Advancing Continuous Predictive Analytics Monitoring: Moving from Implementation to Clinical Action in a Learning Health System.

PubMed

Keim-Malpass, Jessica; Kitzmiller, Rebecca R; Skeeles-Worley, Angela; Lindberg, Curt; Clark, Matthew T; Tai, Robert; Calland, James Forrest; Sullivan, Kevin; Randall Moorman, J; Anderson, Ruth A

2018-06-01

In the intensive care unit, clinicians monitor a diverse array of data inputs to detect early signs of impending clinical demise or improvement. Continuous predictive analytics monitoring synthesizes data from a variety of inputs into a risk estimate that clinicians can observe in a streaming environment. For this to be useful, clinicians must engage with the data in a way that makes sense for their clinical workflow in the context of a learning health system (LHS). This article describes the processes needed to evoke clinical action after initiation of continuous predictive analytics monitoring in an LHS. Copyright © 2018 Elsevier Inc. All rights reserved.

Synchrotron radiation based beam diagnostics at the Fermilab Tevatron

DOE PAGES

Thurman-Keup, R.; Cheung, H. W. K.; Hahn, A.; ...

2011-09-16

Synchrotron radiation has been used for many years as a beam diagnostic at electron accelerators. It is not normally associated with proton accelerators as the intensity of the radiation is too weak to make detection practical. Therefore, if one utilizes the radiation originating near the edge of a bending magnet, or from a short magnet, the rapidly changing magnetic field serves to enhance the wavelengths shorter than the cutoff wavelength, which for more recent high energy proton accelerators such as Fermilab's Tevatron, tends to be visible light. This paper discusses the implementation at the Tevatron of two devices. A transversemore » beam profile monitor images the synchrotron radiation coming from the proton and antiproton beams separately and provides profile data for each bunch. A second monitor measures the low-level intensity of beam in the abort gaps which poses a danger to both the accelerator's superconducting magnets and the silicon detectors of the high energy physics experiments. Comparisons of measurements from the profile monitor to measurements from the flying wire profile systems are presented as are a number of examples of the application of the profile and abort gap intensity measurements to the modelling of Tevatron beam dynamics.« less

The environmental audit. I. Concepts

NASA Astrophysics Data System (ADS)

Schaeffer, David J.; Kerster, Harold W.; Perry, James A.; Cox, David K.

1985-05-01

Extensive criticism of water quality monitoring programs has developed as costs are compared with the benefits produced by monitoring efforts. Collecting water quality data while developing understanding of the functional character of the environment will improve water quality monitoring data utility in environmental management. The “environmental audit” characterizes the attributes of the natural environment (that is, attribute type, intensity, and variability), providing a theoretical as well as practical foundation for data interpretation. In the view proposed here, traditional monitoring means the very narrow activity of collecting samples and perhaps analyzing them and storing the analyses. In the environmental audit, these activities are a mechanism to systematically improve environmental monitoring and assessment by improving the design and implementation of environmental programs. Major reasons why existing programs fail to meet the needs of legislators, regulators, and conservationists are identified.

Healthcare professionals' views of smart glasses in intensive care: A qualitative study.

PubMed

Romare, Charlotte; Hass, Ursula; Skär, Lisa

2018-04-01

The aim of this study was to describe healthcare professionals' views of smart glasses before their implementation in an intensive care unit, both regarding quality of use of the glasses and to identify possible intensive care situations where the glasses could be used to increase patient safety. Data were generated through focus group interviews and analysed using thematic content analysis. The findings describe participants' views of smart glasses divided into three categories; Smart glasses to facilitate work at intensive care unit; Quality of use and Utilisation. Participants assumed smart glasses to cause both effect and affect in intensive care. Participants' concern for patients arose recurrently and through their concern intention to work to promote patient safety. Smart glasses are suggested as a complement to existing monitoring and routines and cannot replace human presence in intensive care. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Quality assurance of research protocols conducted in the community: the National Institute on Drug Abuse Clinical Trials Network experience.

PubMed

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-04-01

Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. : QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed.

Quality assurance of research protocols conducted in the community: The National Institute on Drug Abuse Clinical Trials Network Experience

PubMed Central

Rosa, Carmen; Campbell, Aimee; Kleppinger, Cynthia; Sampson, Royce; Tyson, Clare; Mamay-Gentilin, Stephanie

2009-01-01

Background: Quality assurance (QA) of clinical trials is essential to protect the welfare of trial participants and the integrity of the data collected. However, there is little detailed information available on specific procedures and outcomes of QA monitoring for clinical trials. Purpose: This article describes the experience of the National Institute on Drug Abuse's (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) in devising and implementing a three-tiered QA model for rigorous multi-site randomized clinical trials implemented in community-based substance abuse treatment programs. The CTN QA model combined local and national resources and was developed to address the unique needs of clinical trial sites with limited research experience. Methods: The authors reviewed internal records maintained by the sponsor, a coordinating site (Lead Nodes), and a local site detailing procedural development, training sessions, protocol violation monitoring, and site visit reporting. Results: Between January 2001 and September 2005, the CTN implemented 21 protocols, of which 18 were randomized clinical trials, one was a quality improvement study and two were surveys. Approximately 160 community-based treatment programs participated in the 19 studies that were monitored, with a total of 6560 participants randomized across the sites. During this time 1937 QA site visits were reported across the three tiers of monitoring and the cost depended on the location of the sites and the salaries of the staff involved. One study reported 109 protocol violations (M = 15.6). Examples are presented to highlight training, protocol violation monitoring, site visit frequency and intensity and cost considerations. Limitations: QA data from the entire network were not easily available for review as much of the data were not electronically accessible. The authors reviewed and discussed a representative sample of internal data from the studies and participating sites. Conclusions: The lessons learned from the CTN's experience include the need for balancing thoroughness with efficiency, monitoring early, assessing research staff abilities in order to judge the need for proactive, focused attention, providing targeted training sessions, and developing flexible tools. The CTN model can work for sponsors overseeing studies at sites with limited research experience that require more frequent, in-depth monitoring. We recommend that sponsors not develop a rigid monitoring approach, but work with the study principal investigators to determine the intensity of monitoring needed depending on trial complexity, the risks of the intervention(s), and the experience of the staff with clinical research. After careful evaluation, sponsors should then determine the best approach to site monitoring and what resources will be needed. PMID:19342468

