydrate, which forms a key fuel source for skeletal muscle during intense endurance-type exercise. Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes' performance under conditions where evidence-based nutritional strategies are applied appropriately.

HAZBOT - A hazardous materials emergency response mobile robot

NASA Technical Reports Server (NTRS)

Stone, H. W.; Edmonds, G.

1992-01-01

The authors describe the progress that has been made towards the development of a mobile robot that can be used by hazardous materials emergency response teams to perform a variety of tasks including incident localization and characterization, hazardous material identification/classification, site surveillance and monitoring, and ultimately incident mitigation. In September of 1991, the HAZBOT II vehicle performed its first end-to-end demonstration involving a scenario in which the vehicle: navigated to the incident location from a distant (150-200 ft.) deployment site; entered a building through a door with thumb latch style handle and door closer; located and navigated to the suspected incident location (a chemical storeroom); unlocked and opened the storeroom's door; climbed over the storeroom's 12 in. high threshold to enter the storeroom; and located and identified a broken container of benzene.

HAZBOT - A hazardous materials emergency response mobile robot

NASA Astrophysics Data System (ADS)

Stone, H. W.; Edmonds, G.

The authors describe the progress that has been made towards the development of a mobile robot that can be used by hazardous materials emergency response teams to perform a variety of tasks including incident localization and characterization, hazardous material identification/classification, site surveillance and monitoring, and ultimately incident mitigation. In September of 1991, the HAZBOT II vehicle performed its first end-to-end demonstration involving a scenario in which the vehicle: navigated to the incident location from a distant (150-200 ft.) deployment site; entered a building through a door with thumb latch style handle and door closer; located and navigated to the suspected incident location (a chemical storeroom); unlocked and opened the storeroom's door; climbed over the storeroom's 12 in. high threshold to enter the storeroom; and located and identified a broken container of benzene.

Attrition from emergency medicine clinical practice in the United States.

PubMed

Ginde, Adit A; Sullivan, Ashley F; Camargo, Carlos A

2010-08-01

We estimate the annual attrition from emergency medicine clinical practice. We performed a cross-sectional analysis of the American Medical Association's 2008 Physician Masterfile, which includes data on all physicians who have ever obtained a medical license in at least 1 US state. We restricted the analysis to physicians who completed emergency medicine residency training or who obtained emergency medicine board certification. We defined attrition as not being active in emergency medicine clinical practice. Attrition was reported as cumulative and annualized rates, with stratification by years since training graduation. Death rates were estimated from life tables for the US population. Of the 30,864 emergency medicine-trained or emergency medicine board-certified physicians, 26,826 (87%) remain active in emergency medicine clinical practice. Overall, type of attrition was 45% to non-emergency medicine clinical practice, 22% retired, 14% administration, and 10% research/teaching. Immediate attrition (<2 years since training graduation) was 6.5%. The cumulative attrition rates from 2 to 15 years postgraduation were stable (5% to 9%) and thereafter were progressively higher, with 18% having left emergency medicine clinical practice at 20 years postgraduation and 25% at 30 years postgraduation. Annualized attrition rates were highest for the first 5 years postgraduation and after 40 years postgraduation; between 5 and 40 years, the rates remained low (<1%). The overall annual attrition rate from emergency medicine clinical practice, including estimated death rate, was approximately 1.7%. Despite the high stress and demands of emergency medicine, overall attrition remains low and compares favorably with that of other medical specialties. These data have positive implications for the emergency physician workforce and are important for accurate estimation of and planning for emergency physician workforce needs. 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Dedicated operating room for emergency surgery generates more utilization, less overtime, and less cancellations.

PubMed

van Veen-Berkx, Elizabeth; Elkhuizen, Sylvia G; Kuijper, Bart; Kazemier, Geert

2016-01-01

Two approaches prevail for reserving operating room (OR) capacity for emergency surgery: (1) dedicated emergency ORs and (2) evenly allocating capacity to all elective ORs, thereby creating a virtual emergency team. Previous studies contradict which approach leads to the best performance in OR utilization. Quasi-experimental controlled time-series design with empirical data from 3 university medical centers. Four different time periods were compared with analysis of variance with contrasts. Performance was measured based on 467,522 surgical cases. After closing the dedicated emergency OR, utilization slightly increased; overtime also increased. This was in contrast to earlier simulated results. The 2 control centers, maintaining a dedicated emergency OR, showed a higher increase in utilization and a decrease in overtime, along with a smaller ratio of case cancellations because of emergency surgery. This study shows that in daily practice a dedicated emergency OR is the preferred approach in performance terms regarding utilization, overtime, and case cancellations. Copyright © 2016 Elsevier Inc. All rights reserved.

Support-vector-based emergent self-organising approach for emotional understanding

NASA Astrophysics Data System (ADS)

Nguwi, Yok-Yen; Cho, Siu-Yeung

2010-12-01

This study discusses the computational analysis of general emotion understanding from questionnaires methodology. The questionnaires method approaches the subject by investigating the real experience that accompanied the emotions, whereas the other laboratory approaches are generally associated with exaggerated elements. We adopted a connectionist model called support-vector-based emergent self-organising map (SVESOM) to analyse the emotion profiling from the questionnaires method. The SVESOM first identifies the important variables by giving discriminative features with high ranking. The classifier then performs the classification based on the selected features. Experimental results show that the top rank features are in line with the work of Scherer and Wallbott [(1994), 'Evidence for Universality and Cultural Variation of Differential Emotion Response Patterning', Journal of Personality and Social Psychology, 66, 310-328], which approached the emotions physiologically. While the performance measures show that using the full features for classifications can degrade the performance, the selected features provide superior results in terms of accuracy and generalisation.

GPU accelerated particle visualization with Splotch

NASA Astrophysics Data System (ADS)

Rivi, M.; Gheller, C.; Dykes, T.; Krokos, M.; Dolag, K.

2014-07-01

Splotch is a rendering algorithm for exploration and visual discovery in particle-based datasets coming from astronomical observations or numerical simulations. The strengths of the approach are production of high quality imagery and support for very large-scale datasets through an effective mix of the OpenMP and MPI parallel programming paradigms. This article reports our experiences in re-designing Splotch for exploiting emerging HPC architectures nowadays increasingly populated with GPUs. A performance model is introduced to guide our re-factoring of Splotch. A number of parallelization issues are discussed, in particular relating to race conditions and workload balancing, towards achieving optimal performances. Our implementation was accomplished by using the CUDA programming paradigm. Our strategy is founded on novel schemes achieving optimized data organization and classification of particles. We deploy a reference cosmological simulation to present performance results on acceleration gains and scalability. We finally outline our vision for future work developments including possibilities for further optimizations and exploitation of hybrid systems and emerging accelerators.

Developing Female Coaches: Strategies from Women Themselves

ERIC Educational Resources Information Center

Norman, Leanne

2012-01-01

The purpose of this study was to explore strategies for the development of aspiring female coaches based on the ideas of existing high-performance female coaches. Drawing on semi-structured interviews with national-level female coaches in the United Kingdom, four recurrent ideas for developing female coaches in a male-dominated profession emerged.…

E-Learning as an Emerging Technology in India

ERIC Educational Resources Information Center

Grover, Pooja; Gupta, Nehta

2010-01-01

E-learning is a combination of learning services and technology that allow us to provide high value integrated learning any time, any place. It is about a new blend of resources, interactivity, performance support and structured learning activities. This methodology makes use of various types of technologies in order to enhance or transform the…

Distributed Leadership in Action: Leading High-Performing Leadership Teams in English Schools

ERIC Educational Resources Information Center

Bush, Tony; Glover, Derek

2012-01-01

Heroic models of leadership based on the role of the principal have been supplemented by an emerging recognition of the value of "distributed leadership". The work of effective senior leadership teams (SLTs) is an important manifestation of distributed leadership, but there has been only limited research addressing the relationship…

The Relationship between Principal Leadership Effectiveness and School Performance in South Carolina High Schools

ERIC Educational Resources Information Center

Lempesis, Costa

2009-01-01

A critical component for successful schools is effective leadership. In the 1980's the concept of leadership emerged and the rules changed for school principals (Lashway, 2002). Previously, administrators were primarily evaluated based upon their abilities in managing school facilities and operations efficiently. Academics became the new focus.…

77 FR 34149 - Heavy-Duty Highway Program: Revisions for Emergency Vehicles and SCR Maintenance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-08

... soot. Since this burning can involve extra heat and/or oxygen or oxygen- containing compounds, this... fuel consumption. This loss in performance may be noticed by the vehicle operator in terms of poor... excessive amounts of trapped PM begin to oxidize at high temperatures (i.e., DPF regeneration temperatures...

Transcatheter Aortic Valve Implantation in an Extremely Tortuous S-Shaped Aorta

PubMed Central

Toleva, Olga; Pozeg, Zlatko; Menkis, Alan

2017-01-01

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative technique to treating aortic stenosis in patients with high surgical risk. We present a case of a successful transfemoral TAVI in a high-risk patient with an extremely tortuous iliofemoral system and a significant S-type bend in the descending aorta. With careful preprocedure planning and using all the techniques available, TAVI can be performed in the most challenging patients. PMID:28352480

Low cost, high yield: simulation of obstetric emergencies for family medicine training.

PubMed

Magee, Susanna R; Shields, Robin; Nothnagle, Melissa

2013-01-01

Simulation is now the educational standard for emergency training in residency and is particularly useful on a labor and delivery unit, which is often a stressful environment for learners given the frequency of emergencies. However, simulation can be costly. This study aimed to assess the feasibility and effectiveness of low-cost simulated obstetrical emergencies in training family medicine residents. The study took place in a community hospital in an urban underserved setting in the northeast United States. Low-cost simulations were developed for postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PEC). Twenty residents were randomly assigned to the intervention (simulated PPH or PEC followed by debriefing) or control (lecture on PPH or PEC) group, and equal numbers of residents were assigned to each scenario. All participants completed a written test at baseline and an oral exam 6 months later on the respective scenario to which they were assigned. The participants provided written feedback on their respective teaching interventions. We compared performance on pretests and posttests by group using Wilcoxon Rank Sum. Twenty residents completed the study. Both groups performed similarly on baseline tests for both scenarios. Compared to controls, intervention residents scored significantly higher on the examination on the management of PPH but not for PEC. All intervention group participants reported that the simulation training was "extremely useful," and most found it "enjoyable." We demonstrated the feasibility and acceptability of two low-cost obstetric emergency simulations and found that they may result in persistent increases in trainee knowledge.

Teaching hospital performance: towards a community of shared values?

PubMed

Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

External validation of the Probability of repeated admission (Pra) risk prediction tool in older community-dwelling people attending general practice: a prospective cohort study.

PubMed

Wallace, Emma; McDowell, Ronald; Bennett, Kathleen; Fahey, Tom; Smith, Susan M

2016-11-14

Emergency admission is associated with the potential for adverse events in older people and risk prediction models are available to identify those at highest risk of admission. The aim of this study was to externally validate and compare the performance of the Probability of repeated admission (Pra) risk model and a modified version (incorporating a multimorbidity measure) in predicting emergency admission in older community-dwelling people. 15 general practices (GPs) in the Republic of Ireland. n=862, ≥70 years, community-dwelling people prospectively followed up for 2 years (2010-2012). Pra risk model (original and modified) calculated for baseline year where ≥0.5 denoted high risk (patient questionnaire, GP medical record review) of future emergency admission. Emergency admission over 1 year (GP medical record review). descriptive statistics, model discrimination (c-statistic) and calibration (Hosmer-Lemeshow statistic). Of 862 patients, a total of 154 (18%) had ≥1 emergency admission(s) in the follow-up year. 63 patients (7%) were classified as high risk by the original Pra and of these 26 (41%) were admitted. The modified Pra classified 391 (45%) patients as high risk and 103 (26%) were subsequently admitted. Both models demonstrated only poor discrimination (original Pra: c-statistic 0.65 (95% CI 0.61 to 0.70); modified Pra: c-statistic 0.67 (95% CI 0.62 to 0.72)). When categorised according to risk-category model, specificity was highest for the original Pra at cut-point of ≥0.5 denoting high risk (95%), and for the modified Pra at cut-point of ≥0.7 (95%). Both models overestimated the number of admissions across all risk strata. While the original Pra model demonstrated poor discrimination, model specificity was high and a small number of patients identified as high risk. Future validation studies should examine higher cut-points denoting high risk for the modified Pra, which has practical advantages in terms of application in GP. The original Pra tool may have a role in identifying higher-risk community-dwelling older people for inclusion in future trials aiming to reduce emergency admissions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

FPGA cluster for high-performance AO real-time control system

NASA Astrophysics Data System (ADS)

Geng, Deli; Goodsell, Stephen J.; Basden, Alastair G.; Dipper, Nigel A.; Myers, Richard M.; Saunter, Chris D.

2006-06-01

Whilst the high throughput and low latency requirements for the next generation AO real-time control systems have posed a significant challenge to von Neumann architecture processor systems, the Field Programmable Gate Array (FPGA) has emerged as a long term solution with high performance on throughput and excellent predictability on latency. Moreover, FPGA devices have highly capable programmable interfacing, which lead to more highly integrated system. Nevertheless, a single FPGA is still not enough: multiple FPGA devices need to be clustered to perform the required subaperture processing and the reconstruction computation. In an AO real-time control system, the memory bandwidth is often the bottleneck of the system, simply because a vast amount of supporting data, e.g. pixel calibration maps and the reconstruction matrix, need to be accessed within a short period. The cluster, as a general computing architecture, has excellent scalability in processing throughput, memory bandwidth, memory capacity, and communication bandwidth. Problems, such as task distribution, node communication, system verification, are discussed.

A Simulation-based Approach to Measuring Team Situational Awareness in Emergency Medicine: A Multicenter, Observational Study.

PubMed

Rosenman, Elizabeth D; Dixon, Aurora J; Webb, Jessica M; Brolliar, Sarah; Golden, Simon J; Jones, Kerin A; Shah, Sachita; Grand, James A; Kozlowski, Steve W J; Chao, Georgia T; Fernandez, Rosemarie

2018-02-01

Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA, but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine (EM) teams. We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement. Interprofessional emergency medical teams, consisting of EM resident physicians, nurses, and medical students, were recruited from the University of Washington (Seattle, WA) and Wayne State University (Detroit, MI). Each team completed a simulated emergency resuscitation scenario. Immediately following the simulation, team members completed a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. Subject matter expert reviews and pilot testing of the TSA measure provided evidence of content and response process validity. Simulations were recorded and independently coded for team performance using a previously validated measure. The relationships between the TSA measure and other variables (team clinical performance, team perception of shared understanding, team leader effectiveness, and team experience) were explored. The TSA agreement metric was indexed by averaging the pairwise agreement for each dyad on a team and then averaging across dyads to yield agreement at the team level. For the team perception of shared understanding and team leadership effectiveness measures, individual team member scores were aggregated within a team to create a single team score. We computed descriptive statistics for all outcomes. We calculated Pearson's product-moment correlations to determine bivariate correlations between outcome variables with two-tailed significance testing (p < 0.05). A total of 123 participants were recruited and formed three-person teams (n = 41 teams). All teams completed the assessment scenario and postsimulation measures. TSA agreement ranged from 0.19 to 0.9 and had a mean (±SD) of 0.61 (±0.17). TSA correlated with team clinical performance (p < 0.05) but did not correlate with team perception of shared understanding, team leader effectiveness, or team experience. Team situational awareness supports adaptive teams and is critical for high reliability organizations such as healthcare systems. Simulation can provide a platform for research aimed at understanding and measuring TSA. This study provides a feasible method for simulation-based assessment of TSA in interdisciplinary teams that addresses prior measure limitations and is appropriate for use in highly dynamic, uncertain situations commonly encountered in emergency department systems. Future research is needed to understand the development of and interactions between individual-, team-, and system (distributed)-level cognitive processes. © 2017 by the Society for Academic Emergency Medicine.

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

PubMed Central

Wichaidit, Wit; Alam, Mahbub-Ul; Halder, Amal K.; Unicomb, Leanne; Hamer, Davidson H.; Ram, Pavani K.

2016-01-01

Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC. PMID:27273640

The prehospital emergency care system in Mexico City: a system's performance evaluation.

PubMed

Peralta, Luis Mauricio Pinet

2006-01-01

Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design. The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems. This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers. The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available. There is no evidence of customer satisfaction data. Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Optimization of Mud Hammer Drilling Performance--A Program to Benchmark the Viability of Advanced Mud Hammer Drilling

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

Arnis Judzis

2006-03-01

Operators continue to look for ways to improve hard rock drilling performance through emerging technologies. A consortium of Department of Energy, operator and industry participants put together an effort to test and optimize mud driven fluid hammers as one emerging technology that has shown promise to increase penetration rates in hard rock. The thrust of this program has been to test and record the performance of fluid hammers in full scale test conditions including, hard formations at simulated depth, high density/high solids drilling muds, and realistic fluid power levels. This paper details the testing and results of testing two 7more » 3/4 inch diameter mud hammers with 8 1/2 inch hammer bits. A Novatek MHN5 and an SDS Digger FH185 mud hammer were tested with several bit types, with performance being compared to a conventional (IADC Code 537) tricone bit. These tools functionally operated in all of the simulated downhole environments. The performance was in the range of the baseline ticone or better at lower borehole pressures, but at higher borehole pressures the performance was in the lower range or below that of the baseline tricone bit. A new drilling mode was observed, while operating the MHN5 mud hammer. This mode was noticed as the weight on bit (WOB) was in transition from low to high applied load. During this new ''transition drilling mode'', performance was substantially improved and in some cases outperformed the tricone bit. Improvements were noted for the SDS tool while drilling with a more aggressive bit design. Future work includes the optimization of these or the next generation tools for operating in higher density and higher borehole pressure conditions and improving bit design and technology based on the knowledge gained from this test program.« less

Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era.

PubMed

Seshadri, Niranjan; Whitlow, Patrick L; Acharya, Naveen; Houghtaling, Penny; Blackstone, Eugene H; Ellis, Stephen G

2002-10-29

Since the advent of percutaneous coronary interventions (PCIs), technological advances, adjunctive pharmacotherapy, and increasing operator experience have contributed to lowering the occurrence of major complications. However, emergency coronary artery bypass surgery (CABG) for failed PCI is still associated with important morbidity and mortality, even in the era of coronary stenting. We sought to determine the prevalence, indications, predictors, and complications of emergency CABG after PCI in the past decade. We reviewed 18 593 PCIs performed from 1992 through 2000. There was a need for emergency CABG in 113 (0.61%) cases. The major indications were extensive dissection (n=61, 54%), perforation/tamponade (n=23, 20%), and recurrent acute closure (n=23, 20%). Prevalence of emergency CABG decreased from 1.5% of PCIs in 1992 to 0.14% in 2000 (P<0.001). Independent predictors of the need for emergency CABG included the worst ACC/AHA scoring of the intervened lesion (P<0.001) and female sex (P= 0.028), whereas history of prior bypass surgery and use of stents resulted in a decreased need for emergency CABG (P<0.001 for both). In patients undergoing emergency CABG, there were 17 (15%) in-hospital deaths, 14 (12%) perioperative Q-wave myocardial infarctions, and 6 (5%) cerebrovascular accidents. The need for emergency CABG has considerably decreased over time. Risk factors include female sex and a higher ACC/AHA score of the intervened lesion. However, morbidity and mortality of emergency CABG remain high even in the new millennium.

Incidence and patterns of surgical glove perforations: experience from Addis Ababa, Ethiopia.

PubMed

Bekele, Abebe; Makonnen, Nardos; Tesfaye, Lidya; Taye, Mulat

2017-03-20

Surgical glove perforation is a common event. The operating staff is not aware of the perforation until the procedure is complete, sometimes in as high as 70% of the incidences. Data from Ethiopia indicates that the surgical workforce suffers from a very surgery related accidents, however there is paucity of data regarding surgical glove perforation. The main objective is to describe the incidence and patterns of surgical glove perforation during surgical procedures and to compare the rates between emergency and elective surgeries at one of the main hospitals in Addis Ababa Ethiopia. This is a prospective study, performed at the Minilik II referral hospital, Addis Ababa. All surgical gloves worn during all major surgical procedures (Emergency and Elective) from June 1-July 20, 2016 were collected and used for the study. Standardised visual and hydro insufflation techniques were used to test the gloves for perforations. Parameters recorded included type of procedure performed, number of perforations, localisation of perforation and the roles of the surgical team. A total of 2634 gloves were tested, 1588 from elective and 1026 from emergency procedures. The total rate of perforation in emergency procedures was 41.4%, while perforation in elective surgeries was 30.0%. A statistically significant difference (P < 0.05) was found in between emergency and elective surgeries. There were a very high rate of perforations of gloves among first surgeons 40.6% and scrub nurses 38.8% during elective procedures and among first surgeons (60.14%), and second assistants (53.0%) during emergency surgeries. Only 0.4% of inner gloves were perforated. The left hand, the left index finger and thumb were the most commonly perforated parts of the glove. Glove perforation rate was low among consultant surgeons than residents. Our reported perforation rate is higher than most publications, and this shows that the surgical workforce in Ethiopia is under a clear and present threat. Measures such as double gloving seems to have effectively prevented cutaneous blood exposure and thus should become a routine for all surgical procedures. Manufacturing related defects and faults in glove quality may also be contributing factors.

High-intensity focused ultrasound ablation assisted using color Doppler imaging for the treatment of hepatocellular carcinomas.

PubMed

Fukuda, Hiroyuki; Numata, Kazushi; Nozaki, Akito; Kondo, Masaaki; Morimoto, Manabu; Maeda, Shin; Tanaka, Katsuaki; Ohto, Masao; Ito, Ryu; Ishibashi, Yoshiharu; Oshima, Noriyoshi; Ito, Ayao; Zhu, Hui; Wang, Zhi-Biao

2013-12-01

We evaluated the usefulness of color Doppler flow imaging to compensate for the inadequate resolution of the ultrasound (US) monitoring during high-intensity focused ultrasound (HIFU) for the treatment of hepatocellular carcinoma (HCC). US-guided HIFU ablation assisted using color Doppler flow imaging was performed in 11 patients with small HCC (<3 lesions, <3 cm in diameter). The HIFU system (Chongqing Haifu Tech) was used under US guidance. Color Doppler sonographic studies were performed using an HIFU 6150S US imaging unit system and a 2.7-MHz electronic convex probe. The color Doppler images were used because of the influence of multi-reflections and the emergence of hyperecho. In 1 of the 11 patients, multi-reflections were responsible for the poor visualization of the tumor. In 10 cases, the tumor was poorly visualized because of the emergence of a hyperecho. In these cases, the ability to identify the original tumor location on the monitor by referencing the color Doppler images of the portal vein and the hepatic vein was very useful. HIFU treatments were successfully performed in all 11 patients with the assistance of color Doppler imaging. Color Doppler imaging is useful for the treatment of HCC using HIFU, compensating for the occasionally poor visualization provided by B-mode conventional US imaging.

Emergency management of acute colonic cancer obstruction.

PubMed

Gainant, A

2012-02-01

Emergency management of obstructing colonic cancer depends on both tumor location and stage, general condition of the patient and surgeon's experience. Right sided or transverse colon obstructing cancers are usually treated by right hemicolectomy-extended if necessary to the transverse colon-with primary anastomosis. For left-sided obstructing cancer, in patients with low surgical risk, primary resection and anastomosis associated with on-table irrigation or manual decompression can be performed. It prevents the confection of a loop colostomy but presents the risk of anastomotic leakage. Subtotal or total colectomy allows the surgeon to encompass distended and fecal-loaded colon, and to perform one-stage resection and anastomosis. Its disadvantage is an increased daily frequency of stools. It must be performed only in cases of diastatic colon perforation or synchronous right colonic cancer. In patients with high surgical risk, Hartmann procedure must be preferred. It allows the treatment of both obstruction and cancer, and prevents anastomotic leakage but needs a second operation to reverse the colostomy. Colonic stenting is clinically successful in up to 90% in specialized groups. It is used as palliation in patients with disseminated disease or bridge to surgery in the others. If stent insertion is not possible, loop colostomy is still indicated in patients at high surgical risk. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Impact of immigration on the cost of emergency visits in Barcelona (Spain)

PubMed Central

Cots, Francesc; Castells, Xavier; García, Oscar; Riu, Marta; Felipe, Aida; Vall, Oriol

2007-01-01

Background The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. Methods Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. Results With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. Conclusion Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity. PMID:17239236

Evaluating the cascading impacts of sea level rise and coastal flooding on emergency response spatial accessibility in Lower Manhattan, New York City

NASA Astrophysics Data System (ADS)

Yin, Jie; Yu, Dapeng; Lin, Ning; Wilby, Robert L.

2017-12-01

This paper describes a scenario-based approach for evaluating the cascading impacts of sea level rise (SLR) and coastal flooding on emergency responses. The analysis is applied to Lower Manhattan, New York City, considering FEMA's 100- and 500-year flood scenarios and New York City Panel on Climate Change (NPCC2)'s high-end SLR projections for the 2050s and 2080s, using the current situation as the baseline scenario. Service areas for different response timeframes (3-, 5- and 8-min) and various traffic conditions are simulated for three major emergency responders (i.e. New York Police Department (NYPD), Fire Department, New York (FDNY) and Emergency Medical Service (EMS)) under normal and flood scenarios. The modelling suggests that coastal flooding together with SLR could result in proportionate but non-linear impacts on emergency services at the city scale, and the performance of operational responses is largely determined by the positioning of emergency facilities and the functioning of traffic networks. Overall, emergency service accessibility to the city is primarily determined by traffic flow speed. However, the situation is expected to be further aggravated during coastal flooding, with is set to increase in frequency and magnitude due to SLR.

The organizational commitment of emergency physicians in Spanish public hospitals

PubMed

Noval de la Torre, A; Bulchand Gidumal, J; Melián González, S

2016-12-30

Background. There are not too many studies that deal with the organizational commitment of emergency physicians. This commitment has been shown to impact organizational performance. The aim of this paper is to analyse the degree of commitment of the emergency physicians in Spanish public hospitals and the factors that may influence it. Method. Online survey using SurveyMonkey to emergency physicians in Spanish public hospitals. Results. Two hundred and five questionnaires were received, 162 from physicians and 43 from heads of the emergency service. Results show an intermediate level of commitment, with affective commitment showing the lowest level and continuance commitment showing the highest level. The capabilities of the physician have an influence on their affective commitment; specific training in emergency procedures and seniority has an influence on their continuance commitment; and the opinion they hold about the organization of their service influences affective commitment. Conclusions. Emergency physicians show an average involvement in the hospital in which they work (average 3.8 on a range of 1 to 5), feel an average affection for it (3.4), and have a high intention to keep working there (4.0). The resources the hospital has due to its level do not have an influence on this commitment, while the training and perceptions of the service do have an influence.

Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

PubMed

Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

2017-09-01

Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

Recent progress in high-mobility thin-film transistors based on multilayer 2D materials

NASA Astrophysics Data System (ADS)

Hong, Young Ki; Liu, Na; Yin, Demin; Hong, Seongin; Kim, Dong Hak; Kim, Sunkook; Choi, Woong; Yoon, Youngki

2017-04-01

Two-dimensional (2D) layered semiconductors are emerging as promising candidates for next-generation thin-film electronics because of their high mobility, relatively large bandgap, low-power switching, and the availability of large-area growth methods. Thin-film transistors (TFTs) based on multilayer transition metal dichalcogenides or black phosphorus offer unique opportunities for next-generation electronic and optoelectronic devices. Here, we review recent progress in high-mobility transistors based on multilayer 2D semiconductors. We describe the theoretical background on characterizing methods of TFT performance and material properties, followed by their applications in flexible, transparent, and optoelectronic devices. Finally, we highlight some of the methods used in metal-semiconductor contacts, hybrid structures, heterostructures, and chemical doping to improve device performance.

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

PubMed

Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing patient survey data would be timely, and could improve rigour and comparability across the NHS. Performance comparisons need to be perceived as fair and scientifically robust to maintain confidence in publicly reported data, and to support their use by both the public and the NHS. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

An Unobtrusive System to Measure, Assess, and Predict Cognitive Workload in Real-World Environments

NASA Technical Reports Server (NTRS)

Bracken, Bethany K.; Palmon, Noa; Elkin-Frankston, Seth; Irvin, Scott; Jenkins, Michael; Farry, Mike

2017-01-01

Across many careers, individuals face alternating periods of high and low attention and cognitive workload, which can result in impaired cognitive functioning and can be detrimental to job performance. For example, some professions (e.g., fire fighters, emergency medical personnel, doctors and nurses working in an emergency room, pilots) require long periods of low workload (boredom), followed by sudden, high-tempo operations during which they may be required to respond to an emergency and perform at peak cognitive levels. Conversely, other professions (e.g., air traffic controllers, market investors in financial industries, analysts) require long periods of high workload and multitasking during which the addition of just one more task results in cognitive overload resulting in mistakes. An unobtrusive system to measure, assess, and predict cognitive workload could warn individuals, their teammates, or their supervisors when steps should be taken to augment cognitive readiness. In this talk I will describe an approach to this problem that we have found to be successful across work domains including: (1) a suite of unobtrusive, field-ready neurophysiological, physiological, and behavioral sensors that are chosen to best suit the target environment; (2) custom algorithms and statistical techniques to process and time-align raw data originating from the sensor suite; (3) probabilistic and statistical models designed to interpret the data into the human state of interest (e.g., cognitive workload, attention, fatigue); (4) and machine-learning techniques to predict upcoming performance based on the current pattern of events, and (5) display of each piece of information depending on the needs of the target user who may or may not want to drill down into the functioning of the system to determine how conclusions about human state and performance are determined. I will then focus in on our experimental results from our custom functional near-infrared spectroscopy sensor, designed to operate in real-world environments to be worn comfortably (e.g., positioned into a baseball cap or a surgeons cap) to measure changes in brain blood oxygenation without adding burden to the individual being assessed.

Emergency treatment of splenic injury in a novel mobile minimally invasive interventional shelter following disaster: a feasibility study

PubMed Central

2014-01-01

Background There has been an increase in natural disasters in recent years, which leads to a great number of injuries and deaths. It still remains an unsolved problem to treat patients with vascular injury of solid organs effectively following natural disasters, but on-spot emergency interventional transcatheter arterial embolization (TAE) has been highly recommended to cure serious vascular injury of solid organs nowadays. Spleen is the most vulnerable abdominal organ, severe arterial hemorrhage of which can cause death if untreated timely. In this research, we aimed to study the possibility of performing emergency surgical intervention in mobile minimally invasive interventional shelter for splenic injury in the case of natural disasters. Methods First, the mobile minimally invasive interventional shelter was unfolded in the field, and then disinfection and preoperative preparation were performed immediately. Eight large animal models of splenic injury were created, and angiograms were performed using a digital subtraction angiography machine in the mobile minimally invasive interventional shelter, and then the hemostatic embolizations of injured splenic artery were performed following the established convention of rapid intervention therapy. The operating time was recorded, and the survival condition and postoperative complications were observed for two weeks. Results and discussion The average time of unfolding the shelter, and performing disinfection and preoperative preparation was 33 ± 7 min. The number of colonies in the sterilized shelter body was 86 ± 13 cfu/m3. The average TAE time was 31 ± 7 min. All the hemostatic embolizations of splenic injury were performed successfully in the mobile minimally invasive interventional shelter during the operation. A pseudoaneurysm was found in an animal model using angiography two weeks after the operation. The primary clinical success rate of embolization was 87.5%. The two-week survival rate in all animal models of splenic injury was 100%. Conclusions Our findings in the current study demonstrate that the mobile minimally invasive interventional shelter can be adapted to the field perfectly and complete emergency surgical intervention for splenic injury efficiently and safely. Therefore, on-spot emergency interventional TAE for vascular injury of solid organs (e.g. spleen) in mobile minimally invasive interventional shelter is available and effective. PMID:25103472

Does the emergency surgery score accurately predict outcomes in emergent laparotomies?

PubMed

Peponis, Thomas; Bohnen, Jordan D; Sangji, Naveen F; Nandan, Anirudh R; Han, Kelsey; Lee, Jarone; Yeh, D Dante; de Moya, Marc A; Velmahos, George C; Chang, David C; Kaafarani, Haytham M A

2017-08-01

The emergency surgery score is a mortality-risk calculator for emergency general operation patients. We sought to examine whether the emergency surgery score predicts 30-day morbidity and mortality in a high-risk group of patients undergoing emergent laparotomy. Using the 2011-2012 American College of Surgeons National Surgical Quality Improvement Program database, we identified all patients who underwent emergent laparotomy using (1) the American College of Surgeons National Surgical Quality Improvement Program definition of "emergent," and (2) all Current Procedural Terminology codes denoting a laparotomy, excluding aortic aneurysm rupture. Multivariable logistic regression analyses were performed to measure the correlation (c-statistic) between the emergency surgery score and (1) 30-day mortality, and (2) 30-day morbidity after emergent laparotomy. As sensitivity analyses, the correlation between the emergency surgery score and 30-day mortality was also evaluated in prespecified subgroups based on Current Procedural Terminology codes. A total of 26,410 emergent laparotomy patients were included. Thirty-day mortality and morbidity were 10.2% and 43.8%, respectively. The emergency surgery score correlated well with mortality (c-statistic = 0.84); scores of 1, 11, and 22 correlated with mortalities of 0.4%, 39%, and 100%, respectively. Similarly, the emergency surgery score correlated well with morbidity (c-statistic = 0.74); scores of 0, 7, and 11 correlated with complication rates of 13%, 58%, and 79%, respectively. The morbidity rates plateaued for scores higher than 11. Sensitivity analyses demonstrated that the emergency surgery score effectively predicts mortality in patients undergoing emergent (1) splenic, (2) gastroduodenal, (3) intestinal, (4) hepatobiliary, or (5) incarcerated ventral hernia operation. The emergency surgery score accurately predicts outcomes in all types of emergent laparotomy patients and may prove valuable as a bedside decision-making tool for patient and family counseling, as well as for adequate risk-adjustment in emergent laparotomy quality benchmarking efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

Emergency right hepatectomy after laparoscopic tru-cut liver biopsy

PubMed Central

Quezada, Nicolás; León, Felipe; Martínez, Jorge; Jarufe, Nicolás; Guerra, Juan Francisco

2015-01-01

Background Liver biopsy is a common procedure usually required for final pathologic diagnosis of different liver diseases. Morbidity following tru-cut biopsy is uncommon, with bleeding complications generally self-limited. Few cases of major hemorrhage after liver biopsies have been reported, but to our knowledge, no cases of emergency hepatectomy following a tru-cut liver biopsy have been reported previously. Presentation of case We report the case of a 38 years-old woman who presented with an intrahepatic arterial bleeding after a tru-cut liver biopsy under direct laparoscopic visualization, initially controlled by ligation of the right hepatic artery and temporary liver packing. On tenth postoperative day, she developed a pseudo-aneurysm of the anterior branch of the right hepatic artery, evolving with massive bleeding that was not amenable to control by endovascular therapy. Therefore, an emergency right hepatectomy had to be performed in order to stop the bleeding. The patient achieved hemodynamic stabilization, but developed a biliary fistula from the liver surface, refractory to non-operative treatment. In consequence, a Roux-Y hepatico-jejunostomy was performed at third month, with no further complications. Discussion Bleeding following tru-cut biopsy is a rare event. To our knowledge, this is the first report of an emergency hepatectomy due to hemorrhage following liver biopsy. Risks and complications of liver biopsy are revised. Conclusion Care must be taken when performing this kind of procedures and a high level of suspicion regarding this complication should be taken in count when clinical/hemodynamic deterioration occurs after these procedures. PMID:25618399

A system for the model based emergency detection and communication for the telerehabilitation training of cardiopulmonary patients.