Application of Terrestrial Ecosystem Monitoring under the CAFF Circumpolar Biodiversity Monitoring Program: Designing and Implementing Terrestrial Monitoring to Establish the Canadian High Arctic Research Station as a Flagship Arctic Environmental Monitoring Site

NASA Astrophysics Data System (ADS)

McLennan, D.; Kehler, D.

2016-12-01

The Canadian High Arctic Research Station (CHARS) is scheduled for completion in July 2017 and is the northern science component of Polar Knowledge Canada (POLAR). A mandated goal for POLAR is to establish the adjacent Experimental and Reference Area (ERA) as an Arctic Flagship monitoring site that will track change in Arctic terrestrial, freshwater and marine ecosystems. Situated in the community of Cambridge Bay, CHARS provides the opportunity to draw on the Indigenous Knowledge of local residents to help design and conduct the monitoring, and to operate 12 months a year. Monitoring at CHARS will be linked to networks nationally and internationally, and is being designed so that change in key indicators can be understood in terms of drivers and processes, modeled and scaled up regionally, and used to predict important changes in critical indicators. As a partner in the Circumpolar Biodiversity Monitoring Program (CBMP), the monitoring design for terrestrial ecosystems follows approaches outlined by the CBMP Terrestrial Expert Monitoring Group, who have listed key monitoring questions and identified a list of important Focal Ecosystem Components (FECs). To link drivers to FECs we are proposing a multi-scaled approach: 1) an Intensive Monitoring Area to establish replicated monitoring plots that track change in snow depth and condition, active layer depth, soil temperature, soil moisture, and soil solution chemistry that are spatially and temporally linked to changes in microbiological activity, CO2/CH4 net ecosystem flux, vegetation relative frequency, species composition, growth and foliar nutrient concentration, arthropod abundance, lemming abundance and health, and shorebird/songbird abundance and productivity. 2) These intensive observations are supported by watershed scale measures that will monitor, during the growing season, lemming winter nest abundance, songbird, shorebird and waterfowl staging and nesting, and other observations; in the winter we will monitor muskoxen, caribou, Arctic hare, wolf and Arctic fox using tracks and DNA analysis of fresh scat. 3) Ground measures will be supported by aerial flights and satellite remote sensing approaches to reach out with regional calibration-validation. Feedback is being sought at this time on project design, implementation and scope.

Comparative study of 2 oral care protocols in intensive care units.

PubMed

Ory, Jérôme; Raybaud, Evelyne; Chabanne, Russell; Cosserant, Bernard; Faure, Jean Sébastien; Guérin, Renaud; Calvet, Laure; Pereira, Bruno; Mourgues, Charline; Guelon, Dominique; Traore, Ousmane

2017-03-01

The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The power of FIA Phase 3 Crown-Indicator variables to detect change

Treesearch

William Bechtold; KaDonna Randolph; Stanley Zarnoch

2009-01-01

The goal of Phase 3 Detection Monitoring as implemented by the Forest Inventory and Analysis Program is to identify forest ecosystems where conditions might be deteriorating in subtle ways over large areas. At the relatively sparse sampling intensity of the Phase 3 plot network, a rough measure of success for the forest health indicators developed for this purpose is...

Sensor network based vehicle classification and license plate identification system

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

Frigo, Janette Rose; Brennan, Sean M; Rosten, Edward J

Typically, for energy efficiency and scalability purposes, sensor networks have been used in the context of environmental and traffic monitoring applications in which operations at the sensor level are not computationally intensive. But increasingly, sensor network applications require data and compute intensive sensors such video cameras and microphones. In this paper, we describe the design and implementation of two such systems: a vehicle classifier based on acoustic signals and a license plate identification system using a camera. The systems are implemented in an energy-efficient manner to the extent possible using commercially available hardware, the Mica motes and the Stargate platform.more » Our experience in designing these systems leads us to consider an alternate more flexible, modular, low-power mote architecture that uses a combination of FPGAs, specialized embedded processing units and sensor data acquisition systems.« less

Continuous Metabolic Monitoring Based on Multi-Analyte Biomarkers to Predict Exhaustion

PubMed Central

Kastellorizios, Michail; Burgess, Diane J.

2015-01-01

This work introduces the concept of multi-analyte biomarkers for continuous metabolic monitoring. The importance of using more than one marker lies in the ability to obtain a holistic understanding of the metabolism. This is showcased for the detection and prediction of exhaustion during intense physical exercise. The findings presented here indicate that when glucose and lactate changes over time are combined into multi-analyte biomarkers, their monitoring trends are more sensitive in the subcutaneous tissue, an implantation-friendly peripheral tissue, compared to the blood. This unexpected observation was confirmed in normal as well as type 1 diabetic rats. This study was designed to be of direct value to continuous monitoring biosensor research, where single analytes are typically monitored. These findings can be implemented in new multi-analyte continuous monitoring technologies for more accurate insulin dosing, as well as for exhaustion prediction studies based on objective data rather than the subject’s perception. PMID:26028477

Continuous metabolic monitoring based on multi-analyte biomarkers to predict exhaustion.

PubMed

Kastellorizios, Michail; Burgess, Diane J

2015-06-01

This work introduces the concept of multi-analyte biomarkers for continuous metabolic monitoring. The importance of using more than one marker lies in the ability to obtain a holistic understanding of the metabolism. This is showcased for the detection and prediction of exhaustion during intense physical exercise. The findings presented here indicate that when glucose and lactate changes over time are combined into multi-analyte biomarkers, their monitoring trends are more sensitive in the subcutaneous tissue, an implantation-friendly peripheral tissue, compared to the blood. This unexpected observation was confirmed in normal as well as type 1 diabetic rats. This study was designed to be of direct value to continuous monitoring biosensor research, where single analytes are typically monitored. These findings can be implemented in new multi-analyte continuous monitoring technologies for more accurate insulin dosing, as well as for exhaustion prediction studies based on objective data rather than the subject's perception.

Intensity of Territorial Marking Predicts Wolf Reproduction: Implications for Wolf Monitoring

PubMed Central

García, Emilio J.

2014-01-01

Background The implementation of intensive and complex approaches to monitor large carnivores is resource demanding, restricted to endangered species, small populations, or small distribution ranges. Wolf monitoring over large spatial scales is difficult, but the management of such contentious species requires regular estimations of abundance to guide decision-makers. The integration of wolf marking behaviour with simple sign counts may offer a cost-effective alternative to monitor the status of wolf populations over large spatial scales. Methodology/Principal Findings We used a multi-sampling approach, based on the collection of visual and scent wolf marks (faeces and ground scratching) and the assessment of wolf reproduction using howling and observation points, to test whether the intensity of marking behaviour around the pup-rearing period (summer-autumn) could reflect wolf reproduction. Between 1994 and 2007 we collected 1,964 wolf marks in a total of 1,877 km surveyed and we searched for the pups' presence (1,497 howling and 307 observations points) in 42 sampling sites with a regular presence of wolves (120 sampling sites/year). The number of wolf marks was ca. 3 times higher in sites with a confirmed presence of pups (20.3 vs. 7.2 marks). We found a significant relationship between the number of wolf marks (mean and maximum relative abundance index) and the probability of wolf reproduction. Conclusions/Significance This research establishes a real-time relationship between the intensity of wolf marking behaviour and wolf reproduction. We suggest a conservative cutting point of 0.60 for the probability of wolf reproduction to monitor wolves on a regional scale combined with the use of the mean relative abundance index of wolf marks in a given area. We show how the integration of wolf behaviour with simple sampling procedures permit rapid, real-time, and cost-effective assessments of the breeding status of wolf packs with substantial implications to monitor wolves at large spatial scales. PMID:24663068

Conducting an Efficient Proactive Risk Assessment Prior to CPOE Implementation in an Intensive Care Unit

PubMed Central

Hundt, Ann Schoofs; Adams, Jean A.; Schmid, J. Andrew; Musser, Linda M.; Walker, James M.; Wetterneck, Tosha B; Douglas, Stephen V.; Paris, Bonnie L.; Carayon, Pascale

2012-01-01

Purpose To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU. Methods We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term). Results Sixteen unique relevant vulnerabilities were identified as a result of the PRA team’s efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing “issues list” of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n = 7) or shortly thereafter (n = 9). No other issues were identified beside those identified by the team. Conclusions Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints. PMID:22608242

Implementation and Operational Analysis of an Interactive Intensive Care Unit within a Smart Health Context.

PubMed

Lopez-Iturri, Peio; Aguirre, Erik; Trigo, Jesús Daniel; Astrain, José Javier; Azpilicueta, Leyre; Serrano, Luis; Villadangos, Jesús; Falcone, Francisco

2018-01-29

In the context of hospital management and operation, Intensive Care Units (ICU) are one of the most challenging in terms of time responsiveness and criticality, in which adequate resource management and signal processing play a key role in overall system performance. In this work, a context aware Intensive Care Unit is implemented and analyzed to provide scalable signal acquisition capabilities, as well as to provide tracking and access control. Wireless channel analysis is performed by means of hybrid optimized 3D Ray Launching deterministic simulation to assess potential interference impact as well as to provide required coverage/capacity thresholds for employed transceivers. Wireless system operation within the ICU scenario, considering conventional transceiver operation, is feasible in terms of quality of service for the complete scenario. Extensive measurements of overall interference levels have also been carried out, enabling subsequent adequate coverage/capacity estimations, for a set of Zigbee based nodes. Real system operation has been tested, with ad-hoc designed Zigbee wireless motes, employing lightweight communication protocols to minimize energy and bandwidth usage. An ICU information gathering application and software architecture for Visitor Access Control has been implemented, providing monitoring of the Boxes external doors and the identification of visitors via a RFID system. The results enable a solution to provide ICU access control and tracking capabilities previously not exploited, providing a step forward in the implementation of a Smart Health framework.

Internet based ECG medical information system.