PubMed

Helmer, Axel; Kretschmer, Friedrich; Deparade, Riana; Song, Bianying; Meis, Markus; Hein, Andreas; Marschollek, Michael; Tegtbur, Uwe

2012-01-01

Cardiopulmonary diseases affect millions of people and cause high costs in health care systems worldwide. Patients should perform regular endurance exercises to stabilize their health state and prevent further impairment. However, patients are often uncertain about the level of intensity they should exercise in their current condition. The cost of continuous monitoring for these training sessions in clinics is high and additionally requires the patient to travel to a clinic for each single session. Performing the rehabilitation training at home can raise compliance and reduce costs. To ensure safe telerehabilitation training and to enable patients to control their performance and health state, detection of abnormal events during training is a critical prerequisite. Therefore, we created a model that predicts the heart rate of cardiopulmonary patients and that can be used to detect and avoid abnormal health states. To enable external feedback and an immediate reaction in case of a critical situation, the patient should have the possibility to configure the system to communicate warnings and emergency events to clinical and non-clinical actors. To fulfill this task, we coupled a personal health record (PHR) with a new component that extends the classic home emergency systems. The PHR is also used for a training schedule definition that makes use of the predictive HR model. We used statistical methods to evaluate the prediction model and found that our prediction error of 3.2 heart beats per minute is precise enough to enable a detection of critical states. The concept for the communication of alerts was evaluated through focus group interviews with domain experts who judged that it fulfills the needs of potential users.

Effects of pupil filter patterns in line-scan focal modulation microscopy

NASA Astrophysics Data System (ADS)

Shen, Shuhao; Pant, Shilpa; Chen, Rui; Chen, Nanguang

2018-03-01

Line-scan focal modulation microscopy (LSFMM) is an emerging imaging technique that affords high imaging speed and good optical sectioning at the same time. We present a systematic investigation into optimal design of the pupil filter for LSFMM in an attempt to achieve the best performance in terms of spatial resolutions, optical sectioning, and modulation depth. Scalar diffraction theory was used to compute light propagation and distribution in the system and theoretical predictions on system performance, which were then compared with experimental results.

An Analytical Performance Assessment of a Fuel Cell-powered, Small Electric Airplane

NASA Technical Reports Server (NTRS)

Berton, Jeffrey J.; Freeh, Joshua E.; Wickenheiser, Timothy J.

2003-01-01

Rapidly emerging fuel cell power technologies may be used to launch a new revolution of electric propulsion systems for light aircraft. Future small electric airplanes using fuel cell technologies hold the promise of high reliability, low maintenance, low noise, and with exception of water vapor zero emissions. This paper describes an analytical feasibility and performance assessment conducted by NASA's Glenn Research Center of a fuel cell-powered, propeller-driven, small electric airplane based on a model of the MCR 01 two-place kitplane.

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

Cricothyroidotomy In Situ Simulation Curriculum (CRIC Study): Training Residents for Rare Procedures.

PubMed

Petrosoniak, Andrew; Ryzynski, Agnes; Lebovic, Gerald; Woolfrey, Karen

2017-04-01

Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session. Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale. Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P < 0.0001). Both checklist and global rating scales improved significantly from the pretest to the posttest with a mean difference of 1.82 (P = 0.002) and 6.87 (P = 0.0025), respectively. Postcourse survey responses were favorable for both the overall curriculum experience and the unannounced ISS. This pilot study demonstrated that unannounced ISS is feasible and can be used to effectively measure cricothyroidotomy performance among EM residents. After a two-part training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.

[Emergency Doctor Training for Psychiatric Emergencies: Evaluation of an Interactive Training Program].

PubMed

Flüchter, Peter; Müller, Vincent; Bischof, Felix; Pajonk, Frank-Gerald Bernhard

2017-03-01

Aim Emergency physicians are often confronted with psychiatric emergencies, but are not well trained for it and often feel unable to cope sufficiently with them. The aim of this investigation was to examine whether multisensoric training may improve learning effects in the training of emergency physicians with regard to psychiatric emergencies. Method Participation in a multi-modal, multi-media training program with video case histories and subsequent evaluation by questionnaire. Results 66 emergency physicians assessed their learning effects. 75 % or 73 % rated it as "rather high" or "very high". In particular, in comparison with classical training/self-study 89 % assessed the effects in learning as "rather high" or "very high" . Conclusion This training receives a high level of acceptance. Using videos, learning content may be provided more practice-related. Thus, emergency physicians are able to develop a greater understanding of psychiatric emergencies. © Georg Thieme Verlag KG Stuttgart · New York.

Predictors of in-hospital mortality amongst octogenarians undergoing emergency general surgery: a retrospective cohort study.

PubMed

Wilson, Iain; Paul Barrett, Michael; Sinha, Ashish; Chan, Shirley

2014-11-01

Elderly patients are often judged to be fit for emergency surgery based on age alone. This study identified risk factors predictive of in-hospital mortality amongst octogenarians undergoing emergency general surgery. A retrospective review of octogenarians undergoing emergency general surgery over 3 years was performed. Parametric survival analysis using Cox multivariate regression model was used to identify risk factors predictive of in-hospital mortality. Hazard ratios (HR) and corresponding 95% confidence interval were calculated. Seventy-three patients with a median age of 84 years were identified. Twenty-eight (38%) patients died post-operatively. Multivariate analysis identified ASA grade (ASA 5 HR 23.4 95% CI 2.38-230, p = 0.007) and chronic obstructive pulmonary disease (COPD) (HR 3.35 95% CI 1.15-9.69, p = 0.026) to be the only significant predictors of in-hospital mortality. Identification of high risk surgical patients should be based on physiological fitness for surgery rather than chronological age. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Emergency percutaneous treatment in surgical bile duct injury.

PubMed

Carrafiello, Gianpaolo; Laganà, Domenico; Dizonno, Massimiliano; Ianniello, Andrea; Cotta, Elisa; Dionigi, Gianlorenzo; Dionigi, Renzo; Fugazzola, Carlo

2008-09-01

The aim of this study is to evaluate the efficacy of emergency percutaneous treatment in patients with surgical bile duct injury (SBDI). From May 2004 to May 2007, 11 patients (five men, six women; age range 26-80 years; mean age 58 years) with a critical clinical picture (severe jaundice, bile peritonitis, septic state) due to SBDI secondary to surgical or laparoscopic procedures were treated by percutaneous procedures. We performed four ultrasound-guided percutaneous drainages, four external-internal biliary drainages, one bilioplasty, and two plastic biliary stenting after 2 weeks of external-internal biliary drainage placement. All procedures had 100% technical success with no complications. The clinical emergencies resolved in 3-4 days in 100% of cases. All patients had a benign clinical course, and reoperation was avoided in 100% of cases. Interventional radiological procedures are effective in the emergency management of SBDI since they are minimally invasive and have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options.

Thermal and Power Challenges in High Performance Computing Systems

NASA Astrophysics Data System (ADS)

Natarajan, Venkat; Deshpande, Anand; Solanki, Sudarshan; Chandrasekhar, Arun

2009-05-01

This paper provides an overview of the thermal and power challenges in emerging high performance computing platforms. The advent of new sophisticated applications in highly diverse areas such as health, education, finance, entertainment, etc. is driving the platform and device requirements for future systems. The key ingredients of future platforms are vertically integrated (3D) die-stacked devices which provide the required performance characteristics with the associated form factor advantages. Two of the major challenges to the design of through silicon via (TSV) based 3D stacked technologies are (i) effective thermal management and (ii) efficient power delivery mechanisms. Some of the key challenges that are articulated in this paper include hot-spot superposition and intensification in a 3D stack, design/optimization of thermal through silicon vias (TTSVs), non-uniform power loading of multi-die stacks, efficient on-chip power delivery, minimization of electrical hotspots etc.

Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios.

PubMed

Nicksa, Grace A; Anderson, Cristan; Fidler, Richard; Stewart, Lygia

2015-03-01

The Accreditation Council for Graduate Medical Education core competencies stress nontechnical skills that can be difficult to evaluate and teach to surgical residents. During emergencies, surgeons work in interprofessional teams and are required to perform certain procedures. To obtain proficiency in these skills, residents must be trained. To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of interprofessional simulations. SimMan 3GS was used to simulate high-risk clinical scenarios (15-20 minutes), followed by debriefings with real-time feedback (30 minutes). A modified Oxford Non-Technical Skills scale (score range, 1-4) was used to assess surgical resident performance during the first half of the academic year (July-December 2012) and the second half of the academic year (January-June 2013). Anonymous online surveys were used to solicit participant feedback. Simulations were conducted in the operating room, intensive care unit, emergency department, ward, and simulation center. A total of 43 surgical residents (postgraduate years [PGYs] 1 and 2) participated in interdisciplinary clinical scenarios, with other health care professionals (nursing, anesthesia, critical care, medicine, respiratory therapy, and pharmacy; mean number of nonsurgical participants/session: 4, range 0-9). Thirty seven surgical residents responded to the survey. Simulation of high-risk clinical scenarios: postoperative pulmonary embolus, pneumothorax, myocardial infarction, gastrointestinal bleeding, anaphylaxis with a difficult airway, and pulseless electrical activity arrest. Evaluation of resident skills: communication, leadership, teamwork, problem solving, situation awareness, and confidence in performing emergency procedures (eg, cricothyroidotomy). A total of 31 of 35 (89%) of the residents responding found the sessions useful. Additionally, 28 of 33 (85%) reported improved confidence doing procedures and 29 of 37 (78%) reported knowing when the procedure should be applied. Oxford Non-Technical Skills evaluation demonstrated significant improvement in PGY 2 resident performance assessed during the 2 study periods: communication score increased from 3 to 3.71 (P=.01), leadership score increased from 2.77 to 3.86 (P<.001), teamwork score increased from 3.15 to 3.86 (P=.007), and procedural ability score increased from 2.23 to 3.43 (P=.03). There were no statistically significant improved scores in PGY 2 decision making or situation awareness. No improvements in skills were seen among PGY 1 participants. The PGY 2 residents improved their skills, but the PGY 1 residents did not. Participants found interprofessional simulations to be realistic and a valuable educational tool. Interprofessional simulation provides a valuable means of educating surgical residents and evaluating their skills in real-life clinical scenarios.

Group selection on population size affects life-history patterns in the entomopathogenic nematode Steinernema carpocapsae.

PubMed

Bashey, Farrah; Lively, Curtis M

2009-05-01

Selection is recognized to operate on multiple levels. In disease organisms, selection among hosts is thought to provide an important counterbalance to selection for faster growth within hosts. We performed three experiments, each selecting for a divergence in group size in the entomopathogenic nematode, Steinernema carpocapsae. These nematodes infect and kill insect larvae, reproduce inside the host carcass, and emerge as infective juveniles. We imposed selection on group size by selecting among hosts for either high or low numbers of emerging nematodes. Our goal was to determine whether this trait could respond to selection at the group level, and if so, to examine what other traits would evolve as correlated responses. One of the three experiments showed a significant response to group selection. In that experiment, the high-selected treatment consistently produced more emerging nematodes per host than the low-selected treatment. In addition, nematodes were larger and they emerged later from hosts in the low-selected lines. Despite small effective population sizes, the effects of inbreeding were small in this experiment. Thus, selection among hosts can be effective, leading to both a direct evolutionary response at the population level, as well as to correlated responses in populational and individual traits.

Concentration transport calculations by an original C++ program with interediate fidelity physics through user-defined buildings with an emphasis on release scenarios in radiological facilities

NASA Astrophysics Data System (ADS)

Sayre, George Anthony

The purpose of this dissertation was to develop the C ++ program Emergency Dose to calculate transport of radionuclides through indoor spaces using intermediate fidelity physics that provides improved spatial heterogeneity over well-mixed models such as MELCORRTM and much lower computation times than CFD codes such as FLUENTRTM . Modified potential flow theory, which is an original formulation of potential flow theory with additions of turbulent jet and natural convection approximations, calculates spatially heterogeneous velocity fields that well-mixed models cannot predict. Other original contributions of MPFT are: (1) generation of high fidelity boundary conditions relative to well-mixed-CFD coupling methods (conflation), (2) broadening of potential flow applications to arbitrary indoor spaces previously restricted to specific applications such as exhaust hood studies, and (3) great reduction of computation time relative to CFD codes without total loss of heterogeneity. Additionally, the Lagrangian transport module, which is discussed in Sections 1.3 and 2.4, showcases an ensemble-based formulation thought to be original to interior studies. Velocity and concentration transport benchmarks against analogous formulations in COMSOLRTM produced favorable results with discrepancies resulting from the tetrahedral meshing used in COMSOLRTM outperforming the Cartesian method used by Emergency Dose. A performance comparison of the concentration transport modules against MELCORRTM showed that Emergency Dose held advantages over the well-mixed model especially in scenarios with many interior partitions and varied source positions. A performance comparison of velocity module against FLUENTRTM showed that viscous drag provided the largest error between Emergency Dose and CFD velocity calculations, but that Emergency Dose's turbulent jets well approximated the corresponding CFD jets. Overall, Emergency Dose was found to provide a viable intermediate solution method for concentration transport with relatively low computation times.

The determination of nutritional requirements for Safe Haven Food Supply System (emergency/survival foods)

NASA Technical Reports Server (NTRS)

Ahmed, Selina

1987-01-01

The Space Station Safe Haven Food System must sustain 8 crew members under emergency conditions for 45 days. Emergency Survival Foods are defined as a nutritionally balanced collection of high density food and beverages selected to provide for the survival of Space Station flight crews in contingency situations. Since storage volume is limited, the foods should be highly concentrated. A careful study of different research findings regarding starvation and calorie restricted diets indicates that a minimum nutritional need close to RDA is an important factor for sustaining an individual's life in a stressful environment. Fat, protein, and carbohydrates are 3 energy producing nutrients which play a vital role in the growth and maintenance process of human life. A lower intake of protein can minimize the water intake, but it causes a negative nitrogen balance and a lower performance level. Other macro and micro nutrients are also required for nutritional interrelationships to metabolize the other 3 nutrients to their optimum level. The various options for longer duration than 45 days are under investigation.

Studies on Manfred Eigen's model for the self-organization of information processing.

PubMed

Ebeling, W; Feistel, R

2018-05-01

In 1971, Manfred Eigen extended the principles of Darwinian evolution to chemical processes, from catalytic networks to the emergence of information processing at the molecular level, leading to the emergence of life. In this paper, we investigate some very general characteristics of this scenario, such as the valuation process of phenotypic traits in a high-dimensional fitness landscape, the effect of spatial compartmentation on the valuation, and the self-organized transition from structural to symbolic genetic information of replicating chain molecules. In the first part, we perform an analysis of typical dynamical properties of continuous dynamical models of evolutionary processes. In particular, we study the mapping of genotype to continuous phenotype spaces following the ideas of Wright and Conrad. We investigate typical features of a Schrödinger-like dynamics, the consequences of the high dimensionality, the leading role of saddle points, and Conrad's extra-dimensional bypass. In the last part, we discuss in brief the valuation of compartment models and the self-organized emergence of molecular symbols at the beginning of life.

SEURAT: SPH scheme extended with ultraviolet line radiative transfer

NASA Astrophysics Data System (ADS)

Abe, Makito; Suzuki, Hiroyuki; Hasegawa, Kenji; Semelin, Benoit; Yajima, Hidenobu; Umemura, Masayuki

2018-05-01

We present a novel Lyman alpha (Ly α) radiative transfer code, SEURAT (SPH scheme Extended with Ultraviolet line RAdiative Transfer), where line scatterings are solved adaptively with the resolution of the smoothed particle hydrodynamics (SPH). The radiative transfer method implemented in SEURAT is based on a Monte Carlo algorithm in which the scattering and absorption by dust are also incorporated. We perform standard test calculations to verify the validity of the code; (i) emergent spectra from a static uniform sphere, (ii) emergent spectra from an expanding uniform sphere, and (iii) escape fraction from a dusty slab. Thereby, we demonstrate that our code solves the {Ly} α radiative transfer with sufficient accuracy. We emphasize that SEURAT can treat the transfer of {Ly} α photons even in highly complex systems that have significantly inhomogeneous density fields. The high adaptivity of SEURAT is desirable to solve the propagation of {Ly} α photons in the interstellar medium of young star-forming galaxies like {Ly} α emitters (LAEs). Thus, SEURAT provides a powerful tool to model the emergent spectra of {Ly} α emission, which can be compared to the observations of LAEs.

A Low-Temperature, Solution-Processable, Cu-Doped Nickel Oxide Hole-Transporting Layer via the Combustion Method for High-Performance Thin-Film Perovskite Solar Cells

DOE PAGES

Jung, Jae Woong; Chueh, Chu-Chen; Jen, Alex K. -Y.

2015-10-20

The promising photophysical properties of the emerging organometallic halide perovskites, such as intense broadband absorption, high charge carrier mobility, and long charge diffusion length, have enabled the rapid development in solar cells reaching over 20% power conversion effi ciency (PCE) recently. Especially, the low material cost and facile solution processability of perovskites are very attractive as next-generation photovoltaic materials for sustainable energy.

"Doing Difference" and Fast Food Consumption: Patterns Among a Sample of White and African American Emerging Adults.

PubMed

Wade, Jeannette M

2018-04-01

Previous research has demonstrated that frequent consumption of fast food is linked to obesity and that trends in both are disparate across race and sex categories. Contextualizing race- and sex-related factors that structure fast food consumption in emerging adulthood is a much-needed contribution to social research. Specifically, this study uses the "doing difference" framework, to examine the frequency of fast food consumption in a sample of White and African American (18-25 years old). According to the framework, social inequalities are reproduced through dramaturgical performances of race, class, and gender. Results of this suggest that feminine gender orientation and education serve as protective factors, while African American race and male sex serve as risk factors. African American women emerged as especially high risk given their higher prevalence of traditionally masculine traits.

Scalable and Power Efficient Data Analytics for Hybrid Exascale Systems

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

Choudhary, Alok; Samatova, Nagiza; Wu, Kesheng

This project developed a generic and optimized set of core data analytics functions. These functions organically consolidate a broad constellation of high performance analytical pipelines. As the architectures of emerging HPC systems become inherently heterogeneous, there is a need to design algorithms for data analysis kernels accelerated on hybrid multi-node, multi-core HPC architectures comprised of a mix of CPUs, GPUs, and SSDs. Furthermore, the power-aware trend drives the advances in our performance-energy tradeoff analysis framework which enables our data analysis kernels algorithms and software to be parameterized so that users can choose the right power-performance optimizations.

Some factors affecting the use of lighter than air systems. [economic and performance estimates for dirigibles and semi-buoyant hybrid vehicles

NASA Technical Reports Server (NTRS)

Havill, C. D.

1974-01-01

The uses of lighter-than-air vehicles are examined in the present day transportation environment. Conventional dirigibles were found to indicate an undesirable economic risk due to their low speeds and to uncertainties concerning their operational use. Semi-buoyant hybrid vehicles are suggested as an alternative which does not have many of the inferior characteristics of conventional dirigibles. Economic and performance estimates for hybrid vehicles indicate that they are competitive with other transportation systems in many applications, and unique in their ability to perform some highly desirable emergency missions.

Sports teams as superorganisms: implications of sociobiological models of behaviour for research and practice in team sports performance analysis.

PubMed

Duarte, Ricardo; Araújo, Duarte; Correia, Vanda; Davids, Keith

2012-08-01

Significant criticisms have emerged on the way that collective behaviours in team sports have been traditionally evaluated. A major recommendation has been for future research and practice to focus on the interpersonal relationships developed between team players during performance. Most research has typically investigated team game performance in subunits (attack or defence), rather than considering the interactions of performers within the whole team. In this paper, we offer the view that team performance analysis could benefit from the adoption of biological models used to explain how repeated interactions between grouping individuals scale to emergent social collective behaviours. We highlight the advantages of conceptualizing sports teams as functional integrated 'super-organisms' and discuss innovative measurement tools, which might be used to capture the superorganismic properties of sports teams. These tools are suitable for revealing the idiosyncratic collective behaviours underlying the cooperative and competitive tendencies of different sports teams, particularly their coordination of labour and the most frequent channels of communication and patterns of interaction between team players. The principles and tools presented here can serve as the basis for novel approaches and applications of performance analysis devoted to understanding sports teams as cohesive, functioning, high-order organisms exhibiting their own peculiar behavioural patterns.

Profiles of More and Less Successful L2 Learners: A Cluster Analysis Study

ERIC Educational Resources Information Center

Sparks, Richard L.; Patton, Jon; Ganschow, Leonore

2012-01-01

This retrospective study examined L1 achievement, intelligence, L2 aptitude, and L2 proficiency profiles of 208 students completing two years of high school L2 courses. A cluster analysis was performed to determine whether distinct cognitive and achievement profiles of more and less successful L2 learners would emerge. The results of…

Emotional Intelligence and Perceived Social Support among Italian High School Students

ERIC Educational Resources Information Center

Di Fabio, Annamaria; Kenny, Maureen E.

2012-01-01

Emotional intelligence (EI) has emerged in recent research as a teachable skill that is distinct from personality and is relevant to scholastic and work success and progress in career development. This study adds to that research by examining the relationship of performance and self-report measures of EI and personality traits with perceived…

Challenges and Strategies for E-Learning Development in the Payame Noor University of Iran

ERIC Educational Resources Information Center

Mohamadzadeh, Mahnaz; Farzaneh, Jabraeal; Mousavi, Mina; Ma'ghabl, Rouhallah; Moenikia, Mahdi

2012-01-01

Higher education in Iran is confronting with several challenges; some of them are increasing demand for education and insufficiency of current programs to meet the growing needs, emerging information age and the necessity of achieving information literacy, and extending educational justice. It is assumed that a high performance e-learning system…

Capacity Building: Reshaping Urban Community College Resources in Response to Emerging Challenges

ERIC Educational Resources Information Center

Lassiter, Wright L., Jr.

2013-01-01

Urban community colleges face a myriad of convergent challenges, including the loss of state funding and local property tax support, increased demands for better performance and greater accountability, and record-high enrollment by the most underprepared students in higher education. Sometimes to make sense of it all, it helps to think of an onion.

Cutaneous Recording and Stimulation of Muscles Using Organic Electronic Textiles.

PubMed

Papaiordanidou, Maria; Takamatsu, Seiichi; Rezaei-Mazinani, Shahab; Lonjaret, Thomas; Martin, Alain; Ismailova, Esma

2016-08-01

Electronic textiles are an emerging field providing novel and non-intrusive solutions for healthcare. Conducting polymer-coated textiles enable a new generation of fully organic surface electrodes for electrophysiological evaluations. Textile electrodes are able to assess high quality muscular monitoring and to perform transcutaneous electrical stimulation. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Asymmetric impacts of global risk appetite on the risk premium for an emerging market

NASA Astrophysics Data System (ADS)

Kanlı, İbrahim Burak

2008-05-01

This paper analyzes the impact of global risk appetite on the risk premium utilizing high-frequency data. Taking the Turkish economy as our laboratory, we find that the risk premium volatility responds only to a worsening in the risk appetite for the Turkish economy, which is a result that we do not observe for the other emerging markets. Then, we investigate the role of current account dynamics on this asymmetric effect, by focusing also on an economy with similar current account performance. The empirical results find supporting evidence for the role of current account dynamics on the estimated asymmetry.

Predictive features associated with thyrotoxic storm and management.

PubMed

Bacuzzi, Alessandro; Dionigi, Gianlorenzo; Guzzetti, Luca; De Martino, Alessandro Ivan; Severgnini, Paolo; Cuffari, Salvatore

2017-10-01

Thyroid storm (TS) is an endocrine emergency characterized by rapid deterioration, associated with high mortality rate therefore rapid diagnosis and emergent treatment is mandatory. In the past, thyroid surgery was the most common cause of TS, but recent preoperative medication creates a euthyroid state before performing surgery. An active approach during perioperative period could determine an effective clinical treatment of this life-threating diseases. Recently, the Japan Thyroid Association and Japan Endocrine Society developed diagnostic criteria for TS focusing on premature and prompt diagnosis avoiding inopportune e useless drugs. This review analyses predictive features associated with thyrotoxic storm highlighting recent literature to optimize the patient quality of care.

Charge order-superfluidity transition in a two-dimensional system of hard-core bosons and emerging domain structures

NASA Astrophysics Data System (ADS)

Moskvin, A. S.; Panov, Yu. D.; Rybakov, F. N.; Borisov, A. B.

2017-11-01

We have used high-performance parallel computations by NVIDIA graphics cards applying the method of nonlinear conjugate gradients and Monte Carlo method to observe directly the developing ground state configuration of a two-dimensional hard-core boson system with decrease in temperature, and its evolution with deviation from a half-filling. This has allowed us to explore unconventional features of a charge order—superfluidity phase transition, specifically, formation of an irregular domain structure, emergence of a filamentary superfluid structure that condenses within of the charge-ordered phase domain antiphase boundaries, and formation and evolution of various topological structures.

Emerging therapeutics for the treatment of diabetic nephropathy.

PubMed

Brenneman, Jehrod; Hill, Jon; Pullen, Steve

2016-09-15

Diabetic nephropathy (DN) is the most common pathology contributing to the development of chronic kidney disease (CKD). DN caused by hypertension and unmitigated inflammation in diabetics, renders the kidneys unable to perform normally, and leads to renal fibrosis and organ failure. The increasing global prevalence of DN has been directly attributed to rising incidences of Type II diabetes, and is now the largest non-communicable cause of death worldwide. Despite the high morbidity, successful new treatments for DN are lacking. This review seeks to provide new insight on emerging clinical candidates under investigation for the treatment of DN. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluating input device usability as a function of task difficulty in a tracking task.

PubMed

Rupp, Michael A; Oppold, Paul; McConnell, Daniel S

2015-01-01

Game controllers are emerging as a preferred choice for the manual control of unmanned vehicles, but an understanding of their usability characteristics has yet to emerge. We compared the usability of an Xbox 360 game controller in a dual task situation using MATB II to the traditional joystick and keyboard interface in two experiments. In the first experiment, performance with the game controller was associated with fewer tracking errors. In a second experiment, we trained users on the devices, and found that even after training the game controller was still associated with fewer tracking errors as well as higher usability and lower workload ratings. These results are consistent with the idea that game controllers are highly usable input devices and do not require high mental workload to operate, thus making them suitable for complex control tasks.

NASA's 2004 Hall Thruster Program

NASA Technical Reports Server (NTRS)

Jacobson, David T.; Manzella, David H.; Hofer, Richard R.; Peterson, Peter Y.

2004-01-01

An overview of NASA's Hall thruster research and development tasks conducted during fiscal year 2004 is presented. These tasks focus on: raising the technology readiness level of high power Hall thrusters, developing a moderate-power/ moderate specific impulse Hall thruster, demonstrating high-power/high specific impulse Hall thruster operation, and addressing the fundamental technical challenges of emerging Hall thruster concepts. Programmatic background information, technical accomplishments and out year plans for each program element performed under the sponsorship of the In-Space Transportation Program, Project Prometheus, and the Energetics Project are provided.

Investigating the structure preserving encryption of high efficiency video coding (HEVC)

NASA Astrophysics Data System (ADS)

Shahid, Zafar; Puech, William

2013-02-01

This paper presents a novel method for the real-time protection of new emerging High Efficiency Video Coding (HEVC) standard. Structure preserving selective encryption is being performed in CABAC entropy coding module of HEVC, which is significantly different from CABAC entropy coding of H.264/AVC. In CABAC of HEVC, exponential Golomb coding is replaced by truncated Rice (TR) up to a specific value for binarization of transform coefficients. Selective encryption is performed using AES cipher in cipher feedback mode on a plaintext of binstrings in a context aware manner. The encrypted bitstream has exactly the same bit-rate and is format complaint. Experimental evaluation and security analysis of the proposed algorithm is performed on several benchmark video sequences containing different combinations of motion, texture and objects.

Endogenous Groups and Dynamic Selection in Mechanism Design*

PubMed Central

Madeira, Gabriel A.; Townsend, Robert M.

2010-01-01

We create a dynamic theory of endogenous risk sharing groups, with good internal information, and their coexistence with relative performance, individualistic regimes, which are informationally more opaque. Inequality and organizational form are determined simultaneously. Numerical techniques and succinct re-formulations of mechanism design problems with suitable choice of promised utilities allow the computation of a stochastic steady state and its transitions. Regions of low inequality and moderate to high wealth (utility promises) produce the relative performance regime, while regions of high inequality and low wealth produce the risk sharing group regime. If there is a cost to prevent coalitions, risk sharing groups emerge at high wealth levels also. Transitions from the relative performance regime to the group regime tend to occur when rewards to observed outputs exacerbate inequality, while transitions from the group regime to the relative performance regime tend to come with a decrease in utility promises. Some regions of inequality and wealth deliver long term persistence of organization form and inequality, while other regions deliver high levels of volatility. JEL Classification Numbers: D23,D71,D85,O17. PMID:20107614

Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

DOT National Transportation Integrated Search

2018-01-11

Background: Performance measures are a key component of implementation, dissemination, and evaluation of evidence-based guidelines (EBGs). We developed performance measures for Emergency Medical Services (EMS) stakeholders to enable the implementatio...

Crack-free CH3NH3PbI3 layer via continuous dripping method for high-performance mesoporous perovskite solar cells

NASA Astrophysics Data System (ADS)

Chen, Guo; Zheng, Jianghui; Zheng, LingLing; Yan, Xin; Lin, Huangding; Zhang, Fengyan

2017-01-01

The past five years have witnessed the uniquely rapid emergence of the mixed organic-inorganic halide perovskite solar cells. Here, a modified deposition process, continuous dripping method, is reported for fabricating high-performance and reproducible perovskite solar cells. We have systematically investigated the impact of different molar ratio of lead iodide (PbI2) to dimethylsulfoxide (DMSO) on the growth, morphology and crystallinity of CH3NH3PbI3 (MAPbI3) films obtained via this process. The high power conversion efficiency (PCE) perovskite solar cell originates in crack-free and highly crystallographic perovskite films prepared with optimized ratio of PbI2 to DMSO in first precursor solution. The best PCE of 17.76% and an average PCE of 16.37 ± 0.51% were obtained via this process. Moreover, the conventional solution two steps method was also carried out as a comparison to this process. This work provides a new simple solution approach to obtain high quality of perovskite thin films for high-performance and reproducible PSCs.

Current outcomes of emergency large bowel surgery.

PubMed

Ng, H J; Yule, M; Twoon, M; Binnie, N R; Aly, E H

2015-03-01

Emergency large bowel surgery (ELBS) is known to carry an increased risk of morbidity and mortality. Previous studies have reported morbidity and mortality rates up to 14.3%. However, there has not been a recent study to document the outcomes of ELBS following several major changes in surgical training and provision of emergency surgery. The aim of this study was therefore to explore the current outcomes of ELBS. A retrospective review was performed of a prospectively maintained database of the clinical records of all patients who had ELBS between 2006 and 2013. Data pertaining to patient demographics, ASA (American Society of Anesthesiologists) grade, diagnosis, surgical procedure performed, grade of operating surgeon and assistant, length of hospital stay, postoperative complications and in-hospital mortality were analysed. A total of 202 patients underwent ELBS during the study period. The mean patient age was 62 years and the most common cause was colonic carcinoma (n=67, 33%). There were 32 patients (15.8%) who presented with obstruction and 64 (31.7%) had bowel perforation. The overall in-hospital mortality rate was 14.8% (n=30). A consultant surgeon was involved in 187 cases (92.6%) as either first operator, assistant or available in theatre. ELBS continues to carry a high risk despite several major changes in the provision of emergency surgery. Further developments are needed to improve postoperative outcomes in these patients.

Thinking strategies used by Registered Nurses during emergency department triage.

PubMed

Göransson, Katarina E; Ehnfors, Margareta; Fonteyn, Marsha E; Ehrenberg, Anna

2008-01-01

This paper is a report of a study to describe and compare thinking strategies and cognitive processing in the emergency department triage process by Registered Nurses with high and low triage accuracy. Sound clinical reasoning and accurate decision-making are integral parts of modern nursing practice and are of vital importance during triage in emergency departments. Although studies have shown that individual and contextual factors influence the decisions of Registered Nurses in the triage process, others have failed to explain the relationship between triage accuracy and clinical experience. Furthermore, no study has shown the relationship between Registered Nurses' thinking strategies and their triage accuracy. Using the 'think aloud' method, data were collected in 2004-2005 from 16 RNs working in Swedish emergency departments who had previously participated in a study examining triage accuracy. Content analysis of the data was performed. The Registered Nurses used a variety of thinking strategies, ranging from searching for information, generating hypotheses to stating propositions. They structured the triage process in several ways, beginning by gathering data, generating hypotheses or allocating acuity ratings. Comparison of participants' use of thinking strategies and the structure of the triage process based on their previous triage accuracy revealed only slight differences. The wide range of thinking strategies used by Registered Nurses when performing triage indicates that triage decision-making is complex. Further research is needed to ascertain which skills are most important in triage decision-making.

Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—quantitative findings

PubMed Central

Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl

2007-01-01

Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12 month (2005–6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p⩽0.001) and teamwork (p⩽0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere. PMID:17711938

Current Outcomes of Emergency Large Bowel Surgery

PubMed Central

Ng, HJ; Yule, M; Twoon, M; Binnie, NR

2015-01-01

Introduction Emergency large bowel surgery (ELBS) is known to carry an increased risk of morbidity and mortality. Previous studies have reported morbidity and mortality rates up to 14.3%. However, there has not been a recent study to document the outcomes of ELBS following several major changes in surgical training and provision of emergency surgery. The aim of this study was therefore to explore the current outcomes of ELBS. Methods A retrospective review was performed of a prospectively maintained database of the clinical records of all patients who had ELBS between 2006 and 2013. Data pertaining to patient demographics, ASA (American Society of Anesthesiologists) grade, diagnosis, surgical procedure performed, grade of operating surgeon and assistant, length of hospital stay, postoperative complications and in-hospital mortality were analysed. Results A total of 202 patients underwent ELBS during the study period. The mean patient age was 62 years and the most common cause was colonic carcinoma (n=67, 33%). There were 32 patients (15.8%) who presented with obstruction and 64 (31.7%) had bowel perforation. The overall in-hospital mortality rate was 14.8% (n=30). A consultant surgeon was involved in 187 cases (92.6%) as either first operator, assistant or available in theatre. Conclusions ELBS continues to carry a high risk despite several major changes in the provision of emergency surgery. Further developments are needed to improve postoperative outcomes in these patients. PMID:25723694

Studies for a 10 μs, thin, high resolution CMOS pixel sensor for future vertex detectors

NASA Astrophysics Data System (ADS)

Voutsinas, G.; Amar-Youcef, S.; Baudot, J.; Bertolone, G.; Brogna, A.; Chon-Sen, N.; Claus, G.; Colledani, C.; Dorokhov, A.; Dozière, G.; Dulinski, W.; Degerli, Y.; De Masi, R.; Deveaux, M.; Gelin, M.; Goffe, M.; Hu-Guo, Ch.; Himmi, A.; Jaaskelainen, K.; Koziel, M.; Morel, F.; Müntz, C.; Orsini, F.; Santos, C.; Schrader, C.; Specht, M.; Stroth, J.; Valin, I.; Wagner, F. M.; Winter, M.

2011-06-01

Future high energy physics (HEP) experiments require detectors with unprecedented performances for track and vertex reconstruction. These requirements call for high precision sensors, with low material budget and short integration time. The development of CMOS sensors for HEP applications was initiated at IPHC Strasbourg more than 10 years ago, motivated by the needs for vertex detectors at the International Linear Collider (ILC) [R. Turchetta et al, NIM A 458 (2001) 677]. Since then several other applications emerged. The first real scale digital CMOS sensor MIMOSA26 equips Flavour Tracker at RHIC, as well as for the microvertex detector of the CBM experiment at FAIR. MIMOSA sensors may also offer attractive performances for the ALICE upgrade at LHC. This paper will demonstrate the substantial performance improvement of CMOS sensors based on a high resistivity epitaxial layer. First studies for integrating the sensors into a detector system will be addressed and finally the way to go to a 10 μs readout sensor will be discussed.

Network issues for large mass storage requirements

NASA Technical Reports Server (NTRS)

Perdue, James

1992-01-01

File Servers and Supercomputing environments need high performance networks to balance the I/O requirements seen in today's demanding computing scenarios. UltraNet is one solution which permits both high aggregate transfer rates and high task-to-task transfer rates as demonstrated in actual tests. UltraNet provides this capability as both a Server-to-Server and Server-to-Client access network giving the supercomputing center the following advantages highest performance Transport Level connections (to 40 MBytes/sec effective rates); matches the throughput of the emerging high performance disk technologies, such as RAID, parallel head transfer devices and software striping; supports standard network and file system applications using SOCKET's based application program interface such as FTP, rcp, rdump, etc.; supports access to the Network File System (NFS) and LARGE aggregate bandwidth for large NFS usage; provides access to a distributed, hierarchical data server capability using DISCOS UniTree product; supports file server solutions available from multiple vendors, including Cray, Convex, Alliant, FPS, IBM, and others.

Development of Technologies on Innovative-Simplified Nuclear Power Plant using High-Efficiency Steam Injectors

NASA Astrophysics Data System (ADS)

Ohmori, Shuichi; Narabayashi, Tadashi; Mori, Michitsugu; Iwaki, Chikako; Asanuma, Yutaka; Goto, Shoji

A Steam Injector (SI) is a simple, compact and passive pump and also acts as a high-performance direct-contact heater. This provides SI with capability to serve also as a direct-contact feed-water heater that heats up feed-water by using extracted steam from turbine. Our technology development aims to significantly simplify equipment and reduce physical quantities by applying "High-Efficiency SI", which are applicable to a wide range of operation regimes beyond the performance and applicable range of existing SIs and enables unprecedented multistage and parallel operation, to the low-pressure feed-water heaters and Emergency Core Cooling System of nuclear power plants, as well as achieve high inherent safety to prevent severe accidents by keeping the core covered with water (a Severe Accident-Free Concept). This paper describes the results of the endurance and performance tests of low-pressure SIs for feed-water heaters with Jet-deaerator and core injection system.

Using screen-based simulation to improve performance during pediatric resuscitation.

PubMed

Biese, Kevin J; Moro-Sutherland, Donna; Furberg, Robert D; Downing, Brian; Glickman, Larry; Murphy, Alison; Jackson, Cheryl L; Snyder, Graham; Hobgood, Cherri

2009-12-01

To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills. A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples. Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group. (c) 2009 by the Society for Academic Emergency Medicine.

[Wells clinical prediction criteria in patients suspected of having deep vein thrombosis: evaluation of components and use in the emergency department].

PubMed

García-Castrillo Riesgo, Luis; Jiménez Hernández, Sònia; Piñera Salmerón, Pascual

2015-01-01

To determine the applicability of the Wells clinical prediction criteria for deep vein thrombosis (DVT) in patients in hospital emergency departments and to evaluate the relevance of the score's components. Prospective multicenter cohort study in consecutive hospital emergency department patients suspected of having DVT. Full-leg Doppler compression ultrasound imaging was performed on all patients. We recorded information on variables related to risk for DVT and the components of clinical prediction scales. Wells and Oudega clinical prediction scores were calculated. We studied 362 patients in 23 hospital emergency departments; the mean (SD) age was 65 (18) years and 52.8% were women. DVT was diagnosed in 254 patients (70.16%); 171 (47.2%) had proximal DVT. The clinical probability of DVT according to the Wells scale and the prevalence of proximal DVT were as follows: low probability, 57 patients (14 with DVT, 24.6%); intermediate probability, 124 (43 with DVT, 34.7%), and high probability, 181 (114 with DVT, 63%). Only 5 of the components of the Wells scale were associated with the presence of proximal DVT. The prevalence of DVT is very high in the 3 categories of clinical probability indicated by the Wells score. The prevalences do not correspond to those of the cohort used to validate the scale. It appears to be necessary to develop scales adjusted for use in hospital emergency departments when DVT is suspected.

Ambient Noise in Emergency Rooms and Its Health Hazards

PubMed Central

Filus, Walderes; Lacerda, Adriana Bender Moreira de; Albizu, Evelyn

2014-01-01

Introduction The occupational risk due to high levels of noise in the hospital environment has been recognized, and the National Agency of Sanitary Surveillance of the Ministry of Health recommends evaluation and control of noise in hospital areas. Objectives To assess the sound environment in the emergency ward of a general trauma reference hospital in the city of Curitiba, Parana State, Brazil. Methods In this descriptive study, noise levels were assessed on mornings, afternoons, and evenings using an integrating Bruel & Kjaer (Denmark) calibrated sound level meter, type 2230. Ten indoor points in the emergency ward were assessed; the helicopter as well as several available pieces of equipment in the ward were assessed individually. Results Noise levels in sound pressure level ambiance [dBA] ranged from 56.6 to 68.8. The afternoon period was the noisiest. The helicopter at 119 dBA and the cast saw at 90 dBA were the noisiest equipment, and the lowest noise level found was the activated oximeter at 61.0 dBA. Conclusion In all assessed points, noise levels were above the comfort levels recommended by the Brazilian Association of Technical Standards (1987), which may harm users' and professionals' health as well as influence professional performance in the emergency ward. Sound pressure levels of the helicopter and cast saw reach high hearing hazard levels, requiring professionals to use individual protection equipment, and point to the need for creation and implementation of effective control measures of noise levels in emergency wards. PMID:26157493

Establishing Recommendations for Stroke Systems in the Thrombectomy Era: The Upstate New York Stakeholder Proceedings.

PubMed

Magdon-Ismail, Zainab; Benesch, Curtis; Cushman, Jeremy T; Brissette, Ian; Southerland, Andrew M; Brandler, Ethan S; Sozener, Cemal B; Flor, Sue; Hemmitt, Roseanne; Wales, Kathleen; Parrigan, Krystal; Levine, Steven R

2017-07-01

The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale. Six weeks later, participants finalized recommendations. Seventy-one stakeholders (45% of invitees) attended. Six themes around goals/concerns emerged: (1) emergency medical services capacity, (2) validated prehospital screening tools, (3) facility capability, (4) triage/transport guidelines, (5) data capture/feedback tools, and (6) facility competition. In response, high-impact (level A) prehospital recommendations, stratified by implementation feasibility, were (1) use of online medical control for triage (6%); (2) regional transportation strategy (31%), standardized emergency medical services checklists (18%), quality metrics (14%), standardized prehospital screening tools (13%), and feedback for performance improvement (7%); and (3) smartphone application algorithm for screening/decision-making (6%) and ambulance-based telemedicine (6%). Level A interfacility transfer recommendations were (1) standardized transfer process (32%)/timing goals (16%)/regionalized systems (11%), performance metrics (11%), image sharing capabilities (7%); (2) provider education (9%) and stroke toolbox (5%); and (3) interfacility telemedicine (7%) and feedback (2%). The methods used and recommendations generated provide models for stroke system enhancement. Implementation may vary based on geographic need/capacity and be contingent on establishing standard care practices. Further research is needed to establish optimal implementation strategies. © 2017 American Heart Association, Inc.

Intensive skills week for military medical students increases technical proficiency, confidence, and skills to minimize negative stress.

PubMed

Mueller, Genevieve; Hunt, Bonnie; Wall, Van; Rush, Robert; Molof, Alan; Schoeff, Jonathan; Wedmore, Ian; Schmid, James; Laporta, Anthony

2012-01-01

The effects of stress induced cortisol on learning and memory is well documented in the literature.1-3 Memory and learning are enhanced at low levels while high levels are detrimental. Repetitive training in stressful situations enables management of the stress response4 as demonstrated by the high intensity training military members undergo to prepare for tactical situations. Appropriate management of one?s stress response is critical in the medical field, as the negative effects of stress can potentially hinder life-saving procedures and treatments. This also applies to physicians-in-training as they learn and practice triage, emergency medicine, and surgical skills prior to graduation. Rocky Vista University?s Military Medicine Honor?s Track (MMHT) held a week long high-intensity emergency medicine and surgical Intensive Skills Week (ISW), facilitated by military and university physicians, to advance students? skills and maximize training using the Human Worn Partial Surgical Task Simulator (Cut Suit). The short-term goal of the ISW was to overcome negative stress responses to increase confidence, technical and non-technical knowledge, and skill in surgery and emergency medicine in an effort to improve performance as third-year medical students. The long-term goal was to enhance performance and proficiency in residency and future medical practice. The metrics for the short-term goals were the focus of this pilot study. Results show an increase in confidence and decrease in perceived stress as well as statistically significant improvements in technical and non-technical skills and surgical instrumentation knowledge throughout the week. There is a correlative benefit to physician and non-physician military personnel, especially Special Operations Forces (SOF) medical personnel, from developing and implementing similar training programs when live tissue or cadaver models are unavailable or unfeasible. 2012.

Obstetric team simulation program challenges.

PubMed

Bullough, A S; Wagner, S; Boland, T; Waters, T P; Kim, K; Adams, W

2016-12-01

To describe the challenges associated with the development and assessment of an obstetric emergency team simulation program. The goal was to develop a hybrid, in-situ and high fidelity obstetric emergency team simulation program that incorporated weekly simulation sessions on the labor and delivery unit, and quarterly, education protected sessions in the simulation center. All simulation sessions were video-recorded and reviewed. Labor and delivery unit and simulation center. Medical staff covering labor and delivery, anesthesiology and obstetric residents and obstetric nurses. Assessments included an on-line knowledge multiple-choice questionnaire about the simulation scenarios. This was completed prior to the initial in-situ simulation session and repeated 3 months later, the Clinical Teamwork Scale with inter-rater reliability, participant confidence surveys and subjective participant satisfaction. A web-based curriculum comprising modules on communication skills, team challenges, and team obstetric emergency scenarios was also developed. Over 4 months, only 6 labor and delivery unit in-situ sessions out of a possible 14 sessions were carried out. Four high-fidelity sessions were performed in 2 quarterly education protected meetings in the simulation center. Information technology difficulties led to the completion of only 18 pre/post web-based multiple-choice questionnaires. These test results showed no significant improvement in raw score performance from pre-test to post-test (P=.27). During Clinical Teamwork Scale live and video assessment, trained raters and program faculty were in agreement only 31% and 28% of the time, respectively (Kendall's W=.31, P<.001 and W=.28, P<.001). Participant confidence surveys overall revealed confidence significantly increased (P<.05), from pre-scenario briefing to after post-scenario debriefing. Program feedback indicates a high level of participant satisfaction and improved confidence yet further program refinement is required. Copyright © 2016 Elsevier Inc. All rights reserved.

Lifetime laser damage performance of β -Ga2O3 for high power applications

NASA Astrophysics Data System (ADS)

Yoo, Jae-Hyuck; Rafique, Subrina; Lange, Andrew; Zhao, Hongping; Elhadj, Selim

2018-03-01

Gallium oxide (Ga2O3) is an emerging wide bandgap semiconductor with potential applications in power electronics and high power optical systems where gallium nitride and silicon carbide have already demonstrated unique advantages compared to gallium arsenide and silicon-based devices. Establishing the stability and breakdown conditions of these next-generation materials is critical to assessing their potential performance in devices subjected to large electric fields. Here, using systematic laser damage performance tests, we establish that β-Ga2O3 has the highest lifetime optical damage performance of any conductive material measured to date, above 10 J/cm2 (1.4 GW/cm2). This has direct implications for its use as an active component in high power laser systems and may give insight into its utility for high-power switching applications. Both heteroepitaxial and bulk β-Ga2O3 samples were benchmarked against a heteroepitaxial gallium nitride sample, revealing an order of magnitude higher optical lifetime damage threshold for β-Ga2O3. Photoluminescence and Raman spectroscopy results suggest that the exceptional damage performance of β-Ga2O3 is due to lower absorptive defect concentrations and reduced epitaxial stress.

Three-Dimensional Electrodes for High-Performance Bioelectrochemical Systems

PubMed Central

Yu, Yang-Yang; Zhai, Dan-Dan; Si, Rong-Wei; Sun, Jian-Zhong; Liu, Xiang; Yong, Yang-Chun

2017-01-01

Bioelectrochemical systems (BES) are groups of bioelectrochemical technologies and platforms that could facilitate versatile environmental and biological applications. The performance of BES is mainly determined by the key process of electron transfer at the bacteria and electrode interface, which is known as extracellular electron transfer (EET). Thus, developing novel electrodes to encourage bacteria attachment and enhance EET efficiency is of great significance. Recently, three-dimensional (3D) electrodes, which provide large specific area for bacteria attachment and macroporous structures for substrate diffusion, have emerged as a promising electrode for high-performance BES. Herein, a comprehensive review of versatile methodology developed for 3D electrode fabrication is presented. This review article is organized based on the categorization of 3D electrode fabrication strategy and BES performance comparison. In particular, the advantages and shortcomings of these 3D electrodes are presented and their future development is discussed. PMID:28054970

BEAGLE: an application programming interface and high-performance computing library for statistical phylogenetics.

PubMed

Ayres, Daniel L; Darling, Aaron; Zwickl, Derrick J; Beerli, Peter; Holder, Mark T; Lewis, Paul O; Huelsenbeck, John P; Ronquist, Fredrik; Swofford, David L; Cummings, Michael P; Rambaut, Andrew; Suchard, Marc A

2012-01-01

Phylogenetic inference is fundamental to our understanding of most aspects of the origin and evolution of life, and in recent years, there has been a concentration of interest in statistical approaches such as Bayesian inference and maximum likelihood estimation. Yet, for large data sets and realistic or interesting models of evolution, these approaches remain computationally demanding. High-throughput sequencing can yield data for thousands of taxa, but scaling to such problems using serial computing often necessitates the use of nonstatistical or approximate approaches. The recent emergence of graphics processing units (GPUs) provides an opportunity to leverage their excellent floating-point computational performance to accelerate statistical phylogenetic inference. A specialized library for phylogenetic calculation would allow existing software packages to make more effective use of available computer hardware, including GPUs. Adoption of a common library would also make it easier for other emerging computing architectures, such as field programmable gate arrays, to be used in the future. We present BEAGLE, an application programming interface (API) and library for high-performance statistical phylogenetic inference. The API provides a uniform interface for performing phylogenetic likelihood calculations on a variety of compute hardware platforms. The library includes a set of efficient implementations and can currently exploit hardware including GPUs using NVIDIA CUDA, central processing units (CPUs) with Streaming SIMD Extensions and related processor supplementary instruction sets, and multicore CPUs via OpenMP. To demonstrate the advantages of a common API, we have incorporated the library into several popular phylogenetic software packages. The BEAGLE library is free open source software licensed under the Lesser GPL and available from http://beagle-lib.googlecode.com. An example client program is available as public domain software.

BEAGLE: An Application Programming Interface and High-Performance Computing Library for Statistical Phylogenetics

PubMed Central

Ayres, Daniel L.; Darling, Aaron; Zwickl, Derrick J.; Beerli, Peter; Holder, Mark T.; Lewis, Paul O.; Huelsenbeck, John P.; Ronquist, Fredrik; Swofford, David L.; Cummings, Michael P.; Rambaut, Andrew; Suchard, Marc A.

2012-01-01

Abstract Phylogenetic inference is fundamental to our understanding of most aspects of the origin and evolution of life, and in recent years, there has been a concentration of interest in statistical approaches such as Bayesian inference and maximum likelihood estimation. Yet, for large data sets and realistic or interesting models of evolution, these approaches remain computationally demanding. High-throughput sequencing can yield data for thousands of taxa, but scaling to such problems using serial computing often necessitates the use of nonstatistical or approximate approaches. The recent emergence of graphics processing units (GPUs) provides an opportunity to leverage their excellent floating-point computational performance to accelerate statistical phylogenetic inference. A specialized library for phylogenetic calculation would allow existing software packages to make more effective use of available computer hardware, including GPUs. Adoption of a common library would also make it easier for other emerging computing architectures, such as field programmable gate arrays, to be used in the future. We present BEAGLE, an application programming interface (API) and library for high-performance statistical phylogenetic inference. The API provides a uniform interface for performing phylogenetic likelihood calculations on a variety of compute hardware platforms. The library includes a set of efficient implementations and can currently exploit hardware including GPUs using NVIDIA CUDA, central processing units (CPUs) with Streaming SIMD Extensions and related processor supplementary instruction sets, and multicore CPUs via OpenMP. To demonstrate the advantages of a common API, we have incorporated the library into several popular phylogenetic software packages. The BEAGLE library is free open source software licensed under the Lesser GPL and available from http://beagle-lib.googlecode.com. An example client program is available as public domain software. PMID:21963610

Intrahospital teleradiology from the emergency room

NASA Astrophysics Data System (ADS)

Fuhrman, Carl R.; Slasky, B. S.; Gur, David; Lattner, Stefanie; Herron, John M.; Plunkett, Michael B.; Towers, Jeffrey D.; Thaete, F. Leland

1993-09-01

Off-hour operations of the modern emergency room presents a challenge to conventional image management systems. To assess the utility of intrahospital teleradiology systems from the emergency room (ER), we installed a high-resolution film digitizer which was interfaced to a central archive and to a workstation at the main reading room. The system was designed to allow for digitization of images as soon as the films were processed. Digitized images were autorouted to both destinations, and digitized images could be laser printed (if desired). Almost real time interpretations of nonselected cases were performed at both locations (conventional film in the ER and a workstation in the main reading room), and an analysis of disagreements was performed. Our results demonstrate that in spite of a `significant' difference in reporting, `clinically significant differences' were found in less than 5% of cases. Folder management issues, preprocessing, image orientation, and setting reasonable lookup tables for display were identified as the main limitations to the systems' routine use in a busy environment. The main limitation of the conventional film was the identification of subtle abnormalities in the bright regions of the film. Once identified on either system (conventional film or soft display), all abnormalities were visible and detectable on both display modalities.

Strategies for Optimal MAC Parameters Tuning in IEEE 802.15.6 Wearable Wireless Sensor Networks.

PubMed

Alam, Muhammad Mahtab; Ben Hamida, Elyes

2015-09-01

Wireless body area networks (WBAN) has penetrated immensely in revolutionizing the classical heath-care system. Recently, number of WBAN applications has emerged which introduce potential limits to existing solutions. In particular, IEEE 802.15.6 standard has provided great flexibility, provisions and capabilities to deal emerging applications. In this paper, we investigate the application-specific throughput analysis by fine-tuning the physical (PHY) and medium access control (MAC) parameters of the IEEE 802.15.6 standard. Based on PHY characterizations in narrow band, at the MAC layer, carrier sense multiple access collision avoidance (CSMA/CA) and scheduled access protocols are extensively analyzed. It is concluded that, IEEE 802.15.6 standard can satisfy most of the WBANs applications throughput requirements by maximum achieving 680 Kbps. However, those emerging applications which require high quality audio or video transmissions, standard is not able to meet their constraints. Moreover, delay, energy efficiency and successful packet reception are considered as key performance metrics for comparing the MAC protocols. CSMA/CA protocol provides the best results to meet the delay constraints of medical and non-medical WBAN applications. Whereas, the scheduled access approach, performs very well both in energy efficiency and packet reception ratio.

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

PubMed

Walter, Scott R

2018-06-20

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

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2012 CFR

2012-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2014 CFR

2014-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

40 CFR 60.4390 - What are my reporting requirements if I operate an emergency combustion turbine or a research and...

Code of Federal Regulations, 2013 CFR

2013-07-01

... operate an emergency combustion turbine or a research and development turbine? 60.4390 Section 60.4390... PERFORMANCE FOR NEW STATIONARY SOURCES Standards of Performance for Stationary Combustion Turbines Reporting § 60.4390 What are my reporting requirements if I operate an emergency combustion turbine or a research...

An example of extreme cardiology: chest pain on the high seas and helicoptered medical evacuations: the French Navy experience.

PubMed

Vinsonneau, Ulric; Cavel, Christiane; Bombert, Christophe; Lely, Laurent; Paleiron, Nicolas; Vergez-Larrouget, Claude; Cornily, Jean-Christophe; Castellant, Philippe; Gilard, Martine; Paule, Paule; Bronstein, Jean-Ariel

2012-10-01

Medicalized high sea rescue is very different from prehospital medical evacuation. It requires specifically trained medical teams because the difficulties are marine, aerial, and medically related. The French Navy provides medical evacuations by helicopter on the Atlantic coast, up to 320 km offshore and under all weather conditions. The epidemiology of acute chest pain in the high seas has been poorly described. Therefore, in this retrospective study, we aimed to assess the prevalence and constraints found in the management of these emergencies. From January 1, 2000, to April 30, 2009, 286 medical evacuations by helicopter were performed, 132 of which were due to traumatological emergencies, and 154 to medical emergencies. Acute chest pain, with 36 missions, was the leading cause of medical evacuation. All evacuated patients were men who were either professional sailors or ferry passengers. The median age was 48 years (range, 26-79). The most common prehospital diagnosis was coronary chest pain in 23 patients (64%), including 11 patients with acute coronary syndrome with ST-segment elevation. Thirty-two patients were airlifted by helicopter. All patients benefited from monitoring, electrocardiogram, peripheral venous catheter, and medical management as soon as the technical conditions allowed it. Copyright © 2012 Elsevier Inc. All rights reserved.

Rapid emergence of high-level tigecycline resistance in Escherichia coli strains harbouring blaNDM-5 in vivo.

PubMed

Li, Xi; Mu, Xinli; Yang, Yunxing; Hua, Xiaoting; Yang, Qing; Wang, Nanfei; Du, Xiaoxing; Ruan, Zhi; Shen, Xiaoqiang; Yu, Yunsong

2016-04-01

Tigecycline (TIG) resistance is a growing concern because this antibiotic is regarded as one of the last resorts to treat infections caused by multidrug-resistant and extensively drug-resistant (XDR) bacteria. Information regarding TIG-resistant Escherichia coli isolates is scarce. In this study, we report the emergence of high-level TIG resistance in a longitudinal series of XDR E. coli isolates collected during TIG treatment. Whole-genome sequencing was performed for six E. coli strains harbouring bla(NDM-5) and genomic comparison revealed two amino acid substitutions. Mutation in rpsJ could be a significant factor conferring TIG resistance in these isolates. The fitness cost of TIG resistance in resistant strains was evaluated by determining the relative growth rate, indicating that TIG resistance reduced fitness by ca. 7%. This study is the first report to demonstrate high-level TIG resistance in E. coli in vivo. In addition, we report the first treatment-emergent minimum inhibitory concentration (MIC) development of TIG from 1mg/L to 64 mg/L in E. coli. Clinicians should be aware of the risk of an increase in the MIC of TIG under therapy. Copyright © 2016 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

75 FR 9436 - Submission for OMB Emergency Review: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... Administration. Title of Collection: American Recovery and Reinvestment Act (ARRA) High Growth and Emerging... of competitive grants for worker training and placement in high growth and emerging industries, the American Recovery and Reinvestment Act (ARRA) High Growth and Emerging Industries (HGEI) grants. It is...

Outcomes following major emergency gastric surgery: the importance of specialist surgeons.

PubMed

Khan, O A; McGlone, E R; Mercer, S J; Somers, S S; Toh, S K C

2015-01-01

The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery. Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes. Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03). Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service. Copyright© Acta Chirurgica Belgica.

Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy.

PubMed

Patel, Anup D

2014-02-01

In the United States, approximately one million people are evaluated annually in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential variables associated with recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Institutional review board approval from Nationwide Children's Hospital was obtained prior to study initiation. An accountable care organization (ACO), Partner for Kids (PFK), database was searched for patients with the highest and the lowest number of ED visits and/or unplanned hospitalizations from 2007 through 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and a low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose of emergency seizure medication was cross-checked to the patient's actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Multivariable logistic regression was used to test the effects of factors. When controlling for other factors, patients who were given an incorrect or no emergency seizure dosing had a high probability of having multiple ED visits/unplanned hospitalizations compared with patients who were given correct dosing (odds ratio=11.28, 95% CI of odds ratio=(2.42, 52.63), p value<0.01 (p=0.0021)). Using a similar model, patients who experienced a higher number of no-shows to clinic visits had a higher probability of having multiple ED visits/unplanned hospitalizations (odds ratio=5.73 per 1 more number of no-show, 95% CI of odds ratio=(1.78, 18.44), p value<0.01 (p=0.0034)). Future studies are planned to target these risk factors with the goal of decreased ED and/or hospital utilization for children with epilepsy. Copyright © 2013 Elsevier Inc. All rights reserved.

Application and Evaluation of Control Modes for Risk-Based Engine Performance Enhancements

NASA Technical Reports Server (NTRS)

Liu, Yuan; Litt, Jonathan S.; Sowers, T. Shane; Owen, A. Karl (Compiler); Guo, Ten-Huei

2014-01-01

The engine control system for civil transport aircraft imposes operational limits on the propulsion system to ensure compliance with safety standards. However, during certain emergency situations, aircraft survivability may benefit from engine performance beyond its normal limits despite the increased risk of failure. Accordingly, control modes were developed to improve the maximum thrust output and responsiveness of a generic high-bypass turbofan engine. The algorithms were designed such that the enhanced performance would always constitute an elevation in failure risk to a consistent predefined likelihood. This paper presents an application of these risk-based control modes to a combined engine/aircraft model. Through computer and piloted simulation tests, the aim is to present a notional implementation of these modes, evaluate their effects on a generic airframe, and demonstrate their usefulness during emergency flight situations. Results show that minimal control effort is required to compensate for the changes in flight dynamics due to control mode activation. The benefits gained from enhanced engine performance for various runway incursion scenarios are investigated. Finally, the control modes are shown to protect against potential instabilities during propulsion-only flight where all aircraft control surfaces are inoperable.

Application and Evaluation of Control Modes for Risk-Based Engine Performance Enhancements

NASA Technical Reports Server (NTRS)

Liu, Yuan; Litt, Jonathan S.; Sowers, T. Shane; Owen, A. Karl; Guo, Ten-Huei

2015-01-01

The engine control system for civil transport aircraft imposes operational limits on the propulsion system to ensure compliance with safety standards. However, during certain emergency situations, aircraft survivability may benefit from engine performance beyond its normal limits despite the increased risk of failure. Accordingly, control modes were developed to improve the maximum thrust output and responsiveness of a generic high-bypass turbofan engine. The algorithms were designed such that the enhanced performance would always constitute an elevation in failure risk to a consistent predefined likelihood. This paper presents an application of these risk-based control modes to a combined engine/aircraft model. Through computer and piloted simulation tests, the aim is to present a notional implementation of these modes, evaluate their effects on a generic airframe, and demonstrate their usefulness during emergency flight situations. Results show that minimal control effort is required to compensate for the changes in flight dynamics due to control mode activation. The benefits gained from enhanced engine performance for various runway incursion scenarios are investigated. Finally, the control modes are shown to protect against potential instabilities during propulsion-only flight where all aircraft control surfaces are inoperable.

Improved refractory performance through partnership

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

Linck, F.E.; Peters, D.

1995-12-31

From the early designs and construction of Circulating Fluidized Bed (CFB) boilers, many improvements have been made based upon observations of performance. Included in these improvements have been the refractory linings. The early refractory linings were subjected to extreme fluctuations in temperatures as the units experienced up and down conditions. As the designs were improved refractory failures were mostly due to the operating conditions and other mechanical stresses rather than continual shutdowns and startups. More recent problems observed with refractory linings are localized areas of high erosion, corrosion and cracking which result in hot spots and eventual shutdowns for repair.more » Today the objective of refractory suppliers and installers is to strive towards planned shutdowns rather than emergency shutdowns. This can be accomplished through partnerships between operations, material suppliers and installers. In essence, the concept is a cooperative effort between these groups to solve the variety of refractory problems in order to achieve longer refractory lining performance and less chance for emergency shutdowns. The reliability of the refractory lining is dependent on the successful combination of the material selected, proper design and the installation of the refractory material. Where these three elements combine, the lining has the best chance of performing its intended purpose.« less

Biologically templated assembly of hybrid semiconducting nanomesh for high performance field effect transistors and sensors

NASA Astrophysics Data System (ADS)

Byeon, Hye-Hyeon; Lee, Seung-Woo; Lee, Eun-Hee; Kim, Woong; Yi, Hyunjung

2016-10-01

Delicately assembled composites of semiconducting nanomaterials and biological materials provide an attractive interface for emerging applications, such as chemical/biological sensors, wearable health monitoring devices, and therapeutic agent releasing devices. The nanostructure of composites as a channel and a sensing material plays a critical role in the performance of field effect transistors (FETs). Therefore, it is highly desirable to prepare elaborate composite that can allow the fabrication of high performance FETs and also provide high sensitivity and selectivity in detecting specific chemical/biological targets. In this work, we demonstrate that high performance FETs can be fabricated with a hydrodynamically assembled composite, a semiconducting nanomesh, of semiconducting single-walled carbon nanotubes (S-SWNTs) and a genetically engineered M13 phage to show strong binding affinity toward SWNTs. The semiconducting nanomesh enables a high on/off ratio (~104) of FETs. We also show that the threshold voltage and the channel current of the nanomesh FETs are sensitive to the change of the M13 phage surface charge. This biological gate effect of the phage enables the detection of biologically important molecules such as dopamine and bisphenol A using nanomesh-based FETs. Our results provide a new insight for the preparation of composite material platform for highly controllable bio/electronics interfaces.

Highly Stable, Dual-Gated MoS2 Transistors Encapsulated by Hexagonal Boron Nitride with Gate-Controllable Contact, Resistance, and Threshold Voltage.

PubMed

Lee, Gwan-Hyoung; Cui, Xu; Kim, Young Duck; Arefe, Ghidewon; Zhang, Xian; Lee, Chul-Ho; Ye, Fan; Watanabe, Kenji; Taniguchi, Takashi; Kim, Philip; Hone, James

2015-07-28

Emerging two-dimensional (2D) semiconductors such as molybdenum disulfide (MoS2) have been intensively studied because of their novel properties for advanced electronics and optoelectronics. However, 2D materials are by nature sensitive to environmental influences, such as temperature, humidity, adsorbates, and trapped charges in neighboring dielectrics. Therefore, it is crucial to develop device architectures that provide both high performance and long-term stability. Here we report high performance of dual-gated van der Waals (vdW) heterostructure devices in which MoS2 layers are fully encapsulated by hexagonal boron nitride (hBN) and contacts are formed using graphene. The hBN-encapsulation provides excellent protection from environmental factors, resulting in highly stable device performance, even at elevated temperatures. Our measurements also reveal high-quality electrical contacts and reduced hysteresis, leading to high two-terminal carrier mobility (33-151 cm(2) V(-1) s(-1)) and low subthreshold swing (80 mV/dec) at room temperature. Furthermore, adjustment of graphene Fermi level and use of dual gates enable us to separately control contact resistance and threshold voltage. This novel vdW heterostructure device opens up a new way toward fabrication of stable, high-performance devices based on 2D materials.