PubMed

James, D A; Rowlands, D; Mahnovetski, R; Channells, J; Cutmore, T

2003-03-01

Physiological monitoring of humans for medical applications is well established and ready to be adapted to the Internet. This paper describes the implementation of a Medical Information System (MIS-ECG system) incorporating an Internet based ECG acquisition device. Traditionally clinical monitoring of ECG is largely a labour intensive process with data being typically stored on paper. Until recently, ECG monitoring applications have also been constrained somewhat by the size of the equipment required. Today's technology enables large and fixed hospital monitoring systems to be replaced by small portable devices. With an increasing emphasis on health management a truly integrated information system for the acquisition, analysis, patient particulars and archiving is now a realistic possibility. This paper describes recent Internet and technological advances and presents the design and testing of the MIS-ECG system that utilises those advances.

A compact multi-channel fluorescence sensor with ambient light suppression

NASA Astrophysics Data System (ADS)

Egly, Dominik; Geörg, Daniel; Rädle, Matthias; Beuermann, Thomas

2012-03-01

A multi-channel fluorescence sensor has been developed for process monitoring and fluorescence diagnostics. It comprises a fiber-optic set-up with an immersion probe and an intensity-modulated high power ultraviolet light-emitting diode as a light source for fluorescence excitation. By applying an electronic lock-in procedure, fluorescence signals are selectively detectable at ambient light levels of 1000 000 times higher intensity. The sensor was designed to be compact, low cost and easily adaptable to a wide field of application. The set-up was used to simultaneously monitor three important metabolic fluorophores: NAD(P)H, flavins and porphyrins during the cultivation of a baker's yeast. Moreover, the accumulation and degradation kinetics of protoporphyrin IX induced by 5-aminolevulinic acid on the skin could be recorded by the sensor. The detection limit for protoporphyrin IX was determined to be 4 × 10-11 mol L-1. The linear signal amplification of the sensor and time courses of fluorescence signals monitored during yeast fermentations were validated using a commercial CCD spectrometer. The robust and flexible set-up of the fiber-optic measurement system promises easy implementation of this non-invasive analytical tool to fluorescence monitoring and diagnostics in R&D and production.

[Factors affecting the recovery in the intensive care unit].

PubMed

Turkov, P N; Nikitin, V V; Antsupova, M A; Podkopaev, V N; Panfilova, R P; Ivanova, I N; Nesterova, L I

2013-01-01

Urgency of the problem is defined by economical, regulatory and legislative acts, regional social and moral factors. There is critical situation in Russian Pediatric Healthcare system. This situation is due to inadequate funding, high medical technologies inaccessibility for some Russian children, their adverse health state. The article presents a retrospective analysis of intensive therapy and resuscitation outcomes with technical equipment and work environment assessment in the intensive care unit of Tushinskaya city pediatric clinic for the period from 2007 to 2011. Anaesthetic and emergency care quality and safety depend on several factors: permanent equipment improvement, comprehensive analysis of every fatal case and full implementation of "Anti-epidemic (prophylactic) actions plan" and "Program of monitoring compliance with the sanitary norms".

Monitoring nitrogen deposition in throughfall using ion exchange resin columns: a field test in the San Bernardino Mountains

Treesearch

Mark E. Fenn; Mark A. Poth

2004-01-01

Conventional throughfall collection methods are labor intensive and analytically expensive to implement at broad scales. This study was conducted to test an alternative approach requiring infrequent sample collection and a greatly reduced number of chemical analyses. The major objective of the study was to determine the feasibility of using ion exchange resin (IER) to...

Plan for the Characterization of HIRF Effects on a Fault-Tolerant Computer Communication System

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo; Malekpour, Mahyar R.; Miner, Paul S.; Koppen, Sandra V.

2008-01-01

This report presents the plan for the characterization of the effects of high intensity radiated fields on a prototype implementation of a fault-tolerant data communication system. Various configurations of the communication system will be tested. The prototype system is implemented using off-the-shelf devices. The system will be tested in a closed-loop configuration with extensive real-time monitoring. This test is intended to generate data suitable for the design of avionics health management systems, as well as redundancy management mechanisms and policies for robust distributed processing architectures.

Monitoring process hygiene in Serbian retail establishments

NASA Astrophysics Data System (ADS)

Vesković Moračanin, S.; Baltić, T.; Milojević, L.

2017-09-01

The present study was conducted to estimate the effectiveness of sanitary procedures on food contact surfaces and food handlers’ hands in Serbian retail establishments. For that purpose, a total of 970 samples from food contact surfaces and 525 samples from workers’ hands were microbiologically analyzed. Results of total aerobic plate count and total Enterobacteriaceae count showed that the implemented washing and disinfection procedures, as a part of HACCP plans, were not effective enough in most retail facilities. Constant and intensive education of employees on proper implementation of sanitation procedures are needed in order to ensure food safety in the retail market.

Development and Implementation of Sepsis Alert Systems.

PubMed

Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W; Herasevich, Vitaly

2016-06-01

Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload, and alert fatigue, due to suboptimal alert performance. Outside the ICU, barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Current evidence does not support routine use of sepsis alert systems in clinical practice. Continuous improvement in the afferent and efferent aspects will help translate theoretic advantages into measurable patient benefit. Copyright © 2016 Elsevier Inc. All rights reserved.

The effectiveness of intensive nursing care on seasonal variation of blood pressure in patients on peritoneal dialysis.

PubMed

Quan, Lei; Dong, Jie; Li, Yanjun; Zuo, Li

2012-06-01

  This article is a report of a study to reduce the seasonal variation of blood pressure in patients on peritoneal dialysis through an intensive programme of nursing care.   The seasonal variation of blood pressure is a common phenomenon in patients on maintenance dialysis. Whether or not this variation can be reduced through a given intervention is unknown.   The programme of intensive nursing care including education on volume control, home blood pressure monitoring and intensified antihypertensive treatment, was implemented from December 2006. The blood pressure, fluid and sodium removal and defined daily doses of antihypertensive agents were measured at 1-monthly intervals and averagely quarterly for seasonal values for spring, summer, autumn and winter, respectively, before (December 2005-November 2006) and after intervention (December 2006-November 2007).   A total of 76 clinically stable patients on peritoneal dialysis were enrolled and finally analysed. The mean age was 60·6 years, and dialysis duration was 23·2 months. Before intervention, there were important seasonal variations in systolic and diastolic blood pressure. After intensive nursing care was implemented, the seasonal variation of systolic blood pressure disappeared. The diastolic blood pressure still represented a season pattern, but the discrepancy between winter and summer decreased. There were no seasonal patterns of total fluid and sodium removal before and after intervention.   Intensive nursing care reduced the seasonal variation of blood pressure in patients on peritoneal dialysis. These data provided an evidence for implementing nurse-centred interventions in this population. © 2011 Blackwell Publishing Ltd.

State-of-the-art practices in farmland biodiversity monitoring for North America and Europe.

PubMed

Herzog, Felix; Franklin, Janet

2016-12-01

Policy makers and farmers need to know the status of farmland biodiversity in order to meet conservation goals and evaluate management options. Based on a review of 11 monitoring programs in Europe and North America and on related literature, we identify the design choices or attributes of a program that balance monitoring costs and usefulness for stakeholders. A useful program monitors habitats, vascular plants, and possibly faunal groups (ecosystem service providers, charismatic species) using a stratified random sample of the agricultural landscape, including marginal and intensive regions. The size of landscape samples varies with the grain of the agricultural landscape; for example, samples are smaller in Europe and larger in North America. Raw data are collected in a rolling survey, which distributes sampling over several years. Sufficient practical experience is now available to implement broad monitoring schemes on both continents. Technological developments in remote sensing, metagenomics, and social media may offer new opportunities for affordable farmland biodiversity monitoring and help to lower the overall costs of monitoring programs.

Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

PubMed

Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

2008-09-01

Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

An improvement of drought monitoring through the use of a multivariate magnitude index

NASA Astrophysics Data System (ADS)

Real-Rangel, R. A.; Alcocer-Yamanaka, V. H.; Pedrozo-Acuña, A.; Breña-Naranjo, J. A.; Ocón-Gutiérrez, A. R.

2017-12-01

In drought monitoring activities it is widely acknowledged that the severity of an event is determined in relation to monthly values of univariate indices of one or more hydrological variables. Normally, these indices are estimated using temporal windows from 1 to 12 months or more to aggregate the effects of deficits in the variable of interest. However, the use of these temporal windows may lead to a misperception of both, the drought event intensity and the timing of its occurrence. In this context, this work presents the implementation of a trivariate drought magnitude index, considering key hydrological variables (e.g., precipitation, soil moisture and runoff) using for this the framework of the Multivariate Standardized Drought Index (MSDI). Despite the popularity and simplicity of the concept of drought magnitude for standardized drought indices, its implementation in drought monitoring and early warning systems has not been reported. This approach has been tested for operational purposes in the recently launched Multivariate Drought Monitor of Mexico (MOSEMM) and the results shows that the inclusion of a Magnitude index facilitates the drought detection and, thus, improves the decision making process for emergency managers.

[Designing and implementation of a web-based quality monitoring system for plasma glucose measurement in multicenter population study].

PubMed

Liu, Yong; Wang, Limin; Pang, Richard; Mo, Nanxun; Hu, Yan; Deng, Qian; Hu, Zhaohui

2015-05-01

The aim of this paper is to describe the designing and implementation of a web-based plasma glucose measurement quality monitoring system to assess the analytical quality of plasma glucose measurements in multicenter population study and provide evidence for the future studies. In the chronic non-communicable disease and related factor surveillance in China, a web based quality monitoring system for plasma glucose measurement was established to conduct evaluation on plasma glucose monitoring quality and effectiveness in 302 surveillance centers, including quality control data entry, transmission and feedback. The majority of the surveillance centers met the quality requirements and passed the evaluation of reproducibility and precision of plasma glucose measurement, only a few centers required intensive training and re-assessment. In order to ensure the completeness and reliability of plasma glucose measurement in the surveillance centers, the establishment of web-based plasma glucose measurement quality control system can facilitate the identification of the qualified surveillance centers and evaluation of plasma glucose measurement quality in different regions. Communication and training are important in ensuring plasma glucose measurement quality. It is necessary to further improve this web-based plasma glucose measurement quality monitoring system in the future to reduce the method specific plasma glucose measurement bias.

Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial.

PubMed

Messier, Stephen P; Callahan, Leigh F; Beavers, Daniel P; Queen, Kate; Mihalko, Shannon L; Miller, Gary D; Losina, Elena; Katz, Jeffrey N; Loeser, Richard F; Quandt, Sara A; DeVita, Paul; Hunter, David J; Lyles, Mary F; Newman, Jovita; Hackney, Betsy; Jordan, Joanne M

2017-02-22

Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA. This is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m 2 ) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective. Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by numerous OA treatment guidelines. This study will establish the effectiveness of a community program that will serve as a blueprint and exemplar for clinicians and public health officials in urban and rural communities to implement a diet-induced weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA. clinicaltrials.gov Identifier: NCT02577549 October 12, 2015.

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis.