3D printed high performance strain sensors for high temperature applications

NASA Astrophysics Data System (ADS)

Rahman, Md Taibur; Moser, Russell; Zbib, Hussein M.; Ramana, C. V.; Panat, Rahul

2018-01-01

Realization of high temperature physical measurement sensors, which are needed in many of the current and emerging technologies, is challenging due to the degradation of their electrical stability by drift currents, material oxidation, thermal strain, and creep. In this paper, for the first time, we demonstrate that 3D printed sensors show a metamaterial-like behavior, resulting in superior performance such as high sensitivity, low thermal strain, and enhanced thermal stability. The sensors were fabricated using silver (Ag) nanoparticles (NPs), using an advanced Aerosol Jet based additive printing method followed by thermal sintering. The sensors were tested under cyclic strain up to a temperature of 500 °C and showed a gauge factor of 3.15 ± 0.086, which is about 57% higher than that of those available commercially. The sensor thermal strain was also an order of magnitude lower than that of commercial gages for operation up to a temperature of 500 °C. An analytical model was developed to account for the enhanced performance of such printed sensors based on enhanced lateral contraction of the NP films due to the porosity, a behavior akin to cellular metamaterials. The results demonstrate the potential of 3D printing technology as a pathway to realize highly stable and high-performance sensors for high temperature applications.

Design of high-performance cathode materials with single-phase pathway for sodium ion batteries: A study on P2-Nax(LiyMn1-y)O2 compounds

NASA Astrophysics Data System (ADS)

Yang, Lufeng; Li, Xiang; Ma, Xuetian; Xiong, Shan; Liu, Pan; Tang, Yuanzhi; Cheng, Shuang; Hu, Yan-Yan; Liu, Meilin; Chen, Hailong

2018-03-01

Sodium-ion batteries (SIBs) are an emerging electrochemical energy storage technology that has high promise for electrical grid level energy storage. High capacity, long cycle life, and low cost cathode materials are very much desired for the development of high performance SIB systems. Sodium manganese oxides with different compositions and crystal structures have attracted much attention because of their high capacity and low cost. Here we report our investigations into a group of promising lithium doped sodium manganese oxide cathode materials with exceptionally high initial capacity of ∼223 mAh g-1 and excellent capacity retentions, attributed primarily to the absence of phase transformation in a wide potential range of electrochemical cycling, as confirmed by in-operando X-ray diffraction (XRD), Rietveld refinement, and high-resolution 7Li solid-state NMR characterizations. The systematic study of structural evolution and the correlation with the electrochemical behavior of the doped cathode materials provides new insights into rational design of high-performance intercalation compounds by tailoring the composition and the crystal structure evolution in electrochemical cycling.

High- k Gate Dielectrics for Emerging Flexible and Stretchable Electronics.

PubMed

Wang, Binghao; Huang, Wei; Chi, Lifeng; Al-Hashimi, Mohammed; Marks, Tobin J; Facchetti, Antonio

2018-05-22

Recent advances in flexible and stretchable electronics (FSE), a technology diverging from the conventional rigid silicon technology, have stimulated fundamental scientific and technological research efforts. FSE aims at enabling disruptive applications such as flexible displays, wearable sensors, printed RFID tags on packaging, electronics on skin/organs, and Internet-of-things as well as possibly reducing the cost of electronic device fabrication. Thus, the key materials components of electronics, the semiconductor, the dielectric, and the conductor as well as the passive (substrate, planarization, passivation, and encapsulation layers) must exhibit electrical performance and mechanical properties compatible with FSE components and products. In this review, we summarize and analyze recent advances in materials concepts as well as in thin-film fabrication techniques for high- k (or high-capacitance) gate dielectrics when integrated with FSE-compatible semiconductors such as organics, metal oxides, quantum dot arrays, carbon nanotubes, graphene, and other 2D semiconductors. Since thin-film transistors (TFTs) are the key enablers of FSE devices, we discuss TFT structures and operation mechanisms after a discussion on the needs and general requirements of gate dielectrics. Also, the advantages of high- k dielectrics over low- k ones in TFT applications were elaborated. Next, after presenting the design and properties of high- k polymers and inorganic, electrolyte, and hybrid dielectric families, we focus on the most important fabrication methodologies for their deposition as TFT gate dielectric thin films. Furthermore, we provide a detailed summary of recent progress in performance of FSE TFTs based on these high- k dielectrics, focusing primarily on emerging semiconductor types. Finally, we conclude with an outlook and challenges section.

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

PubMed

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

2018-01-09

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

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

PubMed

Hood, Natalie; Considine, Julie

2015-08-01

Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

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

PubMed

Sørup, Christian Michel; Jacobsen, Peter; Forberg, Jakob Lundager

2013-08-09

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. To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance. 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. 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. 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 towards improved performance measurement and standardised assessment across EDs.

Rapid high-amplitude circumferential slow wave propagation during normal gastric pacemaking and dysrhythmias

PubMed Central

O'Grady, Gregory; Du, Peng; Paskaranandavadivel, Nira; Angeli, Timothy R.; Lammers, Wim JEP; Asirvatham, Samuel J.; Windsor, John A.; Farrugia, Gianrico; Pullan, Andrew J.; Cheng, Leo K.

2012-01-01

Background Gastric slow waves propagate aborally as rings of excitation. Circumferential propagation does not normally occur, except at the pacemaker region. We hypothesized that: i) the unexplained high-velocity, high-amplitude activity associated with the pacemaker region is a consequence of circumferential propagation; ii) rapid, high-amplitude circumferential propagation emerges during gastric dysrhythmias; iii) the driving network conductance might switch between ICC-MP and circular ICC-IM during circumferential propagation; iv) extracellular amplitudes and velocities are correlated. Methods An experimental-theoretical study was performed. HR gastric mapping was performed in pigs during normal activation, pacing and dysrhythmia. Activation profiles, velocities and amplitudes were quantified. ICC pathways were theoretically evaluated in a bidomain model. Extracellular potentials were modelled as a function of membrane potentials. Key Results High-velocity, high-amplitude activation was only recorded in the pacemaker region when circumferential conduction occurred. Circumferential propagation accompanied dysrhythmia in 8/8 experiments, was faster than longitudinal propagation (8.9 vs 6.9 mm/s; p=0.004), and of higher amplitude (739 vs 528 μV; p=0.007). Simulations predicted that ICC-MP could be the driving network during longitudinal propagation, whereas during ectopic pacemaking, ICC-IM could outpace and activate ICC-MP in the circumferential axis. Experimental and modeling data demonstrated a linear relationship between velocities and amplitudes (p<0.001). Conclusions & Inferences The high-velocity and high-amplitude profile of the normal pacemaker region is due to localized circumferential propagation. Rapid circumferential propagation also emerges during a range of gastric dysrhythmias, elevating extracellular amplitudes and organizing transverse wavefronts. One possible explanation for these findings is bidirectional coupling between ICC-MP and circular ICC-IM networks. PMID:22709238

Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation.

PubMed

Johnson, Blake; Runyon, Michael; Weekes, Anthony; Pearson, David

2018-01-01

Out-of-hospital cardiac arrest has high rates of morbidity and mortality, and a growing body of evidence is redefining our approach to the resuscitation of these high-risk patients. Team-focused cardiopulmonary resuscitation (TFCPR), most commonly deployed and described by prehospital care providers, is a focused approach to cardiac arrest care that emphasizes early defibrillation and high-quality, minimally interrupted chest compressions while de-emphasizing endotracheal intubation and intravenous drug administration. TFCPR is associated with statistically significant increases in survival to hospital admission, survival to hospital discharge, and survival with good neurologic outcome; however, the adoption of similar streamlined resuscitation approaches by emergency physicians has not been widely reported. In the absence of a deliberately streamlined approach, such as TFCPR, other advanced therapies and procedures that have not shown similar survival benefit may be prioritized at the expense of simpler evidence-based interventions. This review examines the current literature on cardiac arrest resuscitation. The recent prehospital success of TFCPR is highlighted, including the associated improvements in multiple patient-centered outcomes. The adaptability of TFCPR to the emergency department (ED) setting is also discussed in detail. Finally, we discuss advanced interventions frequently performed during ED cardiac arrest resuscitation that may interfere with early defibrillation and effective high-quality chest compressions. TFCPR has been associated with improved patient outcomes in the prehospital setting. The data are less compelling for other commonly used advanced resuscitation tools and procedures. Emergency physicians should consider incorporating the TFCPR approach into ED cardiac arrest resuscitation to optimize delivery of those interventions most associated with improved outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

A comparative study of the effect of triage training by role-playing and educational video on the knowledge and performance of emergency medical service staffs in Iran.

PubMed

Aghababaeian, Hamidreza; Sedaghat, Soheila; Tahery, Noorallah; Moghaddam, Ali Sadeghi; Maniei, Mohammad; Bahrami, Nosrat; Ahvazi, Ladan Araghi

2013-12-01

Educating emergency medical staffs in triage skills is an important aspect of disaster preparedness. The aim of the study was to compare the effect of role-playing and educational video presentation on the learning and performance of the emergency medical service staffs in Khozestan, Iran A total of 144 emergency technicians were randomly classified into two groups. A researcher trained the first group using an educational video method and the second group with a role-playing method. Data were collected before, immediately, and 15 days after training using a questionnaire covering the three domains of demographic information, triage knowledge, and triage performance. The data were analyzed using defined knowledge and performance parameters. There was no significant difference between the two training methods on performance and immediate knowledge (P = .2), lasting knowledge (P=.05) and immediate performance (P = .35), but there was a statistical advantage for the role-playing method on lasting performance (P = .02). The two educational methods equally increase knowledge and performance, but the role-playing method may have a more desirable and lasting effect on performance.

High-throughput process development: II. Membrane chromatography.

PubMed

Rathore, Anurag S; Muthukumar, Sampath

2014-01-01

Membrane chromatography is gradually emerging as an alternative to conventional column chromatography. It alleviates some of the major disadvantages associated with the latter including high pressure drop across the column bed and dependence on intra-particle diffusion for the transport of solute molecules to their binding sites within the pores of separation media. In the last decade, it has emerged as a method of choice for final polishing of biopharmaceuticals, in particular monoclonal antibody products. The relevance of such a platform is high in view of the constraints with respect to time and resources that the biopharma industry faces today. This protocol describes the steps involved in performing HTPD of a membrane chromatography step. It describes operation of a commercially available device (AcroPrep™ Advance filter plate with Mustang S membrane from Pall Corporation). This device is available in 96-well format with 7 μL membrane in each well. We discuss the challenges that one faces when performing such experiments as well as possible solutions to alleviate them. Besides describing the operation of the device, the protocol also presents an approach for statistical analysis of the data that is gathered from such a platform. A case study involving use of the protocol for examining ion exchange chromatography of Granulocyte Colony Stimulating Factor (GCSF), a therapeutic product, is briefly discussed. This is intended to demonstrate the usefulness of this protocol in generating data that is representative of the data obtained at the traditional lab scale. The agreement in the data is indeed very significant (regression coefficient 0.99). We think that this protocol will be of significant value to those involved in performing high-throughput process development of membrane chromatography.

Systemic inflammatory response syndrome-based severe sepsis screening algorithms in emergency department patients with suspected sepsis.

PubMed

Shetty, Amith L; Brown, Tristam; Booth, Tarra; Van, Kim Linh; Dor-Shiffer, Daphna E; Vaghasiya, Milan R; Eccleston, Cassanne E; Iredell, Jonathan

2016-06-01

Systemic inflammatory response syndrome (SIRS)-based severe sepsis screening algorithms have been utilised in stratification and initiation of early broad spectrum antibiotics for patients presenting to EDs with suspected sepsis. We aimed to investigate the performance of some of these algorithms on a cohort of suspected sepsis patients. We conducted a retrospective analysis on an ED-based prospective sepsis registry at a tertiary Sydney hospital, Australia. Definitions for sepsis were based on the 2012 Surviving Sepsis Campaign guidelines. Numerical values for SIRS criteria and ED investigation results were recorded at the trigger of sepsis pathway on the registry. Performance of specific SIRS-based screening algorithms at sites from USA, Canada, UK, Australia and Ireland health institutions were investigated. Severe sepsis screening algorithms' performance was measured on 747 patients presenting with suspected sepsis (401 with severe sepsis, prevalence 53.7%). Sensitivity and specificity of algorithms to flag severe sepsis ranged from 20.2% (95% CI 16.4-24.5%) to 82.3% (95% CI 78.2-85.9%) and 57.8% (95% CI 52.4-63.1%) to 94.8% (95% CI 91.9-96.9%), respectively. Variations in SIRS values between uncomplicated and severe sepsis cohorts were only minor, except a higher mean lactate (>1.6 mmol/L, P < 0.01). We found the Ireland and JFK Medical Center sepsis algorithms performed modestly in stratifying suspected sepsis patients into high-risk groups. Algorithms with lactate levels thresholds of >2 mmol/L rather than >4 mmol/L performed better. ED sepsis registry-based characterisation of patients may help further refine sepsis definitions of the future. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

The emerging role for robotics in cholecystectomy: the dawn of a new era?

PubMed Central

Zaman, Jessica A.

2018-01-01

Though laparoscopic cholecystectomy (LC) was highly criticized in its early stages, it quickly grew to become a new standard of care and has revolutionized the field of general surgery. Now emerging robotic technology is making its way into the minimally invasive arena. Robotic cholecystectomy (RC) is often disparaged as a costly technology that can lead to increased operative times with outcomes that are quite similar to LC. However, this perspective is skewed as many existing studies were performed in the early phase of learning for this procedure. RC can be performed in a cost-effective manner as the volume of robotic procedures increases. In addition, improved visualization and capability to perform fluorescence cholangiography can improve the safety profile of cholecystectomy to a level that has not yet been achieved with conventional laparoscopy. Advanced simulation technology for robotic surgery, and newer single-site robotic platforms have the potential to further revolutionize this technology and lead to improved patient satisfaction. In this review, we will present current data, trends, and controversies in robotic-assisted cholecystectomy. PMID:29531940

Improving Schools through Collaboration: A Mixed Methods Study of School-to-School Partnerships in the Primary Sector

ERIC Educational Resources Information Center

Muijs, Daniel

2015-01-01

The principle of schools collaborating to improve is one that has seen growing interest in recent years, and there is emerging evidence that in particular collaboration between high and lower performing schools can be an effective school improvement method. However, this evidence relates primarily to secondary schools, and little research has been…

Computer-Aided Design of Drugs on Emerging Hybrid High Performance Computers

DTIC Science & Technology

2013-09-01

solutions to virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a...virtualization include lightweight, user-level implementations on Linux operating systems , but these solutions are often dependent on a specific version of...Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA, 22202-4302

Brief Report: Is Cognitive Rehabilitation Needed in Verbal Adults with Autism? Insights from Initial Enrollment in a Trial of Cognitive Enhancement Therapy

ERIC Educational Resources Information Center

Eack, Shaun M.; Bahorik, Amber L.; Hogarty, Susan S.; Greenwald, Deborah P.; Litschge, Maralee Y.; Mazefsky, Carla A.; Minshew, Nancy J.

2013-01-01

Cognitive rehabilitation is an emerging set of potentially effective interventions for the treatment of autism spectrum disorder, yet the applicability of these approaches for "high functioning" adults who have normative levels of intelligence remains unexplored. This study examined the initial cognitive performance characteristics of 40…

The Manifestation of Symmetry between the Emergence of Consciousness and the Development of Competence.

ERIC Educational Resources Information Center

Bierschenk, Bernhard; Bierschenk, Inger

This paper describes an experiment in which 30 students, classified according to high and low analytical performance, were given a reading and text production test to determine their sensibility to the structure of an Icelandic saga. This material was used because of its extreme simplicity on the textual surface level, a property suited for…

GPUs: An Emerging Platform for General-Purpose Computation

DTIC Science & Technology

2007-08-01

programming; real-time cinematic quality graphics Peak stream (26) License required (limited time no- cost evaluation program) Commercially...folding.stanford.edu (accessed 30 March 2007). 2. Fan, Z.; Qiu, F.; Kaufman, A.; Yoakum-Stover, S. GPU Cluster for High Performance Computing. ACM/IEEE...accessed 30 March 2007). 8. Goodnight, N.; Wang, R.; Humphreys, G. Computation on Programmable Graphics Hardware. IEEE Computer Graphics and

Balancing Identity, Motivation, and Internal Dialogue in the Making of Solos: Conquering the High Wire

ERIC Educational Resources Information Center

Andrzejewski, Carey E.

2011-01-01

This exploratory study emerged out of my interests in dance-making and phenomenology. In order to develop a portrait of how student dance artists choreograph self-performed solos, I asked nine graduate student dance-makers to contribute accounts of their experiences. From my efforts to make meaning of the participants' experiences, a composite…

Moderate sensitivity and high specificity of emergency department administrative data for transient ischemic attacks.

PubMed

Yu, Amy Y X; Quan, Hude; McRae, Andrew; Wagner, Gabrielle O; Hill, Michael D; Coutts, Shelagh B

2017-09-18

Validation of administrative data case definitions is key for accurate passive surveillance of disease. Transient ischemic attack (TIA) is a condition primarily managed in the emergency department. However, prior validation studies have focused on data after inpatient hospitalization. We aimed to determine the validity of the Canadian 10th International Classification of Diseases (ICD-10-CA) codes for TIA in the national ambulatory administrative database. We performed a diagnostic accuracy study of four ICD-10-CA case definition algorithms for TIA in the emergency department setting. The study population was obtained from two ongoing studies on the diagnosis of TIA and minor stroke versus stroke mimic using serum biomarkers and neuroimaging. Two reference standards were used 1) the emergency department clinical diagnosis determined by chart abstractors and 2) the 90-day final diagnosis, both obtained by stroke neurologists, to calculate the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the ICD-10-CA algorithms for TIA. Among 417 patients, emergency department adjudication showed 163 (39.1%) TIA, 155 (37.2%) ischemic strokes, and 99 (23.7%) stroke mimics. The most restrictive algorithm, defined as a TIA code in the main position had the lowest sensitivity (36.8%), but highest specificity (92.5%) and PPV (76.0%). The most inclusive algorithm, defined as a TIA code in any position with and without query prefix had the highest sensitivity (63.8%), but lowest specificity (81.5%) and PPV (68.9%). Sensitivity, specificity, PPV, and NPV were overall lower when using the 90-day diagnosis as reference standard. Emergency department administrative data reflect diagnosis of suspected TIA with high specificity, but underestimate the burden of disease. Future studies are necessary to understand the reasons for the low to moderate sensitivity.

[Paediatric dermatology emergencies in a tertiary hospital].

PubMed

Baquero-Sánchez, E; Bernabéu-Wittel, J; Dominguez-Cruz, J J; Conejo-Mir, J

2015-12-01

In recent years, the increasing demand for dermatological consultations in the Emergency department has resulted in the publication of a variety of studies on this subject. However, most of them deal with the general population, without taking into account the changes in frequencies found in young children (ages 0-14). To determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department, and after referral to Paediatric Dermatology. Firstly, a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013. Secondly, an analytical study was carried by calculating the kappa index calculus, in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist. A total of 861 patients, with a mean age of 4.5 years were included. More than half of the skin disorders analysed were eczema (27%) and infections (26%). The 5 main diagnoses were: atopic dermatitis (16%), acute prurigo simplex (5%), tinea (5%), pyogenic granuloma (4%), and molluscum contagiosum (4%). Additional tests were only required in 16% of the cases. The kappa index obtained was 0.206 (95% CI: 0.170-0.241). The dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases. Collaboration between paediatricians and dermatologists resulted in a high treatment success rate, leading to a low percentage of additional tests required and a high rate of discharges. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Development of a telemedicine model for emerging countries: a case study on pediatric oncology in Brazil.

PubMed

Hira, A Y; Nebel de Mello, A; Faria, R A; Odone Filho, V; Lopes, R D; Zuffo, M K

2006-01-01

This article discusses a telemedicine model for emerging countries, through the description of ONCONET, a telemedicine initiative applied to pediatric oncology in Brazil. The ONCONET core technology is a Web-based system that offers health information and other services specialized in childhood cancer such as electronic medical records and cooperative protocols for complex treatments. All Web-based services are supported by the use of high performance computing infrastructure based on clusters of commodity computers. The system was fully implemented on an open-source and free-software approach. Aspects of modeling, implementation and integration are covered. A model, both technologically and economically viable, was created through the research and development of in-house solutions adapted to the emerging countries reality and with focus on scalability both in the total number of patients and in the national infrastructure.

Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service.

PubMed

Marcolino, Milena Soriano; Santos, Thales Matheus Mendonça; Stefanelli, Fernanda Cotrim; Oliveira, João Antonio de Queiroz; E Silva, Maíra Viana Rego Souza; Andrade, Diomildo Ferreira; Silva, Grace Kelly Matos E; Ribeiro, Antonio Luiz

2017-01-01

Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.

Crisis Reliability Indicators Supporting Emergency Services (CRISES): A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

PubMed

Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Rhoads, Richard; Carson, Chris A

2016-01-01

Crisis and emergency psychiatric services are an integral part of the healthcare system, yet there are no standardized measures for programs providing these services. We developed the Crisis Reliability Indicators Supporting Emergency Services (CRISES) framework to create measures that inform internal performance improvement initiatives and allow comparison across programs. The framework consists of two components-the CRISES domains (timely, safe, accessible, least-restrictive, effective, consumer/family centered, and partnership) and the measures supporting each domain. The CRISES framework provides a foundation for development of standardized measures for the crisis field. This will become increasingly important as pay-for-performance initiatives expand with healthcare reform.

Stretchable, Twisted Conductive Microtubules for Wearable Computing, Robotics, Electronics, and Healthcare.

PubMed

Do, Thanh Nho; Visell, Yon

2017-05-11

Stretchable and flexible multifunctional electronic components, including sensors and actuators, have received increasing attention in robotics, electronics, wearable, and healthcare applications. Despite advances, it has remained challenging to design analogs of many electronic components to be highly stretchable, to be efficient to fabricate, and to provide control over electronic performance. Here, we describe highly elastic sensors and interconnects formed from thin, twisted conductive microtubules. These devices consist of twisted assemblies of thin, highly stretchable (>400%) elastomer tubules filled with liquid conductor (eutectic gallium indium, EGaIn), and fabricated using a simple roller coating process. As we demonstrate, these devices can operate as multimodal sensors for strain, rotation, contact force, or contact location. We also show that, through twisting, it is possible to control their mechanical performance and electronic sensitivity. In extensive experiments, we have evaluated the capabilities of these devices, and have prototyped an array of applications in several domains of stretchable and wearable electronics. These devices provide a novel, low cost solution for high performance stretchable electronics with broad applications in industry, healthcare, and consumer electronics, to emerging product categories of high potential economic and societal significance.

Efficiently-cooled plasmonic amorphous silicon solar cells integrated with a nano-coated heat-pipe plate

PubMed Central

Zhang, Yinan; Du, Yanping; Shum, Clifford; Cai, Boyuan; Le, Nam Cao Hoai; Chen, Xi; Duck, Benjamin; Fell, Christopher; Zhu, Yonggang; Gu, Min

2016-01-01

Solar photovoltaics (PV) are emerging as a major alternative energy source. The cost of PV electricity depends on the efficiency of conversion of light to electricity. Despite of steady growth in the efficiency for several decades, little has been achieved to reduce the impact of real-world operating temperatures on this efficiency. Here we demonstrate a highly efficient cooling solution to the recently emerging high performance plasmonic solar cell technology by integrating an advanced nano-coated heat-pipe plate. This thermal cooling technology, efficient for both summer and winter time, demonstrates the heat transportation capability up to ten times higher than those of the metal plate and the conventional wickless heat-pipe plates. The reduction in temperature rise of the plasmonic solar cells operating under one sun condition can be as high as 46%, leading to an approximate 56% recovery in efficiency, which dramatically increases the energy yield of the plasmonic solar cells. This newly-developed, thermally-managed plasmonic solar cell device significantly extends the application scope of PV for highly efficient solar energy conversion. PMID:27113558

Efficiently-cooled plasmonic amorphous silicon solar cells integrated with a nano-coated heat-pipe plate.

PubMed

Zhang, Yinan; Du, Yanping; Shum, Clifford; Cai, Boyuan; Le, Nam Cao Hoai; Chen, Xi; Duck, Benjamin; Fell, Christopher; Zhu, Yonggang; Gu, Min

2016-04-26

Solar photovoltaics (PV) are emerging as a major alternative energy source. The cost of PV electricity depends on the efficiency of conversion of light to electricity. Despite of steady growth in the efficiency for several decades, little has been achieved to reduce the impact of real-world operating temperatures on this efficiency. Here we demonstrate a highly efficient cooling solution to the recently emerging high performance plasmonic solar cell technology by integrating an advanced nano-coated heat-pipe plate. This thermal cooling technology, efficient for both summer and winter time, demonstrates the heat transportation capability up to ten times higher than those of the metal plate and the conventional wickless heat-pipe plates. The reduction in temperature rise of the plasmonic solar cells operating under one sun condition can be as high as 46%, leading to an approximate 56% recovery in efficiency, which dramatically increases the energy yield of the plasmonic solar cells. This newly-developed, thermally-managed plasmonic solar cell device significantly extends the application scope of PV for highly efficient solar energy conversion.

Efficiently-cooled plasmonic amorphous silicon solar cells integrated with a nano-coated heat-pipe plate

NASA Astrophysics Data System (ADS)

Zhang, Yinan; Du, Yanping; Shum, Clifford; Cai, Boyuan; Le, Nam Cao Hoai; Chen, Xi; Duck, Benjamin; Fell, Christopher; Zhu, Yonggang; Gu, Min

2016-04-01

Solar photovoltaics (PV) are emerging as a major alternative energy source. The cost of PV electricity depends on the efficiency of conversion of light to electricity. Despite of steady growth in the efficiency for several decades, little has been achieved to reduce the impact of real-world operating temperatures on this efficiency. Here we demonstrate a highly efficient cooling solution to the recently emerging high performance plasmonic solar cell technology by integrating an advanced nano-coated heat-pipe plate. This thermal cooling technology, efficient for both summer and winter time, demonstrates the heat transportation capability up to ten times higher than those of the metal plate and the conventional wickless heat-pipe plates. The reduction in temperature rise of the plasmonic solar cells operating under one sun condition can be as high as 46%, leading to an approximate 56% recovery in efficiency, which dramatically increases the energy yield of the plasmonic solar cells. This newly-developed, thermally-managed plasmonic solar cell device significantly extends the application scope of PV for highly efficient solar energy conversion.

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

PubMed

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

2015-08-01

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

Impact of new technologies on stress, attrition and well-being in emergency call centers: the NextGeneration 9-1-1 study protocol.

PubMed

Baseman, Janet; Revere, Debra; Painter, Ian; Stangenes, Scott; Lilly, Michelle; Beaton, Randal; Calhoun, Rebecca; Meischke, Hendrika

2018-05-04

Our public health emergency response system relies on the "first of the first responders"-the emergency call center workforce that handles the emergency needs of a public in distress. Call centers across the United States have been preparing for the "Next Generation 9-1-1" initiative, which will allow citizens to place 9-1-1 calls using a variety of digital technologies. The impacts of this initiative on a workforce that is already highly stressed is unknown. There is concern that these technology changes will increase stress, reduce job performance, contribute to maladaptive coping strategies, lower employee retention, or change morale in the workplace. Understanding these impacts to inform approaches for mitigating the health and performance risks associated with new technologies is crucial for ensuring the 911 system fulfills its mission of providing optimal emergency response to the public. Our project is an observational, prospective cohort study framed by the first new technology that will be implemented: text-to-911 calling. Emergency center call takers will be recruited nationwide. Data will be collected by online surveys distributed at each center before text-to-911 implementation; within the first month of implementation; and 6 months after implementation. Primary outcome measures are stress as measured by the Calgary Symptoms of Stress Index, use of sick leave, job performance, and job satisfaction. Primary analyses will use mixed effects regression models and mixed effects logistic regression models to estimate the change in outcome variables associated with text-to-911 implementation. Multiple secondary analyses will examine effects of stress on absenteeism; associations between technology attitudes and stress; effects of implementation on attitudes towards technology; and mitigating effects of job demands, job satisfaction, attitudes towards workplace technology and workplace support on change in stress. Our public health dependence on this workforce for our security and safety makes it imperative that the impact of technological changes such as text-to-911 are researched so appropriate intervention efforts to can be developed. Failing to protect our 9-1-1 call takers from predictable health risks would be similar to knowingly exposing field emergency responders to a toxic situation without following OSHA required training and practice standards assuring their protection.

Cardiac and great vessel injuries after chest trauma: our 10-year experience.

PubMed

Onan, Burak; Demirhan, Recep; Öz, Kürşad; Onan, Ismihan Selen

2011-09-01

Cardiovascular injuries after trauma present with high mortality. The aim of the study was to present our experience in cardiac and great vessel injuries after chest trauma. During the 10-year period, 104 patients with cardiac (n=94) and great vessel (n=10) injuries presented to our hospital. The demographic data, mechanism of injury, location of injury, other associated injuries, timing of surgical intervention, surgical approach, and clinical outcome were reviewed. Eighty-eight (84.6%) males presented after chest trauma. The mean age of the patients was 32.5±8.2 years (range: 12-76). Penetrating injuries (62.5%) were the most common cause of trauma. Computed tomography was performed in most cases and echocardiography was used in some stable cases. Cardiac injuries mostly included the right ventricle (58.5%). Great vessel injuries involved the subclavian vein in 6, innominate vein in 1, vena cava in 1, and descending aorta in 2 patients. Early operations after admission to the emergency were performed in 75.9% of the patients. Thoracotomy was performed in 89.5% of the patients. Operative mortality was significantly high in penetrating injuries (p=0.01). Clinicians should suspect cardiac and great vessel trauma in every patient presenting to the emergency unit after chest trauma. Computed tomography and echocardiography are beneficial in the management of chest trauma. Operative timing depends on hemodynamic status, and a multidisciplinary team approach improves the patient's prognosis.

[Competence of triage nurses in hospital emergency departments].

PubMed

Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard

2017-06-01

To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.

The internal processes and behavioral dynamics of hospital boards: an exploration of differences between high- and low-performing hospitals.

PubMed

Kane, Nancy M; Clark, Jonathan R; Rivenson, Howard L

2009-01-01

Nonprofit hospital boards are under increasing pressure to improve financial, clinical, and charitable and community benefit performance. Most research on board effectiveness focuses on variables measuring board structure and attributes associated with competing ideal models of board roles. However, the results do not provide clear evidence that one role is superior to another and suggest that in practice boards pursue hybrid roles. Board dynamics and processes have received less attention from researchers, but emerging theoretical frameworks highlight them as key to effective corporate governance. We explored differences in board processes and behavioral dynamics between financially high- and low-performing hospitals, with the goal of developing a better understanding of the best board practices in nonprofit hospitals. A comparative case study approach allowed for in-depth, qualitative assessments of how the internal workings of boards differ between low- and high-performing facilities. Boards of hospitals with strong financial performance exhibited behavioral dynamics and internal processes that differed in important ways from those of hospitals with poor financial performance. Boards need to actively attend to key processes and foster positive group dynamics in decision making to be more effective in governing hospitals.

High performance 3D adaptive filtering for DSP based portable medical imaging systems

NASA Astrophysics Data System (ADS)

Bockenbach, Olivier; Ali, Murtaza; Wainwright, Ian; Nadeski, Mark

2015-03-01

Portable medical imaging devices have proven valuable for emergency medical services both in the field and hospital environments and are becoming more prevalent in clinical settings where the use of larger imaging machines is impractical. Despite their constraints on power, size and cost, portable imaging devices must still deliver high quality images. 3D adaptive filtering is one of the most advanced techniques aimed at noise reduction and feature enhancement, but is computationally very demanding and hence often cannot be run with sufficient performance on a portable platform. In recent years, advanced multicore digital signal processors (DSP) have been developed that attain high processing performance while maintaining low levels of power dissipation. These processors enable the implementation of complex algorithms on a portable platform. In this study, the performance of a 3D adaptive filtering algorithm on a DSP is investigated. The performance is assessed by filtering a volume of size 512x256x128 voxels sampled at a pace of 10 MVoxels/sec with an Ultrasound 3D probe. Relative performance and power is addressed between a reference PC (Quad Core CPU) and a TMS320C6678 DSP from Texas Instruments.

Overcoming seed dormancy using gibberellic acid and the performance of young Syagrus coronata plants under severe drought stress and recovery.

PubMed

Medeiros, Maria J; Oliveira, Marciel T; Willadino, Lilia; Santos, Mauro G

2015-12-01

Syagrus coronata, a native palm tree of the Brazilian semi-arid region, exhibits low germinability due to seed dormancy. This study aimed to increase the germinability, analyze the morphology of seedlings and evaluate the performance of young plants under a water deficit. We used immersion in water and gibberellic acid (GA3) as pyrene (seed with endocarp) pre-germination treatments, and we analyzed the water relations, gas exchange, chlorophyll fluorescence and carbon balance components of young plants under drought and rehydration conditions. The immersion of pyrenes in 0.3 mM GA3 solution for 24 h enhanced the emergence and survival of plants and the emergence rate index. The germination of S. coronata is of the remote tubular type, and seedling growth originates with the protrusion of the cotyledon petiole, followed by the subsequent emergence of the root, leaf sheaths and eophyll. The plants exhibited high tolerance to no irrigation for 37 days, which was attributed to strong stomatal control, a higher proportion of energy dissipation and a higher content of photoprotective pigments. Despite the reduced stomatal conductance (regardless of soil water availability), the photosynthetic rate remained high throughout the day, which indicated a low correlation between these two parameters. After rehydration, we observed that both the leaf water content and photosynthesis recovered, which showed an absence of irreversible damage of the photosynthetic apparatus. The use of 0.3 mM GA3 is recommended as a treatment for overcoming seed dormancy in this species. Young S. coronata plants showed high tolerance during drought and resilience after rehydration by adjusting their leaf metabolism, which could explain the endemism of this species in semi-arid regions and its ability to remain evergreen throughout the year. Furthermore, with high photosynthetic rate in the most favorable time of day, even under drought stress. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Cold aortic flush and chest compressions enable good neurologic outcome after 15 mins of ventricular fibrillation in cardiac arrest in pigs.