PubMed

Tucker, Katherine L; Sheppard, James P; Stevens, Richard; Bosworth, Hayden B; Bove, Alfred; Bray, Emma P; Earle, Kenneth; George, Johnson; Godwin, Marshall; Green, Beverly B; Hebert, Paul; Hobbs, F D Richard; Kantola, Ilkka; Kerry, Sally M; Leiva, Alfonso; Magid, David J; Mant, Jonathan; Margolis, Karen L; McKinstry, Brian; McLaughlin, Mary Ann; Omboni, Stefano; Ogedegbe, Olugbenga; Parati, Gianfranco; Qamar, Nashat; Tabaei, Bahman P; Varis, Juha; Verberk, Willem J; Wakefield, Bonnie J; McManus, Richard J

2017-09-01

Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies. Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.

Implementation and Operational Analysis of an Interactive Intensive Care Unit within a Smart Health Context

PubMed Central

Aguirre, Erik

2018-01-01

In the context of hospital management and operation, Intensive Care Units (ICU) are one of the most challenging in terms of time responsiveness and criticality, in which adequate resource management and signal processing play a key role in overall system performance. In this work, a context aware Intensive Care Unit is implemented and analyzed to provide scalable signal acquisition capabilities, as well as to provide tracking and access control. Wireless channel analysis is performed by means of hybrid optimized 3D Ray Launching deterministic simulation to assess potential interference impact as well as to provide required coverage/capacity thresholds for employed transceivers. Wireless system operation within the ICU scenario, considering conventional transceiver operation, is feasible in terms of quality of service for the complete scenario. Extensive measurements of overall interference levels have also been carried out, enabling subsequent adequate coverage/capacity estimations, for a set of Zigbee based nodes. Real system operation has been tested, with ad-hoc designed Zigbee wireless motes, employing lightweight communication protocols to minimize energy and bandwidth usage. An ICU information gathering application and software architecture for Visitor Access Control has been implemented, providing monitoring of the Boxes external doors and the identification of visitors via a RFID system. The results enable a solution to provide ICU access control and tracking capabilities previously not exploited, providing a step forward in the implementation of a Smart Health framework. PMID:29382148

Why are we prolonging QT interval monitoring?

PubMed

Barrett, Trina

2015-01-01

At present, monitoring of the QT interval (QTI) is not a standard practice in the medical intensive care unit setting, where many drugs that prolong the QTI are administered. This literature review looked at the current research for evidence-based standards to support QTI monitoring of patients with risk factors for QTI prolongation, which can result in life-threatening arrhythmias such as torsade de pointes. The objective of this article is to establish the existence of evidence-based standards for monitoring of the QTI and to raise awareness in the nursing profession of the need for such monitoring among patients who are at high risk for prolonged QTI. To determine whether published standards for QTI monitoring exist, a search was conducted of the bibliographic databases CINAHL, EBSCOhost, Medline, PubMed, Google Scholar, and the Cochrane Library for the years 2013 and 2014. Also, a survey was conducted to determine whether practice standards for QTI monitoring are being implemented at 4 major hospitals in the Memphis area, including a level 1 trauma center. The database search established the existence of published guidelines that support the need for QTI monitoring. Results of the hospital survey indicated that direct care nurses were not aware of the need to identify high-risk patients, drugs with the potential to prolong QTI that were being administered to their patients, or evidence-based standards for QTI monitoring. Review of the research literature underscored the need for QTI monitoring among high-risk patients, that is, those with genetic conditions that predispose them to QTI prolongation, those with existing cardiac conditions being treated with antiarrhythmic medications, or those who are prescribed any new medication classified as high risk on the basis of clinical research. This need is especially crucial in intensive care unit settings, where many antiarrhythmic medications are administered.

Automating ATLAS Computing Operations using the Site Status Board

NASA Astrophysics Data System (ADS)

J, Andreeva; Iglesias C, Borrego; S, Campana; Girolamo A, Di; I, Dzhunov; Curull X, Espinal; S, Gayazov; E, Magradze; M, Nowotka M.; L, Rinaldi; P, Saiz; J, Schovancova; A, Stewart G.; M, Wright

2012-12-01

The automation of operations is essential to reduce manpower costs and improve the reliability of the system. The Site Status Board (SSB) is a framework which allows Virtual Organizations to monitor their computing activities at distributed sites and to evaluate site performance. The ATLAS experiment intensively uses the SSB for the distributed computing shifts, for estimating data processing and data transfer efficiencies at a particular site, and for implementing automatic exclusion of sites from computing activities, in case of potential problems. The ATLAS SSB provides a real-time aggregated monitoring view and keeps the history of the monitoring metrics. Based on this history, usability of a site from the perspective of ATLAS is calculated. The paper will describe how the SSB is integrated in the ATLAS operations and computing infrastructure and will cover implementation details of the ATLAS SSB sensors and alarm system, based on the information in the SSB. It will demonstrate the positive impact of the use of the SSB on the overall performance of ATLAS computing activities and will overview future plans.

The USA National Phenology Network: A national observatory for assessment of biotic response to environmental variation

NASA Astrophysics Data System (ADS)

Weltzin, J. F.; USA National Phenology Network National Coordinating Office

2011-12-01

The USA National Phenology Network (USA-NPN; www.usanpn.org), established in 2007, is a national science and monitoring initiative focused on phenology as a tool to understand how plants, animals and landscapes respond to climatic variability and change. Core functions of the National Coordinating Office (NCO) of USA-NPN are to provide a national information management system including databases, develop and implement internationally standardized phenology monitoring protocols, create partnerships with a variety of organizations including field stations for implementation, facilitate research and the development of decision support tools, and promote education and outreach activities related to phenology and climate change. This presentation will describe programs, tools and materials developed by USA-NPN to facilitate science, management and education related to phenology of plants, animals and landscapes within protected areas at local, regional and national scales. Particular emphasis will be placed on the on-line integrated animal and plant monitoring program, Nature's Notebook, which provides standardized protocols for phenological status monitoring and data management for over 500 animal and plant species. The monitoring system facilitates collection of sampling intensity, absence data, considerable metadata (from site to observation). We recently added functionality for recording estimates of animal abundance and plant canopy development. Real-time raw data for plants (from 2009 to present) and animals (from 2010 to present), including FGDC-compliant metadata and documented methodology, are now available for download from the website. A new data exploration tool premiered in spring 2010 allows sophisticated graphical visualization of integrated phenological and meteorological data. The network seeks to develop partnerships with other organizations interested in (1) implementing vetted, standardized protocols for phenological or ecological monitoring, and (2) using phenology data and information for a variety of modeling applications.

Intensity Thresholds on Raw Acceleration Data: Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD) Approaches

PubMed Central

Bakrania, Kishan; Yates, Thomas; Rowlands, Alex V.; Esliger, Dale W.; Bunnewell, Sarah; Sanders, James; Davies, Melanie; Khunti, Kamlesh; Edwardson, Charlotte L.

2016-01-01

Objectives (1) To develop and internally-validate Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD) thresholds for separating sedentary behaviours from common light-intensity physical activities using raw acceleration data collected from both hip- and wrist-worn tri-axial accelerometers; and (2) to compare and evaluate the performances between the ENMO and MAD metrics. Methods Thirty-three adults [mean age (standard deviation (SD)) = 27.4 (5.9) years; mean BMI (SD) = 23.9 (3.7) kg/m2; 20 females (60.6%)] wore four accelerometers; an ActiGraph GT3X+ and a GENEActiv on the right hip; and an ActiGraph GT3X+ and a GENEActiv on the non-dominant wrist. Under laboratory-conditions, participants performed 16 different activities (11 sedentary behaviours and 5 light-intensity physical activities) for 5 minutes each. ENMO and MAD were computed from the raw acceleration data, and logistic regression and receiver-operating-characteristic (ROC) analyses were implemented to derive thresholds for activity discrimination. Areas under ROC curves (AUROC) were calculated to summarise performances and thresholds were assessed via executing leave-one-out-cross-validations. Results For both hip and wrist monitor placements, in comparison to the ActiGraph GT3X+ monitors, the ENMO and MAD values derived from the GENEActiv devices were observed to be slightly higher, particularly for the lower-intensity activities. Monitor-specific hip and wrist ENMO and MAD thresholds showed excellent ability for separating sedentary behaviours from motion-based light-intensity physical activities (in general, AUROCs >0.95), with validation indicating robustness. However, poor classification was experienced when attempting to isolate standing still from sedentary behaviours (in general, AUROCs <0.65). The ENMO and MAD metrics tended to perform similarly across activities and accelerometer brands. Conclusions Researchers can utilise these robust monitor-specific hip and wrist ENMO and MAD thresholds, in order to accurately separate sedentary behaviours from common motion-based light-intensity physical activities. However, caution should be taken if isolating sedentary behaviours from standing is of particular interest. PMID:27706241

Intensity Thresholds on Raw Acceleration Data: Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD) Approaches.

PubMed

Bakrania, Kishan; Yates, Thomas; Rowlands, Alex V; Esliger, Dale W; Bunnewell, Sarah; Sanders, James; Davies, Melanie; Khunti, Kamlesh; Edwardson, Charlotte L

2016-01-01

(1) To develop and internally-validate Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD) thresholds for separating sedentary behaviours from common light-intensity physical activities using raw acceleration data collected from both hip- and wrist-worn tri-axial accelerometers; and (2) to compare and evaluate the performances between the ENMO and MAD metrics. Thirty-three adults [mean age (standard deviation (SD)) = 27.4 (5.9) years; mean BMI (SD) = 23.9 (3.7) kg/m2; 20 females (60.6%)] wore four accelerometers; an ActiGraph GT3X+ and a GENEActiv on the right hip; and an ActiGraph GT3X+ and a GENEActiv on the non-dominant wrist. Under laboratory-conditions, participants performed 16 different activities (11 sedentary behaviours and 5 light-intensity physical activities) for 5 minutes each. ENMO and MAD were computed from the raw acceleration data, and logistic regression and receiver-operating-characteristic (ROC) analyses were implemented to derive thresholds for activity discrimination. Areas under ROC curves (AUROC) were calculated to summarise performances and thresholds were assessed via executing leave-one-out-cross-validations. For both hip and wrist monitor placements, in comparison to the ActiGraph GT3X+ monitors, the ENMO and MAD values derived from the GENEActiv devices were observed to be slightly higher, particularly for the lower-intensity activities. Monitor-specific hip and wrist ENMO and MAD thresholds showed excellent ability for separating sedentary behaviours from motion-based light-intensity physical activities (in general, AUROCs >0.95), with validation indicating robustness. However, poor classification was experienced when attempting to isolate standing still from sedentary behaviours (in general, AUROCs <0.65). The ENMO and MAD metrics tended to perform similarly across activities and accelerometer brands. Researchers can utilise these robust monitor-specific hip and wrist ENMO and MAD thresholds, in order to accurately separate sedentary behaviours from common motion-based light-intensity physical activities. However, caution should be taken if isolating sedentary behaviours from standing is of particular interest.

Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey.