PubMed

Janata, Andreas; Weihs, Wolfgang; Schratter, Alexandra; Bayegan, Keywan; Holzer, Michael; Frossard, Martin; Sipos, Wolfgang; Springler, Gregor; Schmidt, Peter; Sterz, Fritz; Losert, Udo M; Laggner, Anton N; Kochanek, Patrick M; Behringer, Wilhelm

2010-08-01

The induction of deep cerebral hypothermia via ice-cold saline aortic flush during prolonged ventricular fibrillation cardiac arrest, followed by hypothermic stasis and delayed resuscitation (emergency preservation and resuscitation), improved neurologic outcome after cardiac arrest in pigs, as compared to conventional resuscitation. We hypothesized that emergency preservation and resuscitation with chest compressions would further improve outcome in the same model. Prospective experimental study. University research laboratory. : Twenty-four female, large, white breed pigs (27-37 kg). Fifteen minutes of ventricular fibrillation cardiac arrest were followed by 20 mins of resuscitation with chest compressions (control, n = 8), deep cerebral hypothermia via 200 mL/kg 4 degrees C saline aortic flush and hypothermic stasis (emergency preservation and resuscitation, n = 8), and emergency preservation and resuscitation combined with chest compressions (emergency preservation and resuscitation plus chest compressions, n = 8). At 35 mins after cardiac arrest, cardiopulmonary bypass was initiated, followed by defibrillation. Mild hypothermia was continued for 20 hrs. Pigs were evaluated after 9 days using a neurologic deficit (neurologic deficit score: 100% = brain dead; 0%-10% = normal) and an overall performance category score (overall performance category score: 1 = normal; 2 = slightly handicapped; 3 = severely handicapped; 4 = comatose; 5 = dead/brain dead). Brain temperature decreased from 38.5 degrees C to 15.3 degrees C +/- 3.3 degrees C in the emergency preservation and resuscitation group, and to 11.3 degrees C +/- 1.2 degrees C in the emergency preservation and resuscitation plus chest compressions group. In the control group, restoration of spontaneous circulation was achieved in four out of eight pigs, and one survived to 9 days. In the emergency preservation and resuscitation group, restoration of spontaneous circulation was achieved in seven out of eight pigs and five survived; in the emergency preservation and resuscitation plus chest compressions group, all had restoration of spontaneous circulation and seven survived (restoration of spontaneous circulation, p = .08). Neurologic outcome for (median and interquartile range) the control group included overall performance category score of 3, neurologic deficit score of 45%; for the emergency preservation and resuscitation group, overall performance category score was 3 (2-5) and neurologic deficit score was 45% (36; 50) and in the emergency preservation and resuscitation plus chest compressions group, overall performance category score was 2 (1-3) and neurologic deficit score was 13% (5; 21) (overall performance category score, p = .04; neurologic deficit score emergency preservation and resuscitation vs. emergency preservation and resuscitation plus chest compressions, p = .003). Emergency preservation and resuscitation by deep cerebral hypothermia combined with chest compressions during prolonged cardiac arrest in pigs are feasible and improve neurologic outcome.

Obstetric skills drills: evaluation of teaching methods.

PubMed

Birch, L; Jones, N; Doyle, P M; Green, P; McLaughlin, A; Champney, C; Williams, D; Gibbon, K; Taylor, K

2007-11-01

To determine the most effective method of delivering training to staff on the management of an obstetric emergency. The research was conducted in a District General Hospital in the UK, delivering approximately 3500 women per year. Thirty-six staff, comprising of junior and senior medical and midwifery staff were included as research subjects. Each of the staff members were put into one of six multi-professional teams. Effectively, this gave six teams, each comprising of six members. Three teaching methods were employed. Lecture based teaching (LBT), simulation based teaching (SBT) or a combination of these two (LAS). Each team of staff were randomly allocated to undertake a full day of training in the management of Post Partum Haemorrhage utilising one of these three teaching methods. Team knowledge and performance were assessed pre-training, post training and at three months later. In addition to this assessment of knowledge and performance, qualitative semi-structured interviews were carried out with 50% of the original cohort one year after the training, to explore anxiety, confidence, communication, knowledge retention, enjoyment and transferable skills. All teams improved in their performance and knowledge. The teams taught using simulation only (SBT) were the only group to demonstrate sustained improvement in clinical management of the case, confidence, communication skills and knowledge. However, the study did not have enough power to reach statistical significance. The SBT group reported transferable skills and less anxiety in subsequent emergencies. SBT and LAS reported improved multidisciplinary communication. Although tiring, the SBT was enjoyed the most. Obstetrics is a high risk speciality, in which emergencies are to some extent, inevitable. Training staff to manage these emergencies is a fundamental principal of risk management. Traditional risk management strategies based on incident reporting and event analysis are reactive and not always effective. Simulation based training is an appropriate proactive approach to reducing errors and risk in obstetrics, improving teamwork and communication, whilst giving the student a multiplicity of transferable skills to improve their performance.

High-performance computing with quantum processing units

DOE PAGES

Britt, Keith A.; Oak Ridge National Lab.; Humble, Travis S.; ...

2017-03-01

The prospects of quantum computing have driven efforts to realize fully functional quantum processing units (QPUs). Recent success in developing proof-of-principle QPUs has prompted the question of how to integrate these emerging processors into modern high-performance computing (HPC) systems. We examine how QPUs can be integrated into current and future HPC system architectures by accounting for func- tional and physical design requirements. We identify two integration pathways that are differentiated by infrastructure constraints on the QPU and the use cases expected for the HPC system. This includes a tight integration that assumes infrastructure bottlenecks can be overcome as well asmore » a loose integration that as- sumes they cannot. We find that the performance of both approaches is likely to depend on the quantum interconnect that serves to entangle multiple QPUs. As a result, we also identify several challenges in assessing QPU performance for HPC, and we consider new metrics that capture the interplay between system architecture and the quantum parallelism underlying computational performance.« less

High-performance computing with quantum processing units

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

Britt, Keith A.; Oak Ridge National Lab.; Humble, Travis S.

The prospects of quantum computing have driven efforts to realize fully functional quantum processing units (QPUs). Recent success in developing proof-of-principle QPUs has prompted the question of how to integrate these emerging processors into modern high-performance computing (HPC) systems. We examine how QPUs can be integrated into current and future HPC system architectures by accounting for func- tional and physical design requirements. We identify two integration pathways that are differentiated by infrastructure constraints on the QPU and the use cases expected for the HPC system. This includes a tight integration that assumes infrastructure bottlenecks can be overcome as well asmore » a loose integration that as- sumes they cannot. We find that the performance of both approaches is likely to depend on the quantum interconnect that serves to entangle multiple QPUs. As a result, we also identify several challenges in assessing QPU performance for HPC, and we consider new metrics that capture the interplay between system architecture and the quantum parallelism underlying computational performance.« less

Performance Evaluation of Communication Software Systems for Distributed Computing

NASA Technical Reports Server (NTRS)

Fatoohi, Rod

1996-01-01

In recent years there has been an increasing interest in object-oriented distributed computing since it is better quipped to deal with complex systems while providing extensibility, maintainability, and reusability. At the same time, several new high-speed network technologies have emerged for local and wide area networks. However, the performance of networking software is not improving as fast as the networking hardware and the workstation microprocessors. This paper gives an overview and evaluates the performance of the Common Object Request Broker Architecture (CORBA) standard in a distributed computing environment at NASA Ames Research Center. The environment consists of two testbeds of SGI workstations connected by four networks: Ethernet, FDDI, HiPPI, and ATM. The performance results for three communication software systems are presented, analyzed and compared. These systems are: BSD socket programming interface, IONA's Orbix, an implementation of the CORBA specification, and the PVM message passing library. The results show that high-level communication interfaces, such as CORBA and PVM, can achieve reasonable performance under certain conditions.

The Emergence of Meaning during the Occasion of Performance.

ERIC Educational Resources Information Center

Buzza, Bonnie Wilson

For those analyzing oral interpretation performance, the theory of Symbolic Interactionism can be used to explain two interrelated phenomena that occur during the performance: expanded understanding of the text (emergent meaning) and expanded understanding of oneself (development of the self-concept). George Herbert Mead, a founder of Symbolic…

A qualitative study about experiences and emotions of emergency medical technicians and out-of-hospital emergency nurses after performing cardiopulmonary resuscitation resulting in death.

PubMed

Fernández-Aedo, I; Pérez-Urdiales, I; Unanue-Arza, S; García-Azpiazu, Z; Ballesteros-Peña, S

To explore the experiences, emotions and coping skills among emergency medical technicians and emergency nurses after performing out-of-hospital cardiopulmonary resuscitation manoeuvres resulting in death. An exploratory qualitative research was performed. Seven emergency medical technicians and six emergency nurses were selected by non-probability sampling among emergency medical system workers. The meetings took place up to information saturation, achieved after six individual interviews and a focal group. The meetings were then transcribed and a manual and inductive analysis of the contents performed. After a failed resuscitation several short and long-term reactions appear. They can be negatives, such as sadness or uncertainty, or positives, such as the feeling of having done everything possible to save the patient's life. Emotional stress increases when ambulance staff have to talk with the deceased's family or when the patient is a child. The workers don't know of a coping strategy other than talking about their emotions with their colleagues. Death after a failed resuscitation can be viewed as a traumatic experience for rescuers. Being in contact with the suffering of others is an emotional, stress-generating factor with direct repercussions on the working and personal lives of emergency staff. Nevertheless, structured coping techniques are not common among those professionals. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical Decision Rules for Paediatric Minor Head Injury: Are CT Scans a Necessary Evil?

PubMed

Thiam, Desmond Wei; Yap, Si Hui; Chong, Shu Ling

2015-09-01

High performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population. This is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices. A total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6). The CDRs demonstrated high accuracy in detecting children with positive CT findings but direct application in areas with low rates of significant traumatic brain injury (TBI) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.

Discovery and Synthesis of GS-5734, a Phosphoramidate Prodrug of a Pyrrolo[2,1 f][triazin-4-amino] Adenine C-Nucleoside for the Treatment of Ebola and Emerging Viruses

DTIC Science & Technology

2017-01-26

high- performance liquid chromatography (HPLC) and were greater than 95% unless otherwise noted. HPLC conditions to assess purity were as follows...cell culture plates using a μFlow liquid dispenser and cultured for 4 days at 37 °C. After incubation, the cells were allowed to equilibrate to 25...t1/2) was determined assuming first-order kinetics. LC/MS/MS Instrumentation Liquid chromatography was performed using an Agilent 1200-series

Integrated Requirements Analysis and Technology Roadmaps

NASA Technical Reports Server (NTRS)

1997-01-01

In fiscal year 1997, Strategic Insight performed analytical studies for NASA's Highly Reusable Space Transportation (HRST) program, creating program documents which illuminated technical requirements and critical research opportunities. Studies were performed to structure and confirm HRST's evolving technical requirements, building on Marshall's Phase 1 work, which defined HRST system concepts, analytical tools and high-level issues for assessment in Phase 2. Specifically, Strategic Insight: (1) Performed a requirements analysis to update HRST: An Advanced Concepts Study, Study Guidelines, Version 2.0 of January 22, 1996; only minor changes were recommended for the given parameters of interest to concept designers; (2) Conducted mini-workshops during HRST Working Group meetings on April 14-15, 1997 and July 22-24, 1997; and (3) Created structures for technology road maps of candidate HRST concepts, both subsystem and end-to-end concepts, emerging from the 13 cooperative agreement projects.

Accelerating DNA analysis applications on GPU clusters

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

Tumeo, Antonino; Villa, Oreste

DNA analysis is an emerging application of high performance bioinformatic. Modern sequencing machinery are able to provide, in few hours, large input streams of data which needs to be matched against exponentially growing databases known fragments. The ability to recognize these patterns effectively and fastly may allow extending the scale and the reach of the investigations performed by biology scientists. Aho-Corasick is an exact, multiple pattern matching algorithm often at the base of this application. High performance systems are a promising platform to accelerate this algorithm, which is computationally intensive but also inherently parallel. Nowadays, high performance systems also includemore » heterogeneous processing elements, such as Graphic Processing Units (GPUs), to further accelerate parallel algorithms. Unfortunately, the Aho-Corasick algorithm exhibits large performance variabilities, depending on the size of the input streams, on the number of patterns to search and on the number of matches, and poses significant challenges on current high performance software and hardware implementations. An adequate mapping of the algorithm on the target architecture, coping with the limit of the underlining hardware, is required to reach the desired high throughputs. Load balancing also plays a crucial role when considering the limited bandwidth among the nodes of these systems. In this paper we present an efficient implementation of the Aho-Corasick algorithm for high performance clusters accelerated with GPUs. We discuss how we partitioned and adapted the algorithm to fit the Tesla C1060 GPU and then present a MPI based implementation for a heterogeneous high performance cluster. We compare this implementation to MPI and MPI with pthreads based implementations for a homogeneous cluster of x86 processors, discussing the stability vs. the performance and the scaling of the solutions, taking into consideration aspects such as the bandwidth among the different nodes.« less

Is emergency right hemicolectomy still associated with significant morbidity and mortality rates? An institution's experience of 207 cases over 6 years.

PubMed

Tan, Ker-Kan; Liu, Jody Zhiyang; Yeow, Yuyi; Gunasekaran, Sivaraj; Tan, Jane Jye-Yng

2011-09-01

Emergency right hemicolectomy has been associated with dismal outcome. But, data in Asians is lacking as pathologies that require emergency right hemicolectomy may differ from that in the Western population. The aims of our study were to review our institution's experience with emergency right hemicolectomies and to identify factors that could predict the per-operative outcome. A retrospective review of all patients who underwent emergency right hemicolectomy from August 2003 to April 2008 was performed. Emergency right hemicolectomy was defined as a right colectomy, comprising of an ileo-colic resection, in the emergency setting without the benefit of preoperative bowel preparation. All the complications were graded according to the classification proposed by Clavien and group. A total of 207 patients, median age 62 years (range, 19-94 years), underwent emergency right hemicolectomy during the study period. Neoplasia and complicated diverticular disease were the most common pathologies in 46.4% and 21.7%, respectively. Intestinal obstruction (44.4%) and perforation (26.6%) were the two main indications for surgical intervention in our series. Twenty (9.7%) patients died, and another 39 patients (18.8%) had severe complications. Eight (3.9%) patients had anastomotic dehiscence, while burst abdomen was seen in ten (4.8%) patients. The two independent factors associated with worse outcome were high ASA score and stoma creation. Factors such as age and site of perforation were not related. Emergency right hemicolectomy is associated with a significant morbidity and mortality rate. Patients with higher ASA score and who had stoma created fared worse.

What Matters from Admissions? Identifying Success and Risk Among Canadian Dental Students.

PubMed

Plouffe, Rachel A; Hammond, Robert; Goldberg, Harvey A; Chahine, Saad

2018-05-01

The aims of this study were to determine whether different student profiles would emerge in terms of high and low GPA performance in each year of dental school and to investigate the utility of preadmissions variables in predicting performance and performance stability throughout each year of dental school. Data from 11 graduating cohorts (2004-14) at the Schulich School of Medicine & Dentistry, University of Western Ontario, Canada, were collected and analyzed using bivariate correlations, latent profile analysis, and hierarchical generalized linear models (HGLMs). The data analyzed were for 616 students in total (332 males and 284 females). Four models were developed to predict adequate and poor performance throughout each of four dental school years. An additional model was developed to predict student performance stability across time. Two separate student profiles reflecting high and low GPA performance across each year of dental school were identified, and scores on cognitive preadmissions variables differentially predicted the probability of grouping into high and low performance profiles. Students with higher pre-dental GPAs and DAT chemistry were most likely to remain stable in a high-performance group across each year of dental school. Overall, the findings suggest that selection committees should consider pre-dental GPA and DAT chemistry scores as important tools for predicting dental school performance and stability across time. This research is important in determining how to better predict success and failure in various areas of preclinical dentistry courses and to provide low-performing students with adequate academic assistance.

An economic cost analysis of emergency department key performance indicators in Ireland.

PubMed

Gannon, Brenda; Jones, Cheryl; McCabe, Aileen; O'Sullivan, Ronan; Wakai, Abel

2017-06-01

High quality data is fundamental to using key performance indicators (KPIs) for performance monitoring. However, the resources required to collect high quality data are often significant and should usually be targeted at high priority areas. As part of a study of 11 emergency department (ED) KPIs in Ireland, the primary objective of this study was to estimate the relative cost of collecting the additional minimum data set (MDS) elements for those 11 KPIs. An economic cost analysis focused on 12 EDs in the Republic of Ireland. The resource use data were obtained using two separate focus group interviews. The number of available MDS elements was obtained from a sample of 100 patient records per KPI per participating ED. Unit costs for all resource use were taken at the midpoint of the relevant staff salary scales. An ED would need to spend an estimated additional &OV0556;3561 per month on average to capture all the MDS elements relevant to the 11 KPIs investigated. The additional cost ranges from 14.8 to 39.2%; this range is 13.9-32.3% for small EDs, whereas the range for medium EDs is 11.7-40%. Regional EDs have a higher additional estimated cost to capture all the relevant MDS elements (&OV0556;3907), compared with urban EDs (&OV0556;3353). The additional cost of data collection, contingent on that already collected, required to capture all the relevant MDS elements for the KPIs examined, ranges from 14.8 to 39.2% per KPI, with variation identified between regional and urban hospitals.

[Role of multislice computed tomography in the diagnosis of acute rupture of the thoracic aorta and hepatic artery in a patient with severe concomitant injury].

PubMed

Muslimov, R Sh; Sharifullin, F A; Chernaia, N R; Novruzbekov, M S; Kokov, L S

2015-01-01

Acute traumatic aortic rupture is associated with extremely high mortality rates and requires emergency diagnosis and treatment. This clinical example shows the role of multislice spiral computed tomography in the emergency diagnosis of rupture of two large arterial vessels in severe concomitant injury. It presents the benefits of this rapid and noninvasive imaging technique, an algorithm of the study and the semiotics of injuries in patients with suspected traumatic aortic rupture. The paper also shows the importance of this method in defining treatment policy and then in the assessment of the results of the performed correction.

A Grid Infrastructure for Supporting Space-based Science Operations

NASA Technical Reports Server (NTRS)

Bradford, Robert N.; Redman, Sandra H.; McNair, Ann R. (Technical Monitor)

2002-01-01

Emerging technologies for computational grid infrastructures have the potential for revolutionizing the way computers are used in all aspects of our lives. Computational grids are currently being implemented to provide a large-scale, dynamic, and secure research and engineering environments based on standards and next-generation reusable software, enabling greater science and engineering productivity through shared resources and distributed computing for less cost than traditional architectures. Combined with the emerging technologies of high-performance networks, grids provide researchers, scientists and engineers the first real opportunity for an effective distributed collaborative environment with access to resources such as computational and storage systems, instruments, and software tools and services for the most computationally challenging applications.

Performance Basis for Airborne Separation

NASA Technical Reports Server (NTRS)

Wing, David J.

2008-01-01

Emerging applications of Airborne Separation Assistance System (ASAS) technologies make possible new and powerful methods in Air Traffic Management (ATM) that may significantly improve the system-level performance of operations in the future ATM system. These applications typically involve the aircraft managing certain components of its Four Dimensional (4D) trajectory within the degrees of freedom defined by a set of operational constraints negotiated with the Air Navigation Service Provider. It is hypothesized that reliable individual performance by many aircraft will translate into higher total system-level performance. To actually realize this improvement, the new capabilities must be attracted to high demand and complexity regions where high ATM performance is critical. Operational approval for use in such environments will require participating aircraft to be certified to rigorous and appropriate performance standards. Currently, no formal basis exists for defining these standards. This paper provides a context for defining the performance basis for 4D-ASAS operations. The trajectory constraints to be met by the aircraft are defined, categorized, and assessed for performance requirements. A proposed extension of the existing Required Navigation Performance (RNP) construct into a dynamic standard (Dynamic RNP) is outlined. Sample data is presented from an ongoing high-fidelity batch simulation series that is characterizing the performance of an advanced 4D-ASAS application. Data of this type will contribute to the evaluation and validation of the proposed performance basis.

Emergency Preparedness and Disaster Response: There's An App for That.

PubMed

Bachmann, Daniel J; Jamison, Nathan K; Martin, Andrew; Delgado, Jose; Kman, Nicholas E

2015-10-01

Smartphone applications (or apps) are becoming increasingly popular with emergency responders and health care providers, as well as the public as a whole. There are thousands of medical apps available for Smartphones and tablet computers, with more added each day. These include apps to view textbooks, guidelines, medication databases, medical calculators, and radiology images. Hypothesis/Problem With an ever expanding catalog of apps that relate to disaster medicine, it is hard for both the lay public and responders to know where to turn for effective Smartphone apps. A systematic review of these apps was conducted. A search of the Apple iTunes store (Version 12; Apple Inc.; Cupertino, California USA) was performed using the following terms obtained from the PubMed Medical Subject Headings Database: Emergency Preparedness, Emergency Responders, Disaster, Disaster Planning, Disaster Medicine, Bioterrorism, Chemical Terrorism, Hazardous Materials (HazMat), and the Federal Emergency Management Agency (FEMA). After excluding any unrelated apps, a working list of apps was formed and categorized based on topics. Apps were grouped based on applicability to responders, the lay public, or regional preparedness, and were then ranked based on iTunes user reviews, value, relevance to audience, and user interface. This search revealed 683 applications and was narrowed to 219 based on relevance to the field. After grouping the apps as described above, and subsequently ranking them, the highest quality apps were determined from each group. The Community Emergency Response Teams and FEMA had the best apps for National Disaster Medical System responders. The Centers for Disease Control and Prevention (CDC) had high-quality apps for emergency responders in a variety of fields. The National Library of Medicine's Wireless Information System for Emergency Responders (WISER) app was an excellent app for HazMat responders. The American Red Cross had the most useful apps for natural disasters. Numerous valuable apps for public use, including alert apps, educational apps, and a well-made regional app, were also identified. Smartphone applications are fast becoming essential to emergency responders and the lay public. Many high-quality apps existing in various price ranges and serving different populations were identified. This field is changing rapidly and it deserves continued analysis as more apps are developed.

The Vietnam Initiative on Zoonotic Infections (VIZIONS): A Strategic Approach to Studying Emerging Zoonotic Infectious Diseases.

PubMed

Rabaa, Maia A; Tue, Ngo Tri; Phuc, Tran My; Carrique-Mas, Juan; Saylors, Karen; Cotten, Matthew; Bryant, Juliet E; Nghia, Ho Dang Trung; Cuong, Nguyen Van; Pham, Hong Anh; Berto, Alessandra; Phat, Voong Vinh; Dung, Tran Thi Ngoc; Bao, Long Hoang; Hoa, Ngo Thi; Wertheim, Heiman; Nadjm, Behzad; Monagin, Corina; van Doorn, H Rogier; Rahman, Motiur; Tra, My Phan Vu; Campbell, James I; Boni, Maciej F; Tam, Pham Thi Thanh; van der Hoek, Lia; Simmonds, Peter; Rambaut, Andrew; Toan, Tran Khanh; Van Vinh Chau, Nguyen; Hien, Tran Tinh; Wolfe, Nathan; Farrar, Jeremy J; Thwaites, Guy; Kellam, Paul; Woolhouse, Mark E J; Baker, Stephen

2015-12-01

The effect of newly emerging or re-emerging infectious diseases of zoonotic origin in human populations can be potentially catastrophic, and large-scale investigations of such diseases are highly challenging. The monitoring of emergence events is subject to ascertainment bias, whether at the level of species discovery, emerging disease events, or disease outbreaks in human populations. Disease surveillance is generally performed post hoc, driven by a response to recent events and by the availability of detection and identification technologies. Additionally, the inventory of pathogens that exist in mammalian and other reservoirs is incomplete, and identifying those with the potential to cause disease in humans is rarely possible in advance. A major step in understanding the burden and diversity of zoonotic infections, the local behavioral and demographic risks of infection, and the risk of emergence of these pathogens in human populations is to establish surveillance networks in populations that maintain regular contact with diverse animal populations, and to simultaneously characterize pathogen diversity in human and animal populations. Vietnam has been an epicenter of disease emergence over the last decade, and practices at the human/animal interface may facilitate the likelihood of spillover of zoonotic pathogens into humans. To tackle the scientific issues surrounding the origins and emergence of zoonotic infections in Vietnam, we have established The Vietnam Initiative on Zoonotic Infections (VIZIONS). This countrywide project, in which several international institutions collaborate with Vietnamese organizations, is combining clinical data, epidemiology, high-throughput sequencing, and social sciences to address relevant one-health questions. Here, we describe the primary aims of the project, the infrastructure established to address our scientific questions, and the current status of the project. Our principal objective is to develop an integrated approach to the surveillance of pathogens circulating in both human and animal populations and assess how frequently they are exchanged. This infrastructure will facilitate systematic investigations of pathogen ecology and evolution, enhance understanding of viral cross-species transmission events, and identify relevant risk factors and drivers of zoonotic disease emergence.

High-Performing Local Health Departments Relate Their Experiences at Community Engagement in Emergency Preparedness.

PubMed

Schoch-Spana, Monica; Ravi, Sanjana; Meyer, Diane; Biesiadecki, Laura; Mwaungulu, Geoffrey

Local health departments (LHDs) are implementing a national mandate to engage community partners, including individuals, businesses, and community- and faith-based organizations in the larger public health emergency preparedness (PHEP) enterprise. Investigate how LHDs of varying size and resource levels successfully engage the community in PHEP to help uncover "best practices" that aspiring agencies can replicate, particularly in low-resource environments. In-depth, semistructured qualitative interviews with practitioners from 9 highly performing LHDs. Participating agencies comprised equal amounts of small (serving <50 000 residents), medium (serving 50 000-500 000 residents), and large (serving >500 000 residents) LHDs and were diverse in terms of geographic region, rural-urban environment, and governance structure. A cross section of LHD staff (n = 34) including agency leaders, preparedness coordinators, public information officers, and health educators/promoters. Local health department performance at community engagement as determined by top scores in 2 national LHD surveys (2012, 2015) regarding community engagement in PHEP. Based on key informant accounts, high-performing LHDs show a holistic, organization-wide commitment to, rather than discrete focus on, community engagement. Best practices clustered around 5 domains: administration (eg, top executive who models collaborative behavior), organizational culture (eg, solicitous rather than prescriptive posture regarding community needs), social capital (eg, mining preexisting community connections held by other LHD programs), workforce skills (eg, cultural competence), and methods/tactics (eg, visibility in community events unrelated to PHEP). For LHDs that wish to enhance their performance at community engagement in PHEP, change will entail adoption of evidence-based interventions (the technical "what") as well as evidence-based administrative approaches (the managerial "how"). Smaller, rural LHDs should be encouraged that, in the case of PHEP community engagement, they have unique social assets that may help offset advantages that larger, more materially resourced metropolitan health departments may have.

Phenotypic plasticity facilitates resistance to climate change in a highly variable environment.

PubMed

Richter, Sarah; Kipfer, Tabea; Wohlgemuth, Thomas; Calderón Guerrero, Carlos; Ghazoul, Jaboury; Moser, Barbara

2012-05-01

Increased summer drought will exacerbate the regeneration of many tree species at their lower latitudinal and altitudinal distribution limits. In vulnerable habitats, introduction of more drought-tolerant provenances or species is currently considered to accelerate tree species migration and facilitate forest persistence. Trade-offs between drought adaptation and growth plasticity might, however, limit the effectiveness of assisted migration, especially if introductions focus on provenances or species from different climatic regions. We tested in a common garden experiment the performance of Pinus sylvestris seedlings from the continental Central Alps under increased temperatures and extended spring and/or summer drought, and compared seedling emergence, survival and biomass allocation to that of P. sylvestris and closely related Pinus nigra from a Mediterranean seed source. Soil heating had only minor effects on seedling performance but high spring precipitation doubled the number of continental P. sylvestris seedlings present after the summer drought. At the same time, twice as many seedlings of the Mediterranean than the continental P. sylvestris provenance were present, which was due to both higher emergence and lower mortality under dry conditions. Both P. sylvestris provenances allocated similar amounts of biomass to roots when grown under low summer precipitation. Mediterranean seedlings, however, revealed lower phenotypic plasticity than continental seedlings under high precipitation, which might limit their competitive ability in continental Alpine forests in non-drought years. By contrast, high variability in the response of individual seedlings to summer drought indicates the potential of continental P. sylvestris provenances to adapt to changing environmental conditions.

Evaluation of emergency department nursing services and patient satisfaction of services.

PubMed

Mollaoğlu, Mukadder; Çelik, Pelin

2016-10-01

To identify nursing services and assess patient satisfaction in patients who present to the emergency department. Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. This is a descriptive study. Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues. © 2016 John Wiley & Sons Ltd.

Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians.

PubMed

Eich, Christoph; Russo, Sebastian G; Heuer, Jan F; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus

2009-08-01

In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the characteristics of OOH paediatric emergencies. We retrospectively evaluated all OOH paediatric emergencies (0-14 years) within a 9-year period and attended by physician-staffed ground- or helicopter-based emergency medical service (EMS or HEMS) teams from our centre. We identified 2271 paediatric emergencies, making up 6.3% of all cases (HEMS 8.5%). NACA scores IV-VII were assigned in 27.3% (HEMS 32.0%). The leading diagnosis groups were age dependent: respiratory disorders (infants 34.5%, toddlers 21.8%, school children 15.0%), convulsions (17.2%, 43.2%, and 16.0%, respectively), and trauma (16.0%, 19.5%, and 44.4%, respectively). Endotracheal intubation was performed in 4.2% (HEMS 7.6%) and intraosseous canulation in 0.7% (HEMS 1.0%) of children. Cardiopulmonary resuscitation (CPR) was commenced in 2.3% (HEMS 3.4%). Thoracocentesis, chest drain insertion and defibrillation were rarities. HEMS physicians attended a particularly high fraction of drowning (80.0%), head injury (73.9%) and SIDS (60.0%) cases, whereas 75.6% of all respiratory emergencies were attended by ground-based EPs. Our data suggest that EPs need to be particularly confident with the care of children suffering respiratory disorders, convulsions, and trauma. The incidence of severe paediatric OOH emergencies requiring advanced interventions is higher in HEMS-attended cases. However, well-developed skills in airway management, CPR, and intraosseous canulation in children are essential for all EPs.

Mediaprocessors in medical imaging for high performance and flexibility

NASA Astrophysics Data System (ADS)

Managuli, Ravi; Kim, Yongmin

2002-05-01

New high performance programmable processors, called mediaprocessors, have been emerging since the early 1990s for various digital media applications, such as digital TV, set-top boxes, desktop video conferencing, and digital camcorders. Modern mediaprocessors, e.g., TI's TMS320C64x and Hitachi/Equator Technologies MAP-CA, can offer high performance utilizing both instruction-level and data-level parallelism. During this decade, with continued performance improvement and cost reduction, we believe that the mediaprocessors will become a preferred choice in designing imaging and video systems due to their flexibility in incorporating new algorithms and applications via programming and faster-time-to-market. In this paper, we will evaluate the suitability of these mediaprocessors in medical imaging. We will review the core routines of several medical imaging modalities, such as ultrasound and DR, and present how these routines can be mapped to mediaprocessors and their resultant performance. We will analyze the architecture of several leading mediaprocessors. By carefully mapping key imaging routines, such as 2D convolution, unsharp masking, and 2D FFT, to the mediaprocessor, we have been able to achieve comparable (if not better) performance to that of traditional hardwired approaches. Thus, we believe that future medical imaging systems will benefit greatly from these advanced mediaprocessors, offering significantly increased flexibility and adaptability, reducing the time-to-market, and improving the cost/performance ratio compared to the existing systems while meeting the high computing requirements.

Acute retrobulbar haemorrhage: An ophthalmologic emergency for the emergency physician.

PubMed

Pamukcu, Can; Odabaşı, Mahmut

2015-07-01

Acute retrobulbar haemorrhage (ARBH) is a rare ophthalmic emergency observed following blunt eye trauma. Multiple trauma and loss of consciousness can hide symptoms of ARBH. Rapid diagnosis and immediate lateral canthotomy and cantholysis must be performed to prevent permanent visual loss in patients. Medical treatment can be added to surgical therapy. Lateral canthotomy and cantholysis are simple procedures that can be performed by emergency physicians. In this report, it was aimed to present a case with post-traumatic ARBH and provide general knowledge about the diagnosis, follow-up and treatment of ARBH.

Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic.

PubMed

Shrestha, R; Shakya, R M; Khan A, A

2016-01-01

Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.

Assessing physician-parent communication during emergency medical procedures in children: an observational study in a low-literacy Latino patient population.

PubMed

Dahl, Aaron; Sinha, Madhumita; Rosenberg, David I; Tran, Melissa; Valdez, André

2015-05-01

Effective physician-patient communication is critical to the clinical decision-making process. We studied parental recall of information provided during an informed consent discussion process before performance of emergency medical procedures in a pediatric emergency department of an inner-city hospital with a large bilingual population. Fifty-five parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish postprocedure for recall of informed consent information. Exact logistic regression was used to predict the ability to name a risk, benefit, and alternative to the procedure based on a parent's language, education, and acculturation. Among English-speaking parents, there tended to be higher proportions that could name a risk, benefit, or alternative. Our regression models showed overall that the parents with more than a high school education tended to have nearly 5 times higher odds of being able to name a risk. A gap in communication may exist between physicians and patients (or parents of patients) during the consent-taking process, and this gap may be impacted by socio-demographic factors such as language and education level.

Development of low-cost high-performance multispectral camera system at Banpil

NASA Astrophysics Data System (ADS)

Oduor, Patrick; Mizuno, Genki; Olah, Robert; Dutta, Achyut K.

2014-05-01

Banpil Photonics (Banpil) has developed a low-cost high-performance multispectral camera system for Visible to Short- Wave Infrared (VIS-SWIR) imaging for the most demanding high-sensitivity and high-speed military, commercial and industrial applications. The 640x512 pixel InGaAs uncooled camera system is designed to provide a compact, smallform factor to within a cubic inch, high sensitivity needing less than 100 electrons, high dynamic range exceeding 190 dB, high-frame rates greater than 1000 frames per second (FPS) at full resolution, and low power consumption below 1W. This is practically all the feature benefits highly desirable in military imaging applications to expand deployment to every warfighter, while also maintaining a low-cost structure demanded for scaling into commercial markets. This paper describes Banpil's development of the camera system including the features of the image sensor with an innovation integrating advanced digital electronics functionality, which has made the confluence of high-performance capabilities on the same imaging platform practical at low cost. It discusses the strategies employed including innovations of the key components (e.g. focal plane array (FPA) and Read-Out Integrated Circuitry (ROIC)) within our control while maintaining a fabless model, and strategic collaboration with partners to attain additional cost reductions on optics, electronics, and packaging. We highlight the challenges and potential opportunities for further cost reductions to achieve a goal of a sub-$1000 uncooled high-performance camera system. Finally, a brief overview of emerging military, commercial and industrial applications that will benefit from this high performance imaging system and their forecast cost structure is presented.

Clinical Skills Performed By Iranian Emergency Nurses: Perceived Competency Levels and Attitudes Toward Expanding Professional Roles.

PubMed

Hassankhani, Hadi; Hasanzadeh, Firooz; Powers, Kelly A; Dadash Zadeh, Abbas; Rajaie, Rouzbeh

2018-03-01

Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed. In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings. Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P < .001). Participants had positive attitudes toward expanding their professional roles (2.13 ± 0.92), with 81.5% agreeing it would improve their job satisfaction. Higher perceived competency levels were significantly associated with more frequent performance of clinical skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

RAPID SEPARATION METHOD FOR EMERGENCY WATER AND URINE SAMPLES

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

Maxwell, S.; Culligan, B.

2008-08-27

The Savannah River Site Environmental Bioassay Lab participated in the 2008 NRIP Emergency Response program administered by the National Institute for Standards and Technology (NIST) in May, 2008. A new rapid column separation method was used for analysis of actinides and {sup 90}Sr the NRIP 2008 emergency water and urine samples. Significant method improvements were applied to reduce analytical times. As a result, much faster analysis times were achieved, less than 3 hours for determination of {sup 90}Sr and 3-4 hours for actinides. This represents a 25%-33% improvement in analysis times from NRIP 2007 and a {approx}100% improvement compared tomore » NRIP 2006 report times. Column flow rates were increased by a factor of two, with no significant adverse impact on the method performance. Larger sample aliquots, shorter count times, faster cerium fluoride microprecipitation and streamlined calcium phosphate precipitation were also employed. Based on initial feedback from NIST, the SRS Environmental Bioassay Lab had the most rapid analysis times for actinides and {sup 90}Sr analyses for NRIP 2008 emergency urine samples. High levels of potential matrix interferences may be present in emergency samples and rugged methods are essential. Extremely high levels of {sup 210}Po were found to have an adverse effect on the uranium results for the NRIP-08 urine samples, while uranium results for NRIP-08 water samples were not affected. This problem, which was not observed for NRIP-06 or NRIP-07 urine samples, was resolved by using an enhanced {sup 210}Po removal step, which will be described.« less

Hypertensive emergencies remain a clinical problem and are associated with high mortality.

PubMed

Roubsanthisuk, Weranuj; Wongsurin, Unticha; Buranakitjaroen, Peera

2010-01-01

We suspect that hypertensive emergencies remain a clinical problem and data on their long-term prognosis are lacking. This study was conducted in order to determine the frequency, management, and outcome of hypertensive emergencies in this era, in which hypertension treatment is more effective than in the past. We reviewed the medical records of patients with hypertensive emergencies admitted to the medical wards of Siriraj Hospital in 2003 and collected data on their characteristic, management, investigations, and follow-ups through 31 December 2007. There were 184 patients included. Hypertension has been previously diagnosed in 89% of cases. Nearly half also had diabetes mellitus and around a quarter had chronic kidney failure. Mean +/- SD of blood pressure at presentation was 205.96 +/- 21.36/114.60 +/- 20.59 mmHg. Cardiac complications and stroke accounted for 71% and 23% of all target organ damage, respectively. Intravenous nitroglycerine and furosemide were most frequently prescribed. Additional investigations to search for the causes of hypertension were performed in only 55 cases. The average hospital stay was 9.8 days. The in-hospital mortality rate was 15%. Some 26% of patients were lost to follow-up and another 20% died later. Only 19% of patients had regular follow-ups until the end of 2007 and remained on an average of 2.4 antihypertensive drugs. Hypertensive emergencies are usually found in patients with a history of hypertension and diabetes mellitus or kidney failure. Recommended investigations usually failed to identify the cause of hypertension. The mortality rate of these patients was extremely high while their adherence to treatment was extremely poor.

Diagnostic work-up of patients with suspected pulmonary embolism: a survey of strategies used by emergency physicians.

PubMed

Erdur, Bülent; Karabulut, Nevzat; Türkçüer, Ibrahim; Ergin, Ahmet

2009-09-01

In this study, we aimed to document imaging practices and diagnostic strategies used by emergency physicians in patients with suspected high-probability pulmonary embolism (PE). A questionnaire investigating the diagnostic strategies used by the emergency physicians in the evaluation of venous thromboembolism was mailed electronically to all emergency department residents and specialists practicing in 62 medical institutions in Turkey. The questionnaire gathered information about the availability and frequency of use of diagnostic imaging modalities in different scenarios in patients with suspected high-probability PE. Echocardiography, helical computed tomography (CT), and D-dimer test were the most available tools around the clock with a frequency of use of 78%, 73%, and 67%, respectively. One hundred and nineteen of 176 respondents (68%) reported that they request D-dimer "invariably" before performing an imaging examination in patients with suspected highprobability PE (SHPPE). Before ordering advanced imaging, 136 EPs (77%) would always obtain chest radiographs. Fifty-four residents (55%) and 39 specialists (51%) indicated that CTPA would likely be the first examination for patients with SHPPE and with signs of deep venous thrombosis (DVT) (P = 0.8). The most frequently selected examination for patients with SHPPE and without signs of DVT was CTPA, reported by 69 of the residents (70%) and 53 of the specialists (69%) (P = 0.9). This survey did not show significant variations either in the practices and policies used by emergency physicians, or in the methodological approaches between specialists and residents. Among the imaging modalities, CTPA was the tool most preferred by physicians for patients with suspected acute PE.

Piloted Simulation Assessment of a High-Speed Civil Transport Configuration. [conducted with the Langley six-degree-of-freedom Visual Motion Simulator

NASA Technical Reports Server (NTRS)

Jackson, E. Bruce; Raney, David L.; Glaab, Louis J.; Derry, Stephen D.

2002-01-01

An assessment of a proposed configuration of a high-speed civil transport was conducted by using NASA and industry research pilots. The assessment was conducted to evaluate operational aspects of the configuration from a pilot's perspective, with the primary goal being to identify potential deficiencies in the configuration. The configuration was evaluated within and at the limits of the design operating envelope to determine the suitability of the configuration to maneuver in a typical mission as well as in emergency or envelope-limit conditions. The Cooper-Harper rating scale was used to evaluate the flying qualities of the configuration. A summary flying qualities metric was also calculated. The assessment was performed in the Langley six-degree-of-freedom Visual Motion Simulator. The effect of a restricted cockpit field-of-view due to obstruction by the vehicle nose was not included in this study. Tasks include landings, takeoffs, climbs, descents, overspeeds, coordinated turns, and recoveries from envelope limit excursions. Emergencies included engine failures, loss of stability augmentation, engine inlet unstarts, and emergency descents. Minimum control speeds and takeoff decision, rotation, and safety speeds were also determined.

Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings.

PubMed

Acestor, Nathalie; Goett, Jane; Lee, Arthur; Herrick, Tara M; Engelbrecht, Susheela M; Harner-Jay, Claudia M; Howell, Bonnie J; Weigl, Bernhard H

2016-01-01

In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

BodyHeat Encounter: Performing Technology in Pedagogical Spaces of Surveillance/Intimacy

ERIC Educational Resources Information Center

Fels, Lynn; Ricketts, Kathryn

2015-01-01

What occurs when videographer and performer encounter each other through the lens of a camera? This collaborative performative inquiry focuses on embodiment and emergent narrative as realized through an encounter between technology and the visceral body--a relational body that smells, touches, sees, hears and feels the emergent world through…

Prehospital paediatric emergencies treated by an Australian helicopter emergency medical service.

PubMed

Barker, Claire L; Weatherall, Andrew D

2014-04-01

The aim of this study was to describe the mechanism and severity of injuries in the paediatric population treated by an Australian helicopter emergency medical service and to examine the frequency and nature of interventions performed. This information is important for planning education and continuing professional development in prehospital medicine. The study is a retrospective cohort analysis of 349 patients under the age of 16 treated by CareFlight in Sydney, Australia, between April 2007 and April 2012. Data collected included age, type of incident, medication and fluid administered, procedures performed, receiving hospital, 24 h and 30-day mortality and injuries sustained. Falls (33%), motor vehicle incidents (30%), sport injury (14%) and immersion injury (12%) were the most common mechanisms. A total of 27 children died within 30 days; nontrauma cases were proportionally overrepresented in the deaths. With respect to tasking, 59% cases involved a severely or significantly injured child. Among the children, 97% with a traumatic mechanism were transferred directly to a paediatric trauma centre.In addition, 81% of children had at least one intervention by the helicopter emergency medical services team at the incident scene, most commonly intravenous cannulation (61%), crystalloid bolus (29%), intubation (21%) and intravenous analgesia administration (15%). Paediatric prehospital patients can be of high dependency, requiring urgent critical care procedures. Training in prehospital medicine should include paediatrics. It is essential that practitioners maintain skills in venous access, airway management and provision of adequate analgesia in children.

Increase urban resilience by planning the public spaces uses for humanitarian interventions.

NASA Astrophysics Data System (ADS)

Delaitre, Maxime; Barroca, Bruno; Vargas, Jorge; Cornejo, Christian; Sierra, Alexis

2017-04-01

Challenges in post-disaster crisis of natural origin seem to have a strong relation with territory characteristics (location, habitat, propagation, etc.). Moreover, they determine those requirements needed for humanitarian interventions. Decision-making at response and recuperation stages are supported or limited depending on the availability of public spaces to be used for victims' accommodation, field hospitals and rubble deposits. In the case of Lima and Callao (Peru), the presence and superposition of multiple governmental levels - national, regional (1), provincial (2) and district (50) - result in a highly-complex local Disaster Risk Management system for response coordination. The diversity of actors, their responsibilities and individual initiative suggest competition for the resources available in an emergency situation. Resource location determines if humanitarian operations can be run in an effective and efficient way. In this context, public space is a fundamental resource; if it is well-selected, it will provide access to accumulated resources such as water, electricity and telecommunications for the affected population. To increase urban resilience, it requires previous planning and coordination for emergency response, where institutional and territorial configurations are decisive factors for the recuperation and rehabilitation processes performance. This communication will present the institutional and territorial dimensions of the Peruvian capital which condition emergency management performances to consider the crisis management opportunities, offered by territorial analysis and estimations of actors' needs. It would be a starting point for decision-making on emergence activities locations and for establishing coordination frameworks concerning territorial issues and challenges.

Emerging trends in evolving networks: Recent behaviour dominant and non-dominant model

NASA Astrophysics Data System (ADS)

Abbas, Khushnood; Shang, Mingsheng; Luo, Xin; Abbasi, Alireza

2017-10-01

Novel phenomenon receives similar attention as popular one. Therefore predicting novelty is as important as popularity. Emergence is the side effect of competition and ageing in evolving systems. Recent behaviour or recent link gain in networks plays an important role in emergence. We exploited this wisdom and came up with two models considering different scenarios and systems. Where recent behaviour dominates over total behaviour (total link gain) in the first one, and recent behaviour is as important as total behaviour for future link gain in the second one. It supposes that random walker walks on a network and can jump to any node, the probability of jumping or making a connection to other node is based on which node is recently more active or receiving more links. In our assumption, the random walker can also jump to the node which is already popular but recently not popular. We are able to predict emerging nodes which are generally suppressed under preferential attachment effect. To show the performance of our model we have conducted experiments on four real data sets namely, MovieLens, Netflix, Facebook and Arxiv High Energy Physics paper citation. For testing our model we used four information retrieval indices namely Precision, Novelty, Area Under Receiving Operating Characteristic (AUC) and Kendal's rank correlation coefficient. We have used four benchmark models for validating our proposed models. Although our model does not perform better in all the cases but, it has theoretical significance in working better for recent behaviour dominated systems.

The flex track: flexible partitioning between low- and high-acuity areas of an emergency department.

PubMed

Laker, Lauren F; Froehle, Craig M; Lindsell, Christopher J; Ward, Michael J

2014-12-01

Emergency departments (EDs) with both low- and high-acuity treatment areas often have fixed allocation of resources, regardless of demand. We demonstrate the utility of discrete-event simulation to evaluate flexible partitioning between low- and high-acuity ED areas to identify the best operational strategy for subsequent implementation. A discrete-event simulation was used to model patient flow through a 50-bed, urban, teaching ED that handles 85,000 patient visits annually. The ED has historically allocated 10 beds to a fast track for low-acuity patients. We estimated the effect of a flex track policy, which involved switching up to 5 of these fast track beds to serving both low- and high-acuity patients, on patient waiting times. When the high-acuity beds were not at capacity, low-acuity patients were given priority access to flexible beds. Otherwise, high-acuity patients were given priority access to flexible beds. Wait times were estimated for patients by disposition and Emergency Severity Index score. A flex track policy using 3 flexible beds produced the lowest mean patient waiting time of 30.9 minutes (95% confidence interval [CI] 30.6 to 31.2 minutes). The typical fast track approach of rigidly separating high- and low-acuity beds produced a mean patient wait time of 40.6 minutes (95% CI 40.2 to 50.0 minutes), 31% higher than that of the 3-bed flex track. A completely flexible ED, in which all beds can accommodate any patient, produced mean wait times of 35.1 minutes (95% CI 34.8 to 35.4 minutes). The results from the 3-bed flex track scenario were robust, performing well across a range of scenarios involving higher and lower patient volumes and care durations. Using discrete-event simulation, we have shown that adding some flexibility into bed allocation between low and high acuity can provide substantial reductions in overall patient waiting and a more efficient ED. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital.

PubMed

Lotze, Ulrich; Lemm, Holger; Heyer, Anke; Müller, Karin

2011-01-01

The purpose of this observational study was to test the diagnostic performance of the Elecsys® troponin T high-sensitive system combined with copeptin measurement for early exclusion of acute myocardial infarction (MI) in clinical practice. Troponin T high-sensitive (diagnostic cutoff: <14 pg/mL) and copeptin (diagnostic cutoff: <14 pmol/L) levels were determined at admission in addition to other routine laboratory parameters in patients with suspected acute MI presenting to the emergency department of a general hospital over a period of five months. Data from 142 consecutive patients (mean age 71.2 ± 13.5 years, 76 men) were analyzed. Final diagnoses were acute MI in 13 patients (nine ST elevation MI, four non-ST elevation MI, 9.2%) unstable angina pectoris in three (2.1%), cardiac symptoms not primarily associated with myocardial ischemia in 79 (55.6%), and noncardiac disease in 47 patients (33.1%). The patients with acute MI were younger and had higher troponin T high-sensitive and copeptin values than patients without acute MI. Seventeen patients had very high copeptin values (>150 pmol/L), one of whom had a level of >700 pmol/L and died of pulmonary embolism. A troponin T high-sensitive level of <14 pg/mL in combination with copeptin <14 pmol/L at initial presentation ruled out acute MI in 45 of the 142 patients (31.7%), each with a sensitivity and negative predictive value of 100%. According to this early experience, a single determination of troponin T high-sensitive and copeptin may enable early and accurate exclusion of acute MI in one third of patients, even in an emergency department of a general hospital.

Mental models of audit and feedback in primary care settings.

PubMed

Hysong, Sylvia J; Smitham, Kristen; SoRelle, Richard; Amspoker, Amber; Hughes, Ashley M; Haidet, Paul

2018-05-30

Audit and feedback has been shown to be instrumental in improving quality of care, particularly in outpatient settings. The mental model individuals and organizations hold regarding audit and feedback can moderate its effectiveness, yet this has received limited study in the quality improvement literature. In this study we sought to uncover patterns in mental models of current feedback practices within high- and low-performing healthcare facilities. We purposively sampled 16 geographically dispersed VA hospitals based on high and low performance on a set of chronic and preventive care measures. We interviewed up to 4 personnel from each location (n = 48) to determine the facility's receptivity to audit and feedback practices. Interview transcripts were analyzed via content and framework analysis to identify emergent themes. We found high variability in the mental models of audit and feedback, which we organized into positive and negative themes. We were unable to associate mental models of audit and feedback with clinical performance due to high variance in facility performance over time. Positive mental models exhibit perceived utility of audit and feedback practices in improving performance; whereas, negative mental models did not. Results speak to the variability of mental models of feedback, highlighting how facilities perceive current audit and feedback practices. Findings are consistent with prior research  in that variability in feedback mental models is associated with lower performance.; Future research should seek to empirically link mental models revealed in this paper to high and low levels of clinical performance.

75 FR 49508 - Recovery Policy, RP9525.7, Labor Costs-Emergency Work

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

...] Recovery Policy, RP9525.7, Labor Costs--Emergency Work AGENCY: Federal Emergency Management Agency, DHS... (FEMA) is accepting comments on RP9525.7, Labor Costs--Emergency Work. This is an existing policy that... who perform emergency work (Categories A and B). DATES: Comments must be received by September 13...

STORC safety initiative: a multicentre survey on preparedness & confidence in obstetric emergencies.

PubMed

Guise, Jeanne-Marie; Segel, Sally Y; Larison, Kristine; M Jump, Sarah; Constable, Marion; Li, Hong; Osterweil, Patricia; Dieter Zimmer

2010-12-01

Patient safety is a national and international priority. The purpose of this study was to understand clinicians' perceptions of teamwork during obstetric emergencies in clinical practice, to examine factors associated with confidence in responding to obstetric emergencies and to evaluate perceptions about the value of team training to improve preparedness. An anonymous survey was administered to all clinical staff members who respond to obstetric emergencies in seven Oregon hospitals from June 2006 to August 2006. 614 clinical staff (74.5%) responded. While over 90% felt confident that the appropriate clinical staff would respond to emergencies, more than half reported that other clinical staff members were confused about their role during emergencies. Over 84% were confident that emergency drills or simulation-based team training would improve performance. Clinical staff who respond to obstetric emergencies in their practice reported feeling confident that the qualified personnel would respond to an emergency; however, they were less confident that the responders would perform well as a team. They reported that simulation and team training may improve their preparedness and confidence in responding to emergencies.

A Longitudinal Examination of the Persistence of Late Emerging Reading Disabilities.

PubMed

Etmanskie, Jill M; Partanen, Marita; Siegel, Linda S

2016-01-01

There are some children who encounter unexpected reading difficulties in the fourth grade. This phenomenon has been described as late emerging reading disabilities (LERD). Using Grade 4 as a starting point, this study examined the reading development of 964 children between kindergarten and Grade 7. The results showed that 72.0% of children had typical reading performance in Grade 4, whereas there was 0.7% with poor word reading, 12.6% with poor reading comprehension, 2.5% with poor word reading and comprehension, and 12.2% with borderline performance. We also showed that there were similar proportions of children who had early versus late emerging reading difficulties; however, most of the late emerging poor readers recovered by Grade 7. Furthermore, our study showed that poor comprehenders showed poorer performance than typical readers on word reading, pseudoword decoding, and spelling between Grade 1 and Grade 7 and poorer performance on a working memory task in kindergarten. Overall, this study showed that most children recover from late emerging reading problems and that working memory may be an early indicator for reading comprehension difficulties. © Hammill Institute on Disabilities 2014.

Highly Sensitive Bulk Silicon Chemical Sensors with Sub-5 nm Thin Charge Inversion Layers.

PubMed

Fahad, Hossain M; Gupta, Niharika; Han, Rui; Desai, Sujay B; Javey, Ali

2018-03-27

There is an increasing demand for mass-producible, low-power gas sensors in a wide variety of industrial and consumer applications. Here, we report chemical-sensitive field-effect-transistors (CS-FETs) based on bulk silicon wafers, wherein an electrostatically confined sub-5 nm thin charge inversion layer is modulated by chemical exposure to achieve a high-sensitivity gas-sensing platform. Using hydrogen sensing as a "litmus" test, we demonstrate large sensor responses (>1000%) to 0.5% H 2 gas, with fast response (<60 s) and recovery times (<120 s) at room temperature and low power (<50 μW). On the basis of these performance metrics as well as standardized benchmarking, we show that bulk silicon CS-FETs offer similar or better sensing performance compared to emerging nanostructures semiconductors while providing a highly scalable and manufacturable platform.

Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital

PubMed Central

Hwang, Hamish; Marsh, Ian; Doyle, Jason

2014-01-01

Background Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high false-negative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate. This study was designed to review the accuracy of ultrasonography for diagnosing acute cholecystitis in a regional hospital. Methods We studied all emergency cholecystectomies performed over a 1-year period. All imaging studies were reviewed by a single radiologist, and all pathology was reviewed by a single pathologist. The reviewers were blinded to each other’s results. Results A total of 107 patients required an emergency cholecystectomy in the study period; 83 of them underwent ultrasonography. Interradiologist agreement was 92% for ultrasonography. For cholelithiasis, ultrasonography had 100% sensitivity, 18% specificity, 81% positive predictive value (PPV) and 100% negative predictive value (NPV). For acute cholecystitis, it had 54% sensitivity, 81% specificity, 85% PPV and 47% NPV. All patients had chronic cholecystitis and 67% had acute cholecystitis on histology. When combined with positive Murphy sign and elevated neutrophil count, an ultrasound showing cholelithiasis or acute cholecystitis yielded a sensitivity of 74%, specificity of 62%, PPV of 80% and NPV of 53% for the diagnosis of acute cholecystitis. Conclusion Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis. However, a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count and an ultrasound showing cholelithiasis or cholecystitis. PMID:24869607

Road Accident Prevention with Instant Emergency Warning Message Dissemination in Vehicular Ad-Hoc Network.

PubMed

Gokulakrishnan, P; Ganeshkumar, P

2015-01-01

A Road Accident Prevention (RAP) scheme based on Vehicular Backbone Network (VBN) structure is proposed in this paper for Vehicular Ad-hoc Network (VANET). The RAP scheme attempts to prevent vehicles from highway road traffic accidents and thereby reduces death and injury rates. Once the possibility of an emergency situation (i.e. an accident) is predicted in advance, instantly RAP initiates a highway road traffic accident prevention scheme. The RAP scheme constitutes the following activities: (i) the Road Side Unit (RSU) constructs a Prediction Report (PR) based on the status of the vehicles and traffic in the highway roads, (ii) the RSU generates an Emergency Warning Message (EWM) based on an abnormal PR, (iii) the RSU forms a VBN structure and (iv) the RSU disseminates the EWM to the vehicles that holds the high Risk Factor (RF) and travels in High Risk Zone (HRZ). These vehicles might reside either within the RSU's coverage area or outside RSU's coverage area (reached using VBN structure). The RAP scheme improves the performance of EWM dissemination in terms of increase in notification and decrease in end-to-end delay. The RAP scheme also reduces infrastructure cost (number of RSUs) by formulating and deploying the VBN structure. The RAP scheme with VBN structure improves notification by 19 percent and end-to-end delay by 14.38 percent for a vehicle density of 160 vehicles. It is also proved from the simulation experiment that the performance of RAP scheme is promising in 4-lane highway roads.

The influence of Australian eye banking practices on corneal graft survival.

PubMed

Keane, Miriam C; Lowe, Marie T; Coster, Douglas J; Pollock, Graeme A; Williams, Keryn A

2013-08-19

To identify eye banking practices that influence corneal graft survival. Prospective cohort study of records of 19,254 followed corneal grafts in 15160 patients, submitted to the Australian Corneal Graft Registry between May 1985 and July 2012. Influence of corneal preservation method (organ culture, moist pot, Optisol, other); death-to-enucleation, death-to-preservation and enucleation-to-graft times; transportation by air; graft era; and indication for graft on probability of graft survival at most recent follow-up. In multivariate analysis, 919 penetrating grafts performed using corneas transported interstate by air exhibited worse survival than 14,684 grafts performed using corneas retrieved and used locally (hazard ratio [HR], 1.44; 95% CI, 1.21-1.73; P = 0.001). This was also the case for traditional lamellar grafts (64 corneas transported by air and 813 used locally; HR, 1.69; 95% CI, 1.03-2.78; P = 0.038). Indication for graft influenced survival of penetrating grafts (4611 keratoconus, 727 emergency or high-risk, 10,265 other indication; global P < 0.001) and traditional lamellar grafts (65 keratoconus, 212 emergency or high-risk, 600 other indication; global P < 0.001). The preservation medium in which corneas used for traditional lamellar grafts were stored exerted a marginal influence on graft survival (global P = 0.047). Donor corneas transported interstate exhibited poorer survival after transplantation than those retrieved and grafted locally. Higher proportions of emergency procedures involving transported corneas did not account for this difference. Where possible, efforts to avoid transportation of corneal tissue by air freight within Australia may be warranted.

Road Accident Prevention with Instant Emergency Warning Message Dissemination in Vehicular Ad-Hoc Network

PubMed Central

P, Gokulakrishnan; P, Ganeshkumar

2015-01-01

A Road Accident Prevention (RAP) scheme based on Vehicular Backbone Network (VBN) structure is proposed in this paper for Vehicular Ad-hoc Network (VANET). The RAP scheme attempts to prevent vehicles from highway road traffic accidents and thereby reduces death and injury rates. Once the possibility of an emergency situation (i.e. an accident) is predicted in advance, instantly RAP initiates a highway road traffic accident prevention scheme. The RAP scheme constitutes the following activities: (i) the Road Side Unit (RSU) constructs a Prediction Report (PR) based on the status of the vehicles and traffic in the highway roads, (ii) the RSU generates an Emergency Warning Message (EWM) based on an abnormal PR, (iii) the RSU forms a VBN structure and (iv) the RSU disseminates the EWM to the vehicles that holds the high Risk Factor (RF) and travels in High Risk Zone (HRZ). These vehicles might reside either within the RSU’s coverage area or outside RSU’s coverage area (reached using VBN structure). The RAP scheme improves the performance of EWM dissemination in terms of increase in notification and decrease in end-to-end delay. The RAP scheme also reduces infrastructure cost (number of RSUs) by formulating and deploying the VBN structure. The RAP scheme with VBN structure improves notification by 19 percent and end-to-end delay by 14.38 percent for a vehicle density of 160 vehicles. It is also proved from the simulation experiment that the performance of RAP scheme is promising in 4-lane highway roads. PMID:26636576

Performance Under Stress Conditions During Multidisciplinary Team Immersive Pediatric Simulations.

PubMed

Ghazali, Daniel Aiham; Darmian-Rafei, Ivan; Ragot, Stéphanie; Oriot, Denis

2018-06-01

The primary objective was to determine whether technical and nontechnical performances were in some way correlated during immersive simulation. Performance was measured among French Emergency Medical Service workers at an individual and a team level. Secondary objectives were to assess stress response through collection of physiologic markers (salivary cortisol, heart rate, the proportion derived by dividing the number of interval differences of successive normal-to-normal intervals > 50 ms by the total number of normal-to-normal intervals [pNN50], low- and high-frequency ratio) and affective data (self-reported stress, confidence, and dissatisfaction), and to correlate them to performance scores. Prospective observational study performed as part of a larger randomized controlled trial. Medical simulation laboratory. Forty-eight participants distributed among 12 Emergency Medical System teams. Individual and team performance measures and individual stress response were assessed during a high-fidelity simulation. Technical performance was assessed by the intraosseous access performance scale and the Team Average Performance Assessment Scale; nontechnical performance by the Behavioral Assessment Tool for leaders, and the Clinical Teamwork Scale. Stress markers (salivary cortisol, heart rate, pNN50, low- and high-frequency ratio) were measured both before (T1) and after the session (T2). Participants self-reported stress before and during the simulation, self-confidence, and perception of dissatisfaction with team performance, rated on a scale from 0 to 10. Scores (out of 100 total points, mean ± SD) were intraosseous equals to 65.6 ± 14.4, Team Average Performance Assessment Scale equals to 44.6 ± 18.1, Behavioral Assessment Tool equals to 49.5 ± 22.0, Clinical Teamwork Scale equals to 50.3 ± 18.5. There was a strong correlation between Behavioral Assessment Tool and Clinical Teamwork Scale (Rho = 0.97; p = 0.001), and Behavioral Assessment Tool and Team Average Performance Assessment Scale (Rho = 0.73; p = 0.02). From T1 to T2, all stress markers (salivary cortisol, heart rate, pNN50, and low- and high-frequency ratio) displayed an increase in stress level (p < 0.001 for all). Self-confidence was positively correlated with performance (Clinical Teamwork Scale: Rho = 0.47; p = 0.001, Team Average Performance Assessment Scale: Rho = 0.46; p = 0.001). Dissatisfaction was negatively correlated with performance (Rho = -0.49; p = 0.0008 with Behavioral Assessment Tool, Rho = -0.47; p = 0.001 with Clinical Teamwork Scale, Rho = -0.51; p = 0.0004 with Team Average Performance Assessment Scale). No correlation between stress response and performance was found. There was a positive correlation between leader (Behavioral Assessment Tool) and team (Clinical Teamwork Scale and Team Average Performance Assessment Scale) performances. These performance scores were positively correlated with self-confidence and negatively correlated with dissatisfaction.

Emerging Executive Functioning and Motor Development in Infants at High and Low Risk for Autism Spectrum Disorder.

PubMed

St John, Tanya; Estes, Annette M; Dager, Stephen R; Kostopoulos, Penelope; Wolff, Jason J; Pandey, Juhi; Elison, Jed T; Paterson, Sarah J; Schultz, Robert T; Botteron, Kelly; Hazlett, Heather; Piven, Joseph

2016-01-01

Existing evidence suggests executive functioning (EF) deficits may be present in children with autism spectrum disorder (ASD) by 3 years of age. It is less clear when, prior to 3 years, EF deficits may emerge and how EF unfold over time. The contribution of motor skill difficulties to poorer EF in children with ASD has not been systematically studied. We investigated the developmental trajectory of EF in infants at high and low familial risk for ASD (HR and LR) and the potential associations between motor skills, diagnostic group, and EF performance. Participants included 186 HR and 76 LR infants. EF (A-not-B), motor skills (Fine and Gross Motor), and cognitive ability were directly assessed at 12 months and 24 months of age. Participants were directly evaluated for ASD at 24 months using DSM-IV-TR criteria and categorized as HR-ASD, HR-Negative, and LR-Negative. HR-ASD and HR-Negative siblings demonstrated less improvement in EF over time compared to the LR-Negative group. Motor skills were associated with group and EF performance at 12 months. No group differences were found at 12 months, but at 24 months, the HR-ASD and HR-Negative groups performed worse than the LR-Negative group overall after controlling for visual reception and maternal education. On reversal trials, the HR-ASD group performed worse than the LR-Negative group. Motor skills were associated with group and EF performance on reversal trials at 24 months. Findings suggest that HR siblings demonstrate altered EF development and that motor skills may play an important role in this process.

Emerging Executive Functioning and Motor Development in Infants at High and Low Risk for Autism Spectrum Disorder

PubMed Central

St. John, Tanya; Estes, Annette M.; Dager, Stephen R.; Kostopoulos, Penelope; Wolff, Jason J.; Pandey, Juhi; Elison, Jed T.; Paterson, Sarah J.; Schultz, Robert T.; Botteron, Kelly; Hazlett, Heather; Piven, Joseph

2016-01-01

Existing evidence suggests executive functioning (EF) deficits may be present in children with autism spectrum disorder (ASD) by 3 years of age. It is less clear when, prior to 3 years, EF deficits may emerge and how EF unfold over time. The contribution of motor skill difficulties to poorer EF in children with ASD has not been systematically studied. We investigated the developmental trajectory of EF in infants at high and low familial risk for ASD (HR and LR) and the potential associations between motor skills, diagnostic group, and EF performance. Participants included 186 HR and 76 LR infants. EF (A-not-B), motor skills (Fine and Gross Motor), and cognitive ability were directly assessed at 12 months and 24 months of age. Participants were directly evaluated for ASD at 24 months using DSM-IV-TR criteria and categorized as HR-ASD, HR-Negative, and LR-Negative. HR-ASD and HR-Negative siblings demonstrated less improvement in EF over time compared to the LR-Negative group. Motor skills were associated with group and EF performance at 12 months. No group differences were found at 12 months, but at 24 months, the HR-ASD and HR-Negative groups performed worse than the LR-Negative group overall after controlling for visual reception and maternal education. On reversal trials, the HR-ASD group performed worse than the LR-Negative group. Motor skills were associated with group and EF performance on reversal trials at 24 months. Findings suggest that HR siblings demonstrate altered EF development and that motor skills may play an important role in this process. PMID:27458411

Emergency department performance measures updates: proceedings of the 2014 emergency department benchmarking alliance consensus summit.

PubMed

Wiler, Jennifer L; Welch, Shari; Pines, Jesse; Schuur, Jeremiah; Jouriles, Nick; Stone-Griffith, Suzanne

2015-05-01

The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations. Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus. A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency. Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers. © 2015 by the Society for Academic Emergency Medicine.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-Time Process Analytics in Emergency Healthcare.

PubMed

Koufi, Vassiliki; Malamateniou, Flora; Prentza, Adrianna; Vassilacopoulos, George

2017-01-01

Emergency medical systems (EMS) are considered to be amongst the most crucial systems as they involve a variety of activities which are performed from the time of a call to an ambulance service till the time of patient's discharge from the emergency department of a hospital. These activities are closely interrelated so that collaboration and coordination becomes a vital issue for patients and for emergency healthcare service performance. The utilization of standard workflow technology in the context of Service Oriented Architecture can provide an appropriate technological infrastructure for defining and automating EMS processes that span organizational boundaries so that to create and empower collaboration and coordination among the participating organizations. In such systems, the utilization of leading-edge analytics tools can prove important as it can facilitate real-time extraction and visualization of useful insights from the mountains of generated data pertaining to emergency case management. This paper presents a framework which provides healthcare professionals with just-in-time insight within and across emergency healthcare processes by performing real-time analysis on process-related data in order to better support decision making and identify potential critical risks that may affect the provision of emergency care to patients.

High-performance multiprocessor architecture for a 3-D lattice gas model

NASA Technical Reports Server (NTRS)

Lee, F.; Flynn, M.; Morf, M.

1991-01-01

The lattice gas method has recently emerged as a promising discrete particle simulation method in areas such as fluid dynamics. We present a very high-performance scalable multiprocessor architecture, called ALGE, proposed for the simulation of a realistic 3-D lattice gas model, Henon's 24-bit FCHC isometric model. Each of these VLSI processors is as powerful as a CRAY-2 for this application. ALGE is scalable in the sense that it achieves linear speedup for both fixed and increasing problem sizes with more processors. The core computation of a lattice gas model consists of many repetitions of two alternating phases: particle collision and propagation. Functional decomposition by symmetry group and virtual move are the respective keys to efficient implementation of collision and propagation.

Progress in biocatalysis with immobilized viable whole cells: systems development, reaction engineering and applications.

PubMed

Polakovič, Milan; Švitel, Juraj; Bučko, Marek; Filip, Jaroslav; Neděla, Vilém; Ansorge-Schumacher, Marion B; Gemeiner, Peter

2017-05-01

Viable microbial cells are important biocatalysts in the production of fine chemicals and biofuels, in environmental applications and also in emerging applications such as biosensors or medicine. Their increasing significance is driven mainly by the intensive development of high performance recombinant strains supplying multienzyme cascade reaction pathways, and by advances in preservation of the native state and stability of whole-cell biocatalysts throughout their application. In many cases, the stability and performance of whole-cell biocatalysts can be highly improved by controlled immobilization techniques. This review summarizes the current progress in the development of immobilized whole-cell biocatalysts, the immobilization methods as well as in the bioreaction engineering aspects and economical aspects of their biocatalytic applications.

An integrated framework for high level design of high performance signal processing circuits on FPGAs

NASA Astrophysics Data System (ADS)

Benkrid, K.; Belkacemi, S.; Sukhsawas, S.

2005-06-01

This paper proposes an integrated framework for the high level design of high performance signal processing algorithms' implementations on FPGAs. The framework emerged from a constant need to rapidly implement increasingly complicated algorithms on FPGAs while maintaining the high performance needed in many real time digital signal processing applications. This is particularly important for application developers who often rely on iterative and interactive development methodologies. The central idea behind the proposed framework is to dynamically integrate high performance structural hardware description languages with higher level hardware languages in other to help satisfy the dual requirement of high level design and high performance implementation. The paper illustrates this by integrating two environments: Celoxica's Handel-C language, and HIDE, a structural hardware environment developed at the Queen's University of Belfast. On the one hand, Handel-C has been proven to be very useful in the rapid design and prototyping of FPGA circuits, especially control intensive ones. On the other hand, HIDE, has been used extensively, and successfully, in the generation of highly optimised parameterisable FPGA cores. In this paper, this is illustrated in the construction of a scalable and fully parameterisable core for image algebra's five core neighbourhood operations, where fully floorplanned efficient FPGA configurations, in the form of EDIF netlists, are generated automatically for instances of the core. In the proposed combined framework, highly optimised data paths are invoked dynamically from within Handel-C, and are synthesized using HIDE. Although the idea might seem simple prima facie, it could have serious implications on the design of future generations of hardware description languages.

Evaluation of a Music Therapy Social Skills Development Program for Youth with Limited Resources.

PubMed

Pasiali, Varvara; Clark, Cherie

2018-05-21

Children living in low-resource communities are at risk for poorer socio-emotional development and academic performance. Emerging evidence supports use of group music therapy experiences to support social development through community afterschool programming. To examine the potential benefit of a music therapy social skills development program to improve social skills and academic performance of school-aged children with limited resources in an afterschool program. We used a single-group pre/post-test design, and recruited 20 students (11 females, 9 males), ages 5 to 11 years, from an afterschool program. The music therapy social skills program consisted of eight 50-minute sessions, and we measured social competence and antisocial behavior using the Home & Community Social Behavioral Scale (HCSBS; Merrell & Caldarella, 2008), and social skills, problem behaviors, and academic competence using the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008a, 2008b). Only students who attended a minimum of six sessions (N = 14) were included in data analysis. Results showed no significant change in individual HBSC subscale scores; however, the total number of low-performance/high-risk skills significantly decreased. SSIS teacher results indicated significant improvement in communication, significant decrease of hyperactivity, autistic behavioral tendencies and overall problem behaviors, and marginal decreases in internalization. Parent ratings mirrored, in part, those of the teacher. Results indicated that music therapy has the potential of being an effective intervention for promoting social competence of school-aged children with limited resources, particularly in the areas of communication and low-performance/high-risk behaviors. Teaching skills through song lyrics and improvisation emerged as salient interventions.

Improving Team Performance for Public Health Preparedness.

PubMed

Peck, Megan; Scullard, Mickey; Hedberg, Craig; Moilanen, Emily; Radi, Deborah; Riley, William; Bowen, Paige Anderson; Petersen-Kroeber, Cheryl; Stenberg, Louise; Olson, Debra K

2017-02-01

Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response. Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises. Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period. Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7-10).

[When should a patient with abdominal pain be referred to the emergency ward?].

PubMed

de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

2010-08-25

When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral.

Performance of the Hack's Impairment Index Score: A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients.

PubMed

Hack, Jason B; Goldlust, Eric J; Ferrante, Dennis; Zink, Brian J

2017-10-01

Over 35 million alcohol-impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol-induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED. A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both "usual" and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated. A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R 2  = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients' visits. The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations. © 2017 by the Society for Academic Emergency Medicine.

Retrospective evaluation of urological admissions to emergency service of a training and research hospital.

PubMed

Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

2014-12-01

Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies.

Semiconducting carbon nanotube network thin-film transistors with enhanced inkjet-printed source and drain contact interfaces

NASA Astrophysics Data System (ADS)

Lee, Yongwoo; Yoon, Jinsu; Choi, Bongsik; Lee, Heesung; Park, Jinhee; Jeon, Minsu; Han, Jungmin; Lee, Jieun; Kim, Yeamin; Kim, Dae Hwan; Kim, Dong Myong; Choi, Sung-Jin

2017-10-01

Carbon nanotubes (CNTs) are emerging materials for semiconducting channels in high-performance thin-film transistor (TFT) technology. However, there are concerns regarding the contact resistance (Rcontact) in CNT-TFTs, which limits the ultimate performance, especially the CNT-TFTs with the inkjet-printed source/drain (S/D) electrodes. Thus, the contact interfaces comprising the overlap between CNTs and metal S/D electrodes play a particularly dominant role in determining the performances and degree of variability in the CNT-TFTs with inkjet-printed S/D electrodes. In this work, the CNT-TFTs with improved device performance are demonstrated to enhance contact interfaces by controlling the CNT density at the network channel and underneath the inkjet-printed S/D electrodes during the formation of a CNT network channel. The origin of the improved device performance was systematically investigated by extracting Rcontact in the CNT-TFTs with the enhanced contact interfaces by depositing a high density of CNTs underneath the S/D electrodes, resulting in a 59% reduction in Rcontact; hence, the key performance metrics were correspondingly improved without sacrificing any other device metrics.

Report on the emergency response to the event on May 14, 1997, at the plutonuim reclamation facility, Hanford Site, Richland,Washington

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

Shoop, D.S.

1997-08-20

On the evening of May 14,1997, a chemical explosion Occurred at the Plutonium Reclamation Facility (PRF) in the 200 West Area(200-W) of the Hanford Site. The event warranted the declaration of an Alert emergency, activation of the Hanford Emergency Response Organization (BRO), and notification of offsite agencies. As a result of the emergency declaration, a subsequent evaluation was conducted to assess: 9 the performance of the emergency response organization o the occupational health response related to emergency activities o event notifications to offsite and environmental agencies. Additionally, the evaluation was designed to: 9 document the chronology of emergency and occupationalmore » health responses and environmental notifications connected with the explosion at the facility 0 assess the adequacy of the Hanford Site emergency preparedness activities; response readiness; and emergency management actions, occupational health, and environmental actions 0 provide an analysis of the causes of the deficiencies and weaknesses in the preparedness and response system that have been identified in the evaluation of the response a assign organizational responsibility to correct deficiencies and weaknesses a improve future performance 0 adjust elements of emergency implementing procedures and emergency preparedness activities.« less

Performance Analysis of Classification Methods for Indoor Localization in Vlc Networks

NASA Astrophysics Data System (ADS)

Sánchez-Rodríguez, D.; Alonso-González, I.; Sánchez-Medina, J.; Ley-Bosch, C.; Díaz-Vilariño, L.

2017-09-01

Indoor localization has gained considerable attention over the past decade because of the emergence of numerous location-aware services. Research works have been proposed on solving this problem by using wireless networks. Nevertheless, there is still much room for improvement in the quality of the proposed classification models. In the last years, the emergence of Visible Light Communication (VLC) brings a brand new approach to high quality indoor positioning. Among its advantages, this new technology is immune to electromagnetic interference and has the advantage of having a smaller variance of received signal power compared to RF based technologies. In this paper, a performance analysis of seventeen machine leaning classifiers for indoor localization in VLC networks is carried out. The analysis is accomplished in terms of accuracy, average distance error, computational cost, training size, precision and recall measurements. Results show that most of classifiers harvest an accuracy above 90 %. The best tested classifier yielded a 99.0 % accuracy, with an average error distance of 0.3 centimetres.

Level of impact on the public health of universal human immunodeficiency virus screening in an Emergency Department.

PubMed

Reyes-Urueña, Juliana; Fernàndez-López, Laura; Force, Luis; Daza, Manel; Agustí, Cristina; Casabona, Jordi

The aim of this study was to determine the prevalence of HIV and the acceptability of rapid testing in an emergency department (ED), Barcelona (6/07/2011 to 8/03/2013). A convenience sample was used, depending on nurse availability in the ED. Participants signed an informed consent. Results were confirmed by conventional methods. A total of 2,140 individuals were offered testing, and 5% rejected taking part (107/2,140). Three subjects (3/2,033 [0.15%]) had confirmed reactive test. Individuals with a higher education were more likely to perform a rapid HIV test in ED (P<.005). A low prevalence of new HIV diagnoses was found among participants, although there was a high acceptability rate to perform rapid testing in the ED. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Four Cases of Pediatric Photokeratitis Present to the Emergency Department After Watching the Same Theater Show.

PubMed

Mangan, Mehmet Serhat; Arıcı, Ceyhun; Atalay, Eray; Tanyıldız, Burak; Oruçoğlu, Faik

2015-10-01

We report four consecutive cases of photokeratitis that presented to the emergency department, interestingly after having watched the same theatre performance in the same school. The patients' ages (3 male, 1 female) ranged from 9 to 13 years. All patients presented with similar complaints consisting of pain, tearing, foreign body sensation, photophobia and blurred vision in both eyes. Patients reported watching a theatre performance in the same school approximately 4 hours before symptom onset. On slit-lamp examination, conjunctival injection and corneal punctate epithelial erosions were observed in the interpalpebral zone in both eyes. On fundus examination, no pathology was observed in the vitreous, posterior pole or peripheral retina. All cases were treated with topical antibiotics and lubricant eye drops. Corneas were clear two days later in the control visit. In this case report, exposure to ultraviolet light from high-power lamps used in the theatre was proposed as a possible cause of corneal epithelial cell damage and subsequent photokeratitis.

Planar polymer and glass graded index waveguides for data center applications

NASA Astrophysics Data System (ADS)

Pitwon, Richard; Yamauchi, Akira; Brusberg, Lars; Wang, Kai; Ishigure, Takaaki; Schröder, Henning; Neitz, Marcel; Worrall, Alex

2016-03-01

Embedded optical waveguide technology for optical printed circuit boards (OPCBs) has advanced considerably over the past decade both in terms of materials and achievable waveguide structures. Two distinct classes of planar graded index multimode waveguide have recently emerged based on polymer and glass materials. We report on the suitability of graded index polymer waveguides, fabricated using the Mosquito method, and graded index glass waveguides, fabricated using ion diffusion on thin glass foils, for deployment within future data center environments as part of an optically disaggregated architecture. To this end, we first characterize the wavelength dependent performance of different waveguide types to assess their suitability with respect to two dominant emerging multimode transceiver classes based on directly modulated 850 nm VCSELs and 1310 silicon photonics devices. Furthermore we connect the different waveguide types into an optically disaggregated data storage system and characterize their performance with respect to different common high speed data protocols used at the intra and inter rack level including 10 Gb Ethernet and Serial Attached SCSI.

[Intestinal intussusception due to ileal gastrointestinal stromal tumor--a case report].

PubMed

Andrei, S; Andrei, A; Tonea, A; Andronesi, D; Preda, C; Herlea, V; Popescu, I

2011-01-01

Intestinal occlusion due to intussusception produced by intestinal tumors is a very rare condition. Gastrointestinal stromal tumors are also rare digestive neopasias, with an impredictable malignant behavior, which are usually growing outside the intestinal wall, being rarely the initiators of an intestinal intussusception. We present the case of a 59 years old female, admitted in our hospital to elucidate the etiology of her iron deficient anaemia, which developed an intestinal occlusion at the intestinal preparation for colonoscopy. The abdominal CT scan performed in emergency conditions highlighted occlusive intestinal tumor complicated with intestinal intussusception. We performed an emergency laparotomy that revealed intestinal occlusion due to ileo-ileal intussusception produced by an ileal tumor. The surgical intervention consisted in segmental ileal enterectomy including the tumor with latero-lateral entero-enteral anastomosis. The patient recovered without complications. The histopathological and immunohisto-chemical examinations established the diagnose of gastro-intestinal stromal tumor with high risk malignant behavior, therefore the patient was guided in the oncological department for specific treatment and oncological surveillance.

Design, fabrication & performance analysis of an unmanned aerial vehicle

NASA Astrophysics Data System (ADS)

Khan, M. I.; Salam, M. A.; Afsar, M. R.; Huda, M. N.; Mahmud, T.

2016-07-01

An Unmanned Aerial Vehicle was designed, analyzed and fabricated to meet design requirements and perform the entire mission for an international aircraft design competition. The goal was to have a balanced design possessing, good demonstrated flight handling qualities, practical and affordable manufacturing requirements while providing a high vehicle performance. The UAV had to complete total three missions named ferry flight (1st mission), maximum load mission (2nd mission) and emergency medical mission (3rd mission). The requirement of ferry flight mission was to fly as many as laps as possible within 4 minutes. The maximum load mission consists of flying 3 laps while carrying two wooden blocks which simulate cargo. The requirement of emergency medical mission was complete 3 laps as soon as possible while carrying two attendances and two patients. A careful analysis revealed lowest rated aircraft cost (RAC) as the primary design objective. So, the challenge was to build an aircraft with minimum RAC that can fly fast, fly with maximum payload, and fly fast with all the possible configurations. The aircraft design was reached by first generating numerous design concepts capable of completing the mission requirements. In conceptual design phase, Figure of Merit (FOM) analysis was carried out to select initial aircraft configuration, propulsion, empennage and landing gear. After completion of the conceptual design, preliminary design was carried out. The preliminary design iterations had a low wing loading, high lift coefficient, and a high thrust to weight ratio. To make the aircraft capable of Rough Field Taxi; springs were added in the landing gears for absorbing shock. An airfoil shaped fuselage was designed to allowed sufficient space for payload and generate less drag to make the aircraft fly fast. The final design was a high wing monoplane with conventional tail, single tractor propulsion system and a tail dragger landing gear. Payload was stored in undercarriage box for maximum load mission and emergency medical mission. The aircraft structure, weights 5.6 lb., constructed by balsa wood, depron and covering film was the only feasible match for the given requirements set by the competition organizers. The defined final aircraft was capable of: Completing 3 laps within 4 minutes at the first mission; flying 3 laps with 4 internal payloads at the second mission; flying 3 laps with all possible payload configurations at the third mission.

Making processes reliable: a validated pubmed search strategy for identifying new or emerging technologies.

PubMed

Varela-Lema, Leonora; Punal-Riobóo, Jeanette; Acción, Beatriz Casal; Ruano-Ravina, Alberto; García, Marisa López

2012-10-01

Horizon scanning systems need to handle a wide range of sources to identify new or emerging health technologies. The objective of this study is to develop a validated Medline bibliographic search strategy (PubMed search engine) to systematically identify new or emerging health technologies. The proposed Medline search strategy combines free text terms commonly used in article titles to denote innovation within index terms that make reference to the specific fields of interest. Efficacy was assessed by running the search over a period of 1 year (2009) and analyzing its retrieval performance (number and characteristics). For comparison purposes, all article abstracts published during 2009 in six preselected key research journals and eight high impact surgery journals were scanned. Sensitivity was defined as the proportion of relevant new or emerging technologies published in key journals that would be identified in the search strategy within the first 2 years of publication. The search yielded 6,228 abstracts of potentially new or emerging technologies. Of these, 459 were classified as new or emerging (383 truly new or emerging and 76 new indications). The scanning of 12,061 journal abstracts identified 35 relevant new or emerging technologies. Of these, twenty-nine were located within the Medline search strategy during the first 2 years of publication (sensitivity = 83 percent). The current search strategy, validated against key journals, has demonstrated to be effective for horizon scanning. Even though it can require adaptations depending on the scope of the horizon scanning system, it could serve to simplify and standardize scanning processes.

An evaluation of emergency guidelines issued by the World Health Organization in response to four infectious disease outbreaks.

PubMed

Norris, Susan L; Sawin, Veronica Ivey; Ferri, Mauricio; Raques Sastre, Laura; Porgo, Teegwendé V

2018-01-01

The production of high-quality guidelines in response to public health emergencies poses challenges for the World Health Organization (WHO). The urgent need for guidance and the paucity of structured scientific data on emerging diseases hinder the formulation of evidence-informed recommendations using standard methods and procedures. In the context of the response to recent public health emergencies, this project aimed to describe the information products produced by WHO and assess the quality and trustworthiness of a subset of these products classified as guidelines. We selected four recent infectious disease emergencies: outbreaks of avian influenza A-H1N1 virus (2009) and H7N9 virus (2013), Middle East respiratory syndrome coronavirus (MERS-CoV) (2013), and Ebola virus disease (EVD) (2014 to 2016). We analyzed the development and publication processes and evaluated the quality of emergency guidelines using AGREE-II. We included 175 information products of which 87 were guidelines. These products demonstrated variable adherence to WHO publication requirements including the listing of external contributors, management of declarations of interest, and entry into WHO's public database of publications. For guidelines, the methods for development were incompletely reported; WHO's quality assurance process was rarely used; systematic or other evidence reviews were infrequently referenced; external peer review was not performed; and they scored poorly with AGREE II, particularly for rigour of development and editorial independence. Our study suggests that WHO guidelines produced in the context of a public health emergency can be improved upon, helping to assure the trustworthiness and utility of WHO information products in future emergencies.

Comparison of a percutaneous device and the bougie-assisted surgical technique for emergency cricothyrotomy: an experimental study on a porcine model performed by air ambulance anaesthesiologists.

PubMed

Nakstad, Anders R; Bredmose, Per P; Sandberg, Mårten

2013-07-26

A large number of techniques and devices for cricothyroidotomy have been developed. In this study, the Portex™ Cricothyroidotomy Kit (PCK, Smiths Medical Ltd, Hythe, UK) was compared with the bougie assisted emergency surgical cricothyrotomy technique (BACT). Twenty air ambulance anaesthesiologists performed emergency cricothyrotomy on a cadaveric porcine airway model using both PCK and BACT. Baseline performance and performance after the intensive training package were recorded. Success rate, time to secured airway and tracheal damage were the primary endpoints, and confidence rating was a secondary endpoint. During baseline testing, success rates for PCK and BACT were 60% and 95%, respectively. Tracheal injury rate with PCK was 60% while no such injury was found in BACT. A lecture was given and skills were trained until the participants were able to perform five consecutive successful procedures with both techniques. In the post-training test, all participants were successful with either technique. The mean time to successful insertion was reduced by 15.7 seconds (from 36.3 seconds to 20.6 seconds, p< 0.001) for PCK and by 7.8 seconds (from 44.9 seconds to 37.1 seconds, p=0.021) for BACT. In the post-training scenario, securing the airway with PCK was significantly faster than with BACT (p<0.001). Post-training tracheal laceration occurred in six (30%) of the PCK procedures and in none of the BACT procedures (p=0.028). Testing the base-line PCK skills of prehospital anaesthesiologists revealed low confidence, sub-optimal performance and a very high failure rate. The BACT technique demonstrated a significantly higher success rate and no tracheal damage. In spite of PCK being a significantly faster technique in the post-training test, the anaesthesiologists still reported a higher confidence in BACT. Limitations of the cadaveric porcine airway may have influenced this study because the airway did not challenge the clinicians with realistic tissue bleeding.

Building an automated SOAP classifier for emergency department reports.

PubMed

Mowery, Danielle; Wiebe, Janyce; Visweswaran, Shyam; Harkema, Henk; Chapman, Wendy W

2012-02-01

Information extraction applications that extract structured event and entity information from unstructured text can leverage knowledge of clinical report structure to improve performance. The Subjective, Objective, Assessment, Plan (SOAP) framework, used to structure progress notes to facilitate problem-specific, clinical decision making by physicians, is one example of a well-known, canonical structure in the medical domain. Although its applicability to structuring data is understood, its contribution to information extraction tasks has not yet been determined. The first step to evaluating the SOAP framework's usefulness for clinical information extraction is to apply the model to clinical narratives and develop an automated SOAP classifier that classifies sentences from clinical reports. In this quantitative study, we applied the SOAP framework to sentences from emergency department reports, and trained and evaluated SOAP classifiers built with various linguistic features. We found the SOAP framework can be applied manually to emergency department reports with high agreement (Cohen's kappa coefficients over 0.70). Using a variety of features, we found classifiers for each SOAP class can be created with moderate to outstanding performance with F(1) scores of 93.9 (subjective), 94.5 (objective), 75.7 (assessment), and 77.0 (plan). We look forward to expanding the framework and applying the SOAP classification to clinical information extraction tasks. Copyright © 2011. Published by Elsevier Inc.

Improving Emergency Response and Human-Robotic Performance

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

David I. Gertman; David J. Bruemmer; R. Scott Hartley

2007-08-01

Preparedness for chemical, biological, and radiological/nuclear incidents at nuclear power plants (NPPs) includes the deployment of well trained emergency response teams. While teams are expected to do well, data from other domains suggests that the timeliness and accuracy associated with incident response can be improved through collaborative human-robotic interaction. Many incident response scenarios call for multiple, complex procedure-based activities performed by personnel wearing cumbersome personal protective equipment (PPE) and operating under high levels of stress and workload. While robotic assistance is postulated to reduce workload and exposure, limitations associated with communications and the robot’s ability to act independently have servedmore » to limit reliability and reduce our potential to exploit human –robotic interaction and efficacy of response. Recent work at the Idaho National Laboratory (INL) on expanding robot capability has the potential to improve human-system response during disaster management and recovery. Specifically, increasing the range of higher level robot behaviors such as autonomous navigation and mapping, evolving new abstractions for sensor and control data, and developing metaphors for operator control have the potential to improve state-of-the-art in incident response. This paper discusses these issues and reports on experiments underway intelligence residing on the robot to enhance emergency response.« less

A gastrointestinal stromal tumor of the jejunum presenting with an intratumoral abscess: A case report and a literature review.

PubMed

Ito, Soichi; Tsuchitani, Yuma; Kim, Yuro; Hashimoto, Souhei; Miura, Yuichi; Uemura, Takuji; Katsura, Kazunori; Abe, Takayuki; Sato, Koichiro; Kato, Hirotaka

2018-05-29

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The small intestine is the second-most frequent location where GISTs occur after the stomach. Attention should be paid to small intestinal GISTs because they infrequently present with acute abdomen, which necessitates emergency surgery. This report describes a patient with a small intestinal GIST developing a giant intratumoral abscess, in whom emergency surgery was performed. A 56-year-old woman presented with worsening abdominal pain. Computed tomography scan showed an approximately 9.5 cm × 9 cm tumor bearing a thick and hypervascularized wall with an internal air-fluid level. Emergency laparotomy revealed the tumor originated from the jejunum, and partial resection of the jejunum was performed. A large amount of pus was contained inside the tumor. Immunohistochemically, the tumor was diagnosed as a high risk GIST of the Cjejunum, and imatinib mesylate was initiated. When an intratumoral abscess in the abdomen is confirmed, GISTs should be listed as differential diagnosis. Complete surgical resetcion with careful handling and adjuvant chemotherapy with imatinib mesylate are considered to be important for this state. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Ngi and Internet2: accelerating the creation of tomorrow's internet.

PubMed

Kratz, M; Ackerman, M; Hanss, T; Corbato, S

2001-01-01

Internet2 is a consortium of leading U.S. universities working in partnership with industry and the U.S. government's Next Generation Internet (NGI) initiative to develop a faster, more reliable Internet for research and education including enhanced, high-performance networking services and the advanced applications that are enabled by those services [1]. By facilitating and coordinating the development, deployment, operation, and technology transfer of advanced, network-based applications and network services, Internet2 and NGI are working together to fundamentally change the way scientists, engineers, clinicians, and others work together. [http://www.internet2.edu] The NGI Program has three tracks: research, network testbeds, and applications. The aim of the research track is to promote experimentation with the next generation of network technologies. The network testbed track aims to develop next generation network testbeds to connect universities and federal research institutions at speeds that are sufficient to demonstrate new technologies and support future research. The aim of the applications track is to demonstrate new applications, enabled by the NGI networks, to meet important national goals and missions [2]. [http://www.ngi.gov/] The Internet2/NGI backbone networks, Abilene and vBNS (very high performance Backbone Network Service), provide the basis of collaboration and development for a new breed of advanced medical applications. Academic medical centers leverage the resources available throughout the Internet2 high-performance networking community for high-capacity broadband and selectable quality of service to make effective use of national repositories. The Internet2 Health Sciences Initiative enables a new generation of emerging medical applications whose architecture and development have been restricted by or are beyond the constraints of traditional Internet environments. These initiatives facilitate a variety of activities to foster the development and deployment of emerging applications that meet the requirements of clinical practice, medical and related biological research, education, and medical awareness throughout the public sector. Medical applications that work with high performance networks and supercomputing capabilities offer exciting new solutions for the medical industry. Internet2 and NGI,strive to combine the expertise of their constituents to establish a distributed knowledge system for achieving innovation in research, teaching, learning, and clinical care.

Spontaneous and Selective Nanowelding of Silver Nanowires by Electrochemical Ostwald Ripening and High Electrostatic Potential at the Junctions for High-Performance Stretchable Transparent Electrodes.

PubMed

Lee, Hyo-Ju; Oh, Semi; Cho, Ki-Yeop; Jeong, Woo-Lim; Lee, Dong-Seon; Park, Seong-Ju

2018-04-25

Metal nanowires have been gaining increasing attention as the most promising stretchable transparent electrodes for emerging field of stretchable optoelectronic devices. Nanowelding technology is a major challenge in the fabrication of metal nanowire networks because the optoelectronic performances of metal nanowire networks are mostly limited by the high junction resistance between nanowires. We demonstrate the spontaneous and selective welding of Ag nanowires (AgNWs) by Ag solders via an electrochemical Ostwald ripening process and high electrostatic potential at the junctions of AgNWs. The AgNWs were welded by depositing Ag nanoparticles (AgNPs) on the conducting substrate and then exposing them to water at room temperature. The AgNPs were spontaneously dissolved in water to form Ag + ions, which were then reduced to single-crystal Ag solders selectively at the junctions of the AgNWs. Hence, the welded AgNWs showed higher optoelectronic and stretchable performance compared to that of as-formed AgNWs. These results indicate that electrochemical Ostwald ripening-based welding can be used as a promising method for high-performance metal nanowire electrodes in various next-generation devices such as stretchable solar cells, stretchable displays, organic light-emitting diodes, and skin sensors.

Electrical Stimulation Modulates High γ Activity and Human Memory Performance

PubMed Central

Berry, Brent M.; Miller, Laura R.; Khadjevand, Fatemeh; Ezzyat, Youssef; Wanda, Paul; Sperling, Michael R.; Lega, Bradley; Stead, S. Matt

2018-01-01

Direct electrical stimulation of the brain has emerged as a powerful treatment for multiple neurological diseases, and as a potential technique to enhance human cognition. Despite its application in a range of brain disorders, it remains unclear how stimulation of discrete brain areas affects memory performance and the underlying electrophysiological activities. Here, we investigated the effect of direct electrical stimulation in four brain regions known to support declarative memory: hippocampus (HP), parahippocampal region (PH) neocortex, prefrontal cortex (PF), and lateral temporal cortex (TC). Intracranial EEG recordings with stimulation were collected from 22 patients during performance of verbal memory tasks. We found that high γ (62–118 Hz) activity induced by word presentation was modulated by electrical stimulation. This modulatory effect was greatest for trials with “poor” memory encoding. The high γ modulation correlated with the behavioral effect of stimulation in a given brain region: it was negative, i.e., the induced high γ activity was decreased, in the regions where stimulation decreased memory performance, and positive in the lateral TC where memory enhancement was observed. Our results suggest that the effect of electrical stimulation on high γ activity induced by word presentation may be a useful biomarker for mapping memory networks and guiding therapeutic brain stimulation. PMID:29404403

Requirements for emergent neurosurgical procedures among patients undergoing neuroendovascular procedures in contemporary practice.

PubMed

Khatri, R; Ansar, M; Sultan, F; Chaudhry, S A; Khan, A A; Rodriguez, G J; Tummala, R P; Qureshi, A I

2012-03-01

Provisions for an emergent neurosurgical procedure have been a mandatory component of centers that perform neuroendovascular procedures. We sought to determine the need for emergent neurosurgical procedures following neuroendovascular interventions in 2 comprehensive stroke centers in settings with such provisions. Analysis of retrospectively collected data from procedure logs and patient charts was performed to identify patients who required immediate (before the termination of the intervention) or adjunctive (within 24 hours of the intervention) neurosurgical procedures related to a neuroendovascular intervention complication. The types of neurosurgical procedures and in-hospital outcomes of identified patients are reported as an aggregate and per endovascular procedure-type analyses. We reviewed a total of 933 neuroendovascular procedures performed during 3.5 years (2006-2010). A total of 759 intracranial procedures were performed. There was a need for emergent neurosurgical procedures in 8 patients (0.85% cumulative incidence and 1.05% for major intracranial procedures) (mean age, 46 years; 7 were women); the procedures were categorized as 3 immediate and 5 adjunctive procedures. There were 5 in-hospital deaths (62.5%) among these 8 patients. Neurosurgical procedures performed were external ventricular drainage placement in 6 (6 of 8, 75%) patients, decompressive craniectomy in 1 (12.5%) patient, and both surgical procedures in 1 (12.5%) patient. The need for emergent neurosurgical procedures is very low among patients undergoing intracranial neuroendovascular procedures. Survival in such patients despite emergent neurosurgical procedures is quite low.

Dynamic carrier transport modulation for constructing advanced devices with improved performance by piezotronic and piezo-phototronic effects: a brief review

NASA Astrophysics Data System (ADS)

Guo, Zhen; Pan, Haixi; Li, Chuanyu; Zhang, Lili; Yan, Shuai; Zhang, Wei; Yao, Jia; Tang, Yuguo; Yang, Hongbo; Wu, Yihui; Feng, Liping; Zhou, Lianqun

2017-08-01

Carrier generation, transport, separation, and recombination behaviors can be modulated for improving the performance of semiconductor devices by using piezotronic and piezo-phototronic effects with creating piezopotential in crystals based on non-centrosymmetric semiconductor materials such as group II-VI and III-V semiconductors and transition metal dichalcogenides (TMDCs), which have emerged as attractive materials for electronic/photonic applications because of their novel properties. Until now, much effort has been devoted to improving the performance of devices based on the aforementioned materials through modulation of the carrier behavior. However, due to existing drawbacks, it has been difficult to further enhance the device performance for a built structure. However, effective exploration of the piezotronic and piezo-phototronic effects in these semiconducting materials could pave the way to the realization of high-performance devices. In general, the effective modulation of carrier behavior dynamically in devices such as light-emitting diodes, photodetectors, solar cells, nanogenerators, and so on, remains a key challenge. Due to the polarization of ions in semiconductor materials with noncentral symmetry under external strain, a piezopotential is created considering piezotronic and piezo-photoronic effects, which could dynamically modulate charge carrier transport behaviors across p-n junctions or metal-semiconductor interfaces. Through a combination of these effects and semiconductor properties, the performance of the related devices could be improved and new types of devices such as piezoelectric field-effect transistors and sensors have emerged, with potential applications in self-driven devices for effective energy harvesting and biosensing with high sensitivity, which are different from those traditionally designed and may have potential applications in strained triggered devices. The objective of this review is to briefly introduce the corresponding mechanisms for modulating carrier behavior on the basis of piezotronic and piezo-phototronic effects in materials such as group II-VI and group III-V semiconductors and TMDCs, as well as to discuss possible solutions to effectively enhance the performance of the devices via carrier modulation.

Predictors of a Top Performer During Emergency Medicine Residency.

PubMed

Bhat, Rahul; Takenaka, Katrin; Levine, Brian; Goyal, Nikhil; Garg, Manish; Visconti, Annette; Oyama, Leslie; Castillo, Edward; Broder, Joshua; Omron, Rodney; Hayden, Stephen

2015-10-01

Emergency Medicine (EM) residency program directors and faculty spend significant time and effort creating a residency rank list. To date, however, there have been few studies to assist program directors in determining which pre-residency variables best predict performance during EM residency. To evaluate which pre-residency variables best correlated with an applicant's performance during residency. This was a retrospective multicenter sample of all residents in the three most recent graduating classes from nine participating EM residency programs. The outcome measure of top residency performance was defined as placement in the top third of a resident's graduating class based on performance on the final semi-annual evaluation. A total of 277 residents from nine institutions were evaluated. Eight of the predictors analyzed had a significant correlation with the outcome of resident performance. Applicants' grade during home and away EM rotations, designation as Alpha Omega Alpha (AOA), U.S. Medical Licensing Examination (USMLE) Step 1 score, interview scores, "global rating" and "competitiveness" on nonprogram leadership standardized letter of recommendation (SLOR), and having five or more publications or presentations showed a significant association with residency performance. We identified several predictors of top performers in EM residency: an honors grade for an EM rotation, USMLE Step 1 score, AOA designation, interview score, high SLOR rankings from nonprogram leadership, and completion of five or more presentations and publications. EM program directors may consider utilizing these variables during the match process to choose applicants who have the highest chance of top performance during residency. Copyright © 2015 Elsevier Inc. All rights reserved.

Early experiences in developing and managing the neuroscience gateway.

PubMed

Sivagnanam, Subhashini; Majumdar, Amit; Yoshimoto, Kenneth; Astakhov, Vadim; Bandrowski, Anita; Martone, MaryAnn; Carnevale, Nicholas T

2015-02-01

The last few decades have seen the emergence of computational neuroscience as a mature field where researchers are interested in modeling complex and large neuronal systems and require access to high performance computing machines and associated cyber infrastructure to manage computational workflow and data. The neuronal simulation tools, used in this research field, are also implemented for parallel computers and suitable for high performance computing machines. But using these tools on complex high performance computing machines remains a challenge because of issues with acquiring computer time on these machines located at national supercomputer centers, dealing with complex user interface of these machines, dealing with data management and retrieval. The Neuroscience Gateway is being developed to alleviate and/or hide these barriers to entry for computational neuroscientists. It hides or eliminates, from the point of view of the users, all the administrative and technical barriers and makes parallel neuronal simulation tools easily available and accessible on complex high performance computing machines. It handles the running of jobs and data management and retrieval. This paper shares the early experiences in bringing up this gateway and describes the software architecture it is based on, how it is implemented, and how users can use this for computational neuroscience research using high performance computing at the back end. We also look at parallel scaling of some publicly available neuronal models and analyze the recent usage data of the neuroscience gateway.

Early experiences in developing and managing the neuroscience gateway

PubMed Central

Sivagnanam, Subhashini; Majumdar, Amit; Yoshimoto, Kenneth; Astakhov, Vadim; Bandrowski, Anita; Martone, MaryAnn; Carnevale, Nicholas. T.

2015-01-01

SUMMARY The last few decades have seen the emergence of computational neuroscience as a mature field where researchers are interested in modeling complex and large neuronal systems and require access to high performance computing machines and associated cyber infrastructure to manage computational workflow and data. The neuronal simulation tools, used in this research field, are also implemented for parallel computers and suitable for high performance computing machines. But using these tools on complex high performance computing machines remains a challenge because of issues with acquiring computer time on these machines located at national supercomputer centers, dealing with complex user interface of these machines, dealing with data management and retrieval. The Neuroscience Gateway is being developed to alleviate and/or hide these barriers to entry for computational neuroscientists. It hides or eliminates, from the point of view of the users, all the administrative and technical barriers and makes parallel neuronal simulation tools easily available and accessible on complex high performance computing machines. It handles the running of jobs and data management and retrieval. This paper shares the early experiences in bringing up this gateway and describes the software architecture it is based on, how it is implemented, and how users can use this for computational neuroscience research using high performance computing at the back end. We also look at parallel scaling of some publicly available neuronal models and analyze the recent usage data of the neuroscience gateway. PMID:26523124

Low-Carbohydrate-High-Fat Diet: Can it Help Exercise Performance?

PubMed Central

Borer, Katarina; Lin, Po-Ju

2017-01-01

Abstract Low-carbohydrate-high-fat (LCHF) diets have been used as a means of weight loss and control of symptoms in several clinical conditions. There is emerging evidence that the metabolic changes induced by LCHF diets enhance endurance performance. The aims of this review are to examine the evidence of LCHF diets in improving various aspects of athletic performance. Long-term LCHF dietary intake may help control body weight and fat mass while maintaining lean body mass in athletes in weight-sensitive sports. LCHF-adapted endurance athletes can reach the maximal fat oxidation rate of approximately 1.5 g/min, with a lower carbohydrate oxidation rate and similar muscle glycogen content and a resynthesis rate compared to their counterparts consuming high-carbohydrate-low-fat (HCLF) diets. The elevated fat oxidation rate and glycogen sparing effect may improve performance in ultra-endurance events. These metabolic changes may also prevent the decline in performance in later stages of repeated high-intensity movements, in which the aerobic metabolism becomes more important. However, elevated blood concentrations of non-esterified fatty acids and ammonia during exercise after LCHF diets may lead to early development of central fatigue. It appears that at least several months of adaptation to a LCHF diet are required for the metabolic changes and restoration of muscle glycogen to occur. Further investigations on LCHF diets are needed regarding (1) performance after weight loss in weight-categorized sports; (2) repeated high-intensity exercise performance; (3) development of central fatigue during endurance events; (4) perceptual-motor performance during prolonged intermittent sports; and (5) ideal dietary fatty acid compositions. PMID:28469746

Low-Carbohydrate-High-Fat Diet: Can it Help Exercise Performance?

PubMed

Chang, Chen-Kang; Borer, Katarina; Lin, Po-Ju

2017-02-01

Low-carbohydrate-high-fat (LCHF) diets have been used as a means of weight loss and control of symptoms in several clinical conditions. There is emerging evidence that the metabolic changes induced by LCHF diets enhance endurance performance. The aims of this review are to examine the evidence of LCHF diets in improving various aspects of athletic performance. Long-term LCHF dietary intake may help control body weight and fat mass while maintaining lean body mass in athletes in weight-sensitive sports. LCHF-adapted endurance athletes can reach the maximal fat oxidation rate of approximately 1.5 g/min, with a lower carbohydrate oxidation rate and similar muscle glycogen content and a resynthesis rate compared to their counterparts consuming high-carbohydrate-low-fat (HCLF) diets. The elevated fat oxidation rate and glycogen sparing effect may improve performance in ultra-endurance events. These metabolic changes may also prevent the decline in performance in later stages of repeated high-intensity movements, in which the aerobic metabolism becomes more important. However, elevated blood concentrations of non-esterified fatty acids and ammonia during exercise after LCHF diets may lead to early development of central fatigue. It appears that at least several months of adaptation to a LCHF diet are required for the metabolic changes and restoration of muscle glycogen to occur. Further investigations on LCHF diets are needed regarding (1) performance after weight loss in weight-categorized sports; (2) repeated high-intensity exercise performance; (3) development of central fatigue during endurance events; (4) perceptual-motor performance during prolonged intermittent sports; and (5) ideal dietary fatty acid compositions.

The role of flight planning in aircrew decision performance

NASA Technical Reports Server (NTRS)

Pepitone, Dave; King, Teresa; Murphy, Miles

1989-01-01

The role of flight planning in increasing the safety and decision-making performance of the air transport crews was investigated in a study that involved 48 rated airline crewmembers on a B720 simulator with a model-board-based visual scene and motion cues with three degrees of freedom. The safety performance of the crews was evaluated using videotaped replays of the flight. Based on these evaluations, the crews could be divided into high- and low-safety groups. It was found that, while collecting information before flights, the high-safety crews were more concerned with information about alternative airports, especially the fuel required to get there, and were characterized by making rapid and appropriate decisions during the emergency part of the flight scenario, allowing these crews to make an early diversion to other airports. These results suggest that contingency planning that takes into account alternative courses of action enhances rapid and accurate decision-making under time pressure.

Rate of initial recovery and subsequent radar monitoring performance following a simulated emergency involving startle.

DOT National Transportation Integrated Search

1983-09-01

The present study employed auditory startle to simulate the principal components (unexpectedness, fear, and physiological arousal) that are common to many types of sudden emergencies and compared performance recovery following startle with recovery f...

Affective attention under cognitive load: reduced emotional biases but emergent anxiety-related costs to inhibitory control

PubMed Central

Berggren, Nick; Richards, Anne; Taylor, Joseph; Derakshan, Nazanin

2013-01-01

Trait anxiety is associated with deficits in attentional control, particularly in the ability to inhibit prepotent responses. Here, we investigated this effect while varying the level of cognitive load in a modified antisaccade task that employed emotional facial expressions (neutral, happy, and angry) as targets. Load was manipulated using a secondary auditory task requiring recognition of tones (low load), or recognition of specific tone pitch (high load). Results showed that load increased antisaccade latencies on trials where gaze toward face stimuli should be inhibited. This effect was exacerbated for high anxious individuals. Emotional expression also modulated task performance on antisaccade trials for both high and low anxious participants under low cognitive load, but did not influence performance under high load. Collectively, results (1) suggest that individuals reporting high levels of anxiety are particularly vulnerable to the effects of cognitive load on inhibition, and (2) support recent evidence that loading cognitive processes can reduce emotional influences on attention and cognition. PMID:23717273

Engineering triangular carbon quantum dots with unprecedented narrow bandwidth emission for multicolored LEDs.

PubMed

Yuan, Fanglong; Yuan, Ting; Sui, Laizhi; Wang, Zhibin; Xi, Zifan; Li, Yunchao; Li, Xiaohong; Fan, Louzhen; Tan, Zhan'ao; Chen, Anmin; Jin, Mingxing; Yang, Shihe

2018-06-08

Carbon quantum dots (CQDs) have emerged as promising materials for optoelectronic applications on account of carbon's intrinsic merits of high stability, low cost, and environment-friendliness. However, the CQDs usually give broad emission with full width at half maximum exceeding 80 nm, which fundamentally limit their display applications. Here we demonstrate multicolored narrow bandwidth emission (full width at half maximum of 30 nm) from triangular CQDs with a quantum yield up to 54-72%. Detailed structural and optical characterizations together with theoretical calculations reveal that the molecular purity and crystalline perfection of the triangular CQDs are key to the high color-purity. Moreover, multicolored light-emitting diodes based on these CQDs display good stability, high color-purity, and high-performance with maximum luminance of 1882-4762 cd m -2 and current efficiency of 1.22-5.11 cd A -1 . This work will set the stage for developing next-generation high-performance CQDs-based light-emitting diodes.

a Real-Time GIS Platform for High Sour Gas Leakage Simulation, Evaluation and Visualization

NASA Astrophysics Data System (ADS)

Li, M.; Liu, H.; Yang, C.

2015-07-01

The development of high-sulfur gas fields, also known as sour gas field, is faced with a series of safety control and emergency management problems. The GIS-based emergency response system is placed high expectations under the consideration of high pressure, high content, complex terrain and highly density population in Sichuan Basin, southwest China. The most researches on high hydrogen sulphide gas dispersion simulation and evaluation are used for environmental impact assessment (EIA) or emergency preparedness planning. This paper introduces a real-time GIS platform for high-sulfur gas emergency response. Combining with real-time data from the leak detection systems and the meteorological monitoring stations, GIS platform provides the functions of simulating, evaluating and displaying of the different spatial-temporal toxic gas distribution patterns and evaluation results. This paper firstly proposes the architecture of Emergency Response/Management System, secondly explains EPA's Gaussian dispersion model CALPUFF simulation workflow under high complex terrain and real-time data, thirdly explains the emergency workflow and spatial analysis functions of computing the accident influencing areas, population and the optimal evacuation routes. Finally, a well blow scenarios is used for verify the system. The study shows that GIS platform which integrates the real-time data and CALPUFF models will be one of the essential operational platforms for high-sulfur gas fields emergency management.

Evaluating the Performance of a Climate-Driven Mortality Model during Heat Waves and Cold Spells in Europe

PubMed Central

Lowe, Rachel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R.; Rodó, Xavier

2015-01-01

The impact of climate change on human health is a serious concern. In particular, changes in the frequency and intensity of heat waves and cold spells are of high relevance in terms of mortality and morbidity. This demonstrates the urgent need for reliable early-warning systems to help authorities prepare and respond to emergency situations. In this study, we evaluate the performance of a climate-driven mortality model to provide probabilistic predictions of exceeding emergency mortality thresholds for heat wave and cold spell scenarios. Daily mortality data corresponding to 187 NUTS2 regions across 16 countries in Europe were obtained from 1998–2003. Data were aggregated to 54 larger regions in Europe, defined according to similarities in population structure and climate. Location-specific average mortality rates, at given temperature intervals over the time period, were modelled to account for the increased mortality observed during both high and low temperature extremes and differing comfort temperatures between regions. Model parameters were estimated in a Bayesian framework, in order to generate probabilistic simulations of mortality across Europe for time periods of interest. For the heat wave scenario (1–15 August 2003), the model was successfully able to anticipate the occurrence or non-occurrence of mortality rates exceeding the emergency threshold (75th percentile of the mortality distribution) for 89% of the 54 regions, given a probability decision threshold of 70%. For the cold spell scenario (1–15 January 2003), mortality events in 69% of the regions were correctly anticipated with a probability decision threshold of 70%. By using a more conservative decision threshold of 30%, this proportion increased to 87%. Overall, the model performed better for the heat wave scenario. By replacing observed temperature data in the model with forecast temperature, from state-of-the-art European forecasting systems, probabilistic mortality predictions could potentially be made several months ahead of imminent heat waves and cold spells. PMID:25625407

Evaluating the performance of a climate-driven mortality model during heat waves and cold spells in Europe.

PubMed

Lowe, Rachel; Ballester, Joan; Creswick, James; Robine, Jean-Marie; Herrmann, François R; Rodó, Xavier

2015-01-23

The impact of climate change on human health is a serious concern. In particular, changes in the frequency and intensity of heat waves and cold spells are of high relevance in terms of mortality and morbidity. This demonstrates the urgent need for reliable early-warning systems to help authorities prepare and respond to emergency situations. In this study, we evaluate the performance of a climate-driven mortality model to provide probabilistic predictions of exceeding emergency mortality thresholds for heat wave and cold spell scenarios. Daily mortality data corresponding to 187 NUTS2 regions across 16 countries in Europe were obtained from 1998-2003. Data were aggregated to 54 larger regions in Europe, defined according to similarities in population structure and climate. Location-specific average mortality rates, at given temperature intervals over the time period, were modelled to account for the increased mortality observed during both high and low temperature extremes and differing comfort temperatures between regions. Model parameters were estimated in a Bayesian framework, in order to generate probabilistic simulations of mortality across Europe for time periods of interest. For the heat wave scenario (1-15 August 2003), the model was successfully able to anticipate the occurrence or non-occurrence of mortality rates exceeding the emergency threshold (75th percentile of the mortality distribution) for 89% of the 54 regions, given a probability decision threshold of 70%. For the cold spell scenario (1-15 January 2003), mortality events in 69% of the regions were correctly anticipated with a probability decision threshold of 70%. By using a more conservative decision threshold of 30%, this proportion increased to 87%. Overall, the model performed better for the heat wave scenario. By replacing observed temperature data in the model with forecast temperature, from state-of-the-art European forecasting systems, probabilistic mortality predictions could potentially be made several months ahead of imminent heat waves and cold spells.

Emergent literacy profiles of preschool-age children with specific language impairment.

PubMed

Cabell, Sonia Q; Lomax, Richard G; Justice, Laura M; Breit-Smith, Allison; Skibbe, Lori E; McGinty, Anita S

2010-12-01

The primary aim of the present study was to explore the heterogeneity of emergent literacy skills among preschool-age children with specific language impairment (SLI) through examination of profiles of performance. Fifty-nine children with SLI were assessed on a battery of emergent literacy skills (i.e., alphabet knowledge, print concepts, emergent writing, rhyme awareness) and oral language skills (i.e., receptive/expressive vocabulary and grammar). Cluster analysis techniques identified three emergent literacy profiles: (1) Highest Emergent Literacy, Strength in Alphabet Knowledge; (2) Average Emergent Literacy, Strength in Print Concepts; and (3) Lowest Emergent Literacy across Skills. After taking into account the contribution of child age, receptive and expressive language skills made a small contribution to the prediction of profile membership. The present findings, which may be characterized as exploratory given the relatively modest sample size, suggest that preschool-age children with SLI display substantial individual differences with regard to their emergent literacy skills and that these differences cannot be fully determined by children's age or oral language performance. Replication of the present findings with a larger sample of children is needed.

On the Impact of Execution Models: A Case Study in Computational Chemistry

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

Chavarría-Miranda, Daniel; Halappanavar, Mahantesh; Krishnamoorthy, Sriram

2015-05-25

Efficient utilization of high-performance computing (HPC) platforms is an important and complex problem. Execution models, abstract descriptions of the dynamic runtime behavior of the execution stack, have significant impact on the utilization of HPC systems. Using a computational chemistry kernel as a case study and a wide variety of execution models combined with load balancing techniques, we explore the impact of execution models on the utilization of an HPC system. We demonstrate a 50 percent improvement in performance by using work stealing relative to a more traditional static scheduling approach. We also use a novel semi-matching technique for load balancingmore » that has comparable performance to a traditional hypergraph-based partitioning implementation, which is computationally expensive. Using this study, we found that execution model design choices and assumptions can limit critical optimizations such as global, dynamic load balancing and finding the correct balance between available work units and different system and runtime overheads. With the emergence of multi- and many-core architectures and the consequent growth in the complexity of HPC platforms, we believe that these lessons will be beneficial to researchers tuning diverse applications on modern HPC platforms, especially on emerging dynamic platforms with energy-induced performance variability.« less

Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment.

PubMed

Mistry, Binoy; Stewart De Ramirez, Sarah; Kelen, Gabor; Schmitz, Paulo S K; Balhara, Kamna S; Levin, Scott; Martinez, Diego; Psoter, Kevin; Anton, Xavier; Hinson, Jeremiah S

2018-05-01

We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites. This cross-sectional multicenter study enrolled 87 ESI-trained nurses from EDs in Brazil, the United Arab Emirates, and the United States. Standardized triage scenarios published by the Agency for Healthcare Research and Quality (AHRQ) were used. Accuracy was defined by concordance with the AHRQ key and calculated as percentages. Accuracy comparisons were made with one-way ANOVA and paired t test. Interrater reliability was measured with Krippendorff's α. Subanalyses based on nursing experience and triage scenario type were also performed. Mean accuracy pooled across all sites and scenarios was 59.2% (95% confidence interval [CI] 56.4% to 62.0%) and interrater reliability was modest (α=.730; 95% CI .692 to .767). There was no difference in overall accuracy between sites or according to nurse experience. Medium-acuity scenarios were scored with greater accuracy (76.4%; 95% CI 72.6% to 80.3%) than high- or low-acuity cases (44.1%, 95% CI 39.3% to 49.0% and 54%, 95% CI 49.9% to 58.2%), and adult scenarios were scored with greater accuracy than pediatric ones (66.2%, 95% CI 62.9% to 69.7% versus 46.9%, 95% CI 43.4% to 50.3%). In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Emergency Department Management of Patients With Febrile Neutropenia: Guideline Concordant or Overly Aggressive?

PubMed

Baugh, Christopher W; Wang, Thomas J; Caterino, Jeffrey M; Baker, Olesya N; Brooks, Gabriel A; Reust, Audrey C; Pallin, Daniel J

2017-01-01

The Infectious Diseases Society of America and the American Society of Clinical Oncology recommend risk stratification of patients with febrile neutropenia (FN) and discharge with oral antibiotics for low-risk patients. We studied guideline concordance and clinical outcomes of FN management in our emergency department (ED). Our urban, tertiary care teaching hospital provides all emergency and inpatient services to a large comprehensive cancer center. We performed a structured chart review of all FN patients seen in our ED from January 2010 to December 2014. Using electronic medical records, we identified all visits by patients with fever and an absolute neutrophil count of <1000 cells/mm 3 and then included only patients without a clear source of infection. Following national guidelines, we classified patients as low or high risk and assessed guideline concordance in disposition and parenteral versus oral antibiotic therapy by risk category as our main outcome measure. Of 173 qualifying visits, we classified 44 (25%) as low risk and 129 (75%) as high risk. Management was guideline concordant in 121 (70%, 95% confidence interval [CI] = 63% to 77%). Management was guideline discordant in 43 (98%, 95% CI = 88% to 100%) of low-risk patients versus 9 (7%, 95% CI = 3% to 13%) of high-risk patients (relative risk [RR] = 14, 95% CI = 7.5 to 26). Of 52 guideline-discordant cases, 36 (83%, 95% CI = 72% to 93%) involved low-risk cases with treatment that was more aggressive than recommended. Guideline concordance was low among low-risk patients, with management tending to be more aggressive than recommended. Unless data emerge that undermine the guidelines, we believe that many of these hospitalizations and parenteral antibiotic regimens can be avoided, decreasing the risks associated with hospitalization, while improving antibiotic stewardship and patient comfort. © 2016 by the Society for Academic Emergency Medicine.

Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study.

PubMed

Bakke, Håkon Kvåle; Steinvik, Tine; Ruud, Håkon; Wisborg, Torben

2017-03-07

Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated. For 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed. A total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid. Overall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect. This study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers' possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.

OpenSHMEM-UCX : Evaluation of UCX for implementing OpenSHMEM Programming Model

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

Baker, Matthew B; Gorentla Venkata, Manjunath; Aderholdt, William Ferrol

2016-01-01

The OpenSHMEM reference implementation was developed towards the goal of developing an open source and high-performing Open- SHMEM implementation. To achieve portability and performance across various networks, the OpenSHMEM reference implementation uses GAS- Net and UCCS for network operations. Recently, new network layers have emerged with the promise of providing high-performance, scalabil- ity, and portability for HPC applications. In this paper, we implement the OpenSHMEM reference implementation to use the UCX framework for network operations. Then, we evaluate its performance and scalabil- ity on Cray XK systems to understand UCX s suitability for developing the OpenSHMEM programming model. Further, wemore » develop a bench- mark called SHOMS for evaluating the OpenSHMEM implementation. Our experimental results show that OpenSHMEM-UCX outperforms the vendor supplied OpenSHMEM implementation in most cases on the Cray XK system by up to 40% with respect to message rate and up to 70% for the execution of application kernels.« less

Electrolyte bi-layering strategy to improve the performance of an intermediate temperature solid oxide fuel cell: A review

NASA Astrophysics Data System (ADS)

Shri Prakash, B.; Pavitra, R.; Senthil Kumar, S.; Aruna, S. T.

2018-03-01

Lowering of operation temperature has become one of the primary goals of solid oxide fuel (SOFC) research as reduced temperature improves the prospects for widespread commercialization of this energy system. Reduced operational temperature also mitigates the issues associated with high temperature SOFCs and paves way not only for the large scale stationary power generation but also makes SOFCs viable for portable and transport applications. However, there are issues with electrolyte and cathode materials at low temperatures, individually as well as in association with other components, which makes the performance of the SOFCs less satisfactory than expected at lowered temperatures. Bi-layering of electrolytes and impregnation of cathodes have emerged as two important strategies to overcome these issues and achieve higher performance at low temperatures. This review article provides the perspective on the strategy of bi-layering of electrolyte to achieve the desired high performance from SOFC at low to intermediate temperatures.

Medical Emergency Exceptions in State Abortion Statutes: The Statistical Record.

PubMed

Linton, Paul Benjamin

2016-01-01

This article attempts to determine, first, whether emergency exceptions in statutes regulating abortion have been abused and, second, whether the standard used in such an exception--subjective or objective--makes a difference in the reported incidence of such emergencies. A review of the statistical data supports two conclusions. First, physicians who perform abortions and have complied with state reporting requirements have not relied upon the medical emergency exceptions in state abortion statutes to evade the requirements of those statutes. Second, the use of an objective standard for evaluating medical emergencies ("reasonable medical judgment") has not been associated with fewer reported emergencies (per number of abortions performed) than the use of a subjective standard ("good faith clinical judgment"). Both of these conclusions may be relevant in drafting other abortion statutes including prohibitions (e.g., post-viability abortions).

Consistent Individual Differences Drive Collective Behavior and Group Functioning of Schooling Fish.

PubMed

Jolles, Jolle W; Boogert, Neeltje J; Sridhar, Vivek H; Couzin, Iain D; Manica, Andrea

2017-09-25

The ubiquity of consistent inter-individual differences in behavior ("animal personalities") [1, 2] suggests that they might play a fundamental role in driving the movements and functioning of animal groups [3, 4], including their collective decision-making, foraging performance, and predator avoidance. Despite increasing evidence that highlights their importance [5-16], we still lack a unified mechanistic framework to explain and to predict how consistent inter-individual differences may drive collective behavior. Here we investigate how the structure, leadership, movement dynamics, and foraging performance of groups can emerge from inter-individual differences by high-resolution tracking of known behavioral types in free-swimming stickleback (Gasterosteus aculeatus) shoals. We show that individual's propensity to stay near others, measured by a classic "sociability" assay, was negatively linked to swim speed across a range of contexts, and predicted spatial positioning and leadership within groups as well as differences in structure and movement dynamics between groups. In turn, this trait, together with individual's exploratory tendency, measured by a classic "boldness" assay, explained individual and group foraging performance. These effects of consistent individual differences on group-level states emerged naturally from a generic model of self-organizing groups composed of individuals differing in speed and goal-orientedness. Our study provides experimental and theoretical evidence for a simple mechanism to explain the emergence of collective behavior from consistent individual differences, including variation in the structure, leadership, movement dynamics, and functional capabilities of groups, across social and ecological scales. In addition, we demonstrate individual performance is conditional on group composition, indicating how social selection may drive behavioral differentiation between individuals. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Association of pretreatment neutrophil-lymphocyte ratio and outcome in emergency colorectal cancer care.

PubMed

Palin, R P; Devine, A T; Hicks, G; Burke, D

2018-04-01

Introduction The association between the neutrophil-lymphocyte ratio (NLR) and outcome in elective colorectal cancer surgery is well established; the relationship between NLR and the emergency colorectal cancer patient is, as yet, unexplored. This paper evaluates the predictive quality of the NLR for outcome in the emergency colorectal cancer patient. Materials and Methods A total of 187 consecutive patients who underwent emergency surgery for colorectal cancer were included in the study. NLR was calculated from the haematological tests done on admission. Receiver operating characteristic analyses were used to determine the most suitable cut-off for NLR. Outcomes were assessed by mortality at 30 and 90 days using stepwise Cox proportional hazards regression. Results An NLR cut-off of 5 was found to have the highest sensitivity and specificity. At 30 days, age and time from admission to surgery were associated with increased mortality; a high NLR was associated with an increased risk of mortality in univariate but not multivariate analysis. At 90 days, age, NLR, time from admission to surgery and nodal status were all significantly associated with increased mortality on multivariate analysis. Conclusions Pre-operative NLR is a cheap, easily performed and useful clinical tool to aid prediction of outcome in the emergency colorectal cancer patient.

High Altitude Platforms for Disaster Recovery: Capabilities, Strategies, and Techniques for Providing Emergency Telecommunications

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

Juan D. Deaton

2008-05-01

Natural disasters and terrorist acts have significant potential to disrupt emergency communication systems. These emergency communication networks include first-responder, cellular, landline, and emergency answering services such as 911, 112, or 999. Without these essential emergency communications capabilities, search, rescue, and recovery operations during a catastrophic event will be severely debilitated. High altitude platforms could be fitted with telecommunications equipment and used to support these critical communications missions once the catastrophic event occurs. With the ability to be continuously on station, HAPs provide excellent options for providing emergency coverage over high-risk areas before catastrophic incidents occur. HAPs could also provide enhancedmore » 911 capabilities using either GPS or reference stations. This paper proposes potential emergency communications architecture and presents a method for estimating emergency communications systems traffic patterns for a catastrophic event.« less

The effect of a performance-based intra-procedural checklist on a simulated emergency laparoscopic task in novice surgeons.

PubMed

El Boghdady, Michael; Tang, Benjie; Alijani, Afshin

2017-05-01

Surgical checklists are in use as means to reduce errors. Checklists are infrequently applied during emergency situations in surgery. We aimed to study the effect of a simple self-administered performance-based checklist on the laparoscopic task when applied during an emergency-simulated scenario. The aviation checklist for unexpected situations is commonly used for simulated training of pilots to handle emergency during flights. This checklist was adopted for use as a standardised-performance-based checklist during emergency surgical tasks. Thirty consented laparoscopic novices were exposed unexpectedly to a bleeding vessel in a laparoscopic virtual reality simulator as an emergency scenario. The task consisted of using laparoscopic clips to achieve haemostasis. Subjects were randomly allocated into two equal groups; those using the checklist that was applied once every 20 s (checklist group) and those without (control group). The checklist group performed significantly better in 5 out of 7 technical factors when compared to the control group: right instrument path length (m), median (IQR) 1.44 [1.22] versus 2.06 [1.70] (p = 0.029), right instrument angular path (degree) 312.10 (269.44 versus 541.80 [455.16] (p = 0.014), left instrument path length (m) 1.20 [0.60] versus 2.08 [2.02] (p = 0.004), and left instrument angular path (degree) 277.62 [132.11] versus 385.88 [428.42] (p = 0.017). The checklist group committed significantly fewer number of errors in the application of haemostatic clips, 3 versus 28 (p = 0.006). Although statistically not significant, total blood loss (lit) decreased in the checklist group from 0.83 [1.23] to 0.78 [0.28] (p = 0.724) and total time (sec) from 186.51 [145.69] to 125.14 [101.46] (p = 0.165). The performance-based intra-procedural checklist significantly enhanced the surgical task performance of novices in an emergency-simulated scenario.

High-Fidelity Simulation: Preparing Dental Hygiene Students for Managing Medical Emergencies.

PubMed

Bilich, Lisa A; Jackson, Sarah C; Bray, Brenda S; Willson, Megan N

2015-09-01

Medical emergencies can occur at any time in the dental office, so being prepared to properly manage the situation can be the difference between life and death. The entire dental team must be properly trained regarding all aspects of emergency management in the dental clinic. The aim of this study was to evaluate a new educational approach using a high-fidelity simulator to prepare dental hygiene students for medical emergencies. This study utilized high-fidelity simulation (HFS) to evaluate the abilities of junior dental hygiene students at Eastern Washington University to handle a medical emergency in the dental hygiene clinic. Students were given a medical emergency scenario requiring them to assess the emergency and implement life-saving protocols in a simulated "real-life" situation using a high-fidelity manikin. Retrospective data were collected for four years from the classes of 2010 through 2013 (N=114). The results indicated that learning with simulation was effective in helping the students identify the medical emergency in a timely manner, implement emergency procedures correctly, locate and correctly utilize contents of the emergency kit, administer appropriate intervention/treatment for a specific patient, and provide the patient with appropriate follow-up instructions. For dental hygiene programs seeking to enhance their curricula in the area of medical emergencies, this study suggests that HFS is an effective tool to prepare students to appropriately handle medical emergencies. Faculty calibration is essential to standardize simulation.

On-Chip Biomedical Imaging

PubMed Central

Göröcs, Zoltán; Ozcan, Aydogan

2012-01-01

Lab-on-a-chip systems have been rapidly emerging to pave the way toward ultra-compact, efficient, mass producible and cost-effective biomedical research and diagnostic tools. Although such microfluidic and micro electromechanical systems achieved high levels of integration, and are capable of performing various important tasks on the same chip, such as cell culturing, sorting and staining, they still rely on conventional microscopes for their imaging needs. Recently several alternative on-chip optical imaging techniques have been introduced, which have the potential to substitute conventional microscopes for various lab-on-a-chip applications. Here we present a critical review of these recently emerging on-chip biomedical imaging modalities, including contact shadow imaging, lensfree holographic microscopy, fluorescent on-chip microscopy and lensfree optical tomography. PMID:23558399

Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

PubMed

Skaugset, L Melissa; Farrell, Susan; Carney, Michele; Wolff, Margaret; Santen, Sally A; Perry, Marcia; Cico, Stephen John

2016-08-01

Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Experimental Simulation-Based Performance Evaluation of an SMS-Based Emergency Geolocation Notification System

PubMed Central

Osebor, Isibor

2017-01-01

In an emergency, a prompt response can save the lives of victims. This statement generates an imperative issue in emergency medical services (EMS). Designing a system that brings simplicity in locating emergency scenes is a step towards improving response time. This paper therefore implemented and evaluated the performance of an SMS-based emergency geolocation notification system with emphasis on its SMS delivery time and the system's geolocation and dispatch time. Using the RAS metrics recommended by IEEE for evaluation, the designed system was found to be efficient and effective as its reliability stood within 62.7% to 70.0% while its availability stood at 99% with a downtime of 3.65 days/year. PMID:29065643

Gyrokinetic particle-in-cell optimization on emerging multi- and manycore platforms

DOE PAGES

Madduri, Kamesh; Im, Eun-Jin; Ibrahim, Khaled Z.; ...

2011-03-02

The next decade of high-performance computing (HPC) systems will see a rapid evolution and divergence of multi- and manycore architectures as power and cooling constraints limit increases in microprocessor clock speeds. Understanding efficient optimization methodologies on diverse multicore designs in the context of demanding numerical methods is one of the greatest challenges faced today by the HPC community. In this paper, we examine the efficient multicore optimization of GTC, a petascale gyrokinetic toroidal fusion code for studying plasma microturbulence in tokamak devices. For GTC’s key computational components (charge deposition and particle push), we explore efficient parallelization strategies across a broadmore » range of emerging multicore designs, including the recently-released Intel Nehalem-EX, the AMD Opteron Istanbul, and the highly multithreaded Sun UltraSparc T2+. We also present the first study on tuning gyrokinetic particle-in-cell (PIC) algorithms for graphics processors, using the NVIDIA C2050 (Fermi). Our work discusses several novel optimization approaches for gyrokinetic PIC, including mixed-precision computation, particle binning and decomposition strategies, grid replication, SIMDized atomic floating-point operations, and effective GPU texture memory utilization. Overall, we achieve significant performance improvements of 1.3–4.7× on these complex PIC kernels, despite the inherent challenges of data dependency and locality. Finally, our work also points to several architectural and programming features that could significantly enhance PIC performance and productivity on next-generation architectures.« less

Role of transcatheter arterial embolization for massive bleeding from gastroduodenal ulcers

PubMed Central

Loffroy, Romaric; Guiu, Boris

2009-01-01

Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients, endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduodenal ulcers after failed endoscopic hemostasis. Here, we present an overview of indications, techniques, and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment, can be performed with high technical and clinical success rates, and should be considered the salvage treatment of choice in patients at high surgical risk. PMID:20014452

Proceedings of the Northumbria International Conference on Performance Measurement in Libraries and Information Services: "Meaningful Measures for Emerging Realities" (4th, Pittsburgh, Pennsylvania, August 12-16, 2001).

ERIC Educational Resources Information Center

Stein, Joan, Ed.; Kyrillidou, Martha, Ed.; Davis, Denise, Ed.

This Fourth Northumbria International Conference on Performance Measurement in Libraries and Information Services centered on the theme of "meaningful measures for emerging realities" and contributors surveyed the field of performance measurement from that perspective. The proceedings begins with seven keynote and invited papers from…

Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study.

PubMed

Chen, Jie; Yang, Jian; Hu, Fen; Yu, Si-Hong; Yang, Bing-Xiang; Liu, Qian; Zhu, Xiao-Ping

2018-06-01

Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. Two-group, non-randomised quasi-experimental design. A simulation centre in a Chinese University School of Nursing. Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation. Copyright © 2018 Elsevier Ltd. All rights reserved.