PubMed

Hannan, Amanda L; Hing, Wayne; Climstein, Mike; Coombes, Jeff S; Furness, James; Jayasinghe, Rohan; Byrnes, Joshua

2018-01-01

This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT). A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally. A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6-8 weeks (49%) at moderate intensity (54%) for 46-60 min (62%), and serviced 101-500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions. There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes.

Environmental auditing: Capabilities and management utility of recreation impact monitoring programs

USGS Publications Warehouse

Marion, J.L.

1995-01-01

A recreation impact monitoring system was developed and applied in 1984?1986 and in 1991 to all backcountry river-accessed campsites within Delaware Water Gap National Recreation Area, Pennsylvania and New Jersey. Results suggest that actions implemented by park managers in response to problems identified by the initial survey were highly effective in reducing resource degradation caused by camping. In particular, the elimination of some designated campsites and installation of anchored firegrates reduced the total area of disturbance by 50%. Firegrate installation provided a focal point that increased the concentration of camping activities, allowing peripheral areas to recover. As suggested by predictive models, additional resource degradation caused by increased camping intensities is more than offset by improvements in the condition of areas where use is eliminated. The capabilities and management utility of recreation impact monitoring programs, illustrated by the Delaware Water Gap monitoring program, are also presented and discussed.

Accuracy of intensity and inclinometer output of three activity monitors for identification of sedentary behavior and light-intensity activity.

PubMed

Carr, Lucas J; Mahar, Matthew T

2012-01-01

Purpose. To examine the accuracy of intensity and inclinometer output of three physical activity monitors during various sedentary and light-intensity activities. Methods. Thirty-six participants wore three physical activity monitors (ActiGraph GT1M, ActiGraph GT3X+, and StepWatch) while completing sedentary (lying, sitting watching television, sitting using computer, and standing still) light (walking 1.0 mph, pedaling 7.0 mph, pedaling 15.0 mph) intensity activities under controlled settings. Accuracy for correctly categorizing intensity was assessed for each monitor and threshold. Accuracy of the GT3X+ inclinometer function (GT3X+Incl) for correctly identifying anatomical position was also assessed. Percentage agreement between direct observation and the monitor recorded time spent in sedentary behavior and light intensity was examined. Results. All monitors using all thresholds accurately identified over 80% of sedentary behaviors and 60% of light-intensity walking time based on intensity output. The StepWatch was the most accurate in detecting pedaling time but unable to detect pedal workload. The GT3X+Incl accurately identified anatomical position during 70% of all activities but demonstrated limitations in discriminating between activities of differing intensity. Conclusions. Our findings suggest that all three monitors accurately measure most sedentary and light-intensity activities although choice of monitors should be based on study-specific needs.

Passive microlesion detection and mapping for treatment of hypertrophic cardiomyopathy

NASA Astrophysics Data System (ADS)

Zhu, Yiying I.; Miller, Douglas L.; Dou, Chunyan; Kripfgans, Oliver D.

2017-03-01

Intermittent high intensity ultrasound pulses with circulating contrast agent microbubbles can induce scattered microlesions of potential value for myocardial reduction therapy. This paper presents an in vitro setup imitating the treatment for monitoring development. A preclinical imaging system with a single element transducer, synchronization and receive-only imaging transducer array has been implemented on a research platform. Contrast agent microbubbles pumped in a dialysis tubing setup were exposed to high intensity focused ultrasound at 1.0/3.5 MHz center frequencies. Polystyrene spheres were employed as linear scatterers compared to contrast agents for system transfer function equalization. A cavitation mapping technique was employed to spatially locate and depict microbubble activity during treatment. For high acoustic pressure amplitudes a 5 dB difference between contrast agent and solid spheres was observed and spatially mapped. The in-plane resolution was 4.5 mm for axial and 1.5 mm laterally. In the future, this cavitation detection scheme will be applied to monitor in vivo microlesioning in real-time.

A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

PubMed

Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

2016-02-01

Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

Evaluating the Use of Tissue Oximetry to Decrease Intensive Unit Monitoring for Free Flap Breast Reconstruction.

PubMed

Ricci, Joseph A; Vargas, Christina R; Ho, Olivia A; Lin, Samuel J; Tobias, Adam M; Lee, Bernard T

2017-07-01

Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008-2014) and cases requiring return to the operating room were identified. Data evaluated included patient demographics, the take back time course, and complications of flap loss and salvage. A cost-benefit analysis was performed to analyse the utility of a postoperative intensive monitoring setting. There were 900 flaps performed and 32 required an unplanned return to the operating room. There were 16 flaps that required a reexploration within the first 24 hours; the standard length of intensive unit monitoring. After 4 hours, there were 7 flaps (44%) detected by tissue oximetry for reexploration. After 15 hours of intensive monitoring postoperatively, cost analysis revealed that the majority (15/16; 94%) of failing flaps had been identified and the cost of identifying each subsequent failing flap exceeded the cost of another hour of intensive monitoring. The postoperative paradigm for microsurgical flaps has historically required intensive unit monitoring. Using tissue oximetry, a fast-track pathway can reduce time spent in an intensive monitoring setting from 24 to 15 hours with significant cost savings and minimal risk of missing a failing free flap.

Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

USGS Publications Warehouse

Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

2013-01-01

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.

Meeting the mental health needs of today's college student: Reinventing services through Stepped Care 2.0.

PubMed

Cornish, Peter A; Berry, Gillian; Benton, Sherry; Barros-Gomes, Patricia; Johnson, Dawn; Ginsburg, Rebecca; Whelan, Beth; Fawcett, Emily; Romano, Vera

2017-11-01

A new stepped care model developed in North America reimagines the original United Kingdom model for the modern university campus environment. It integrates a range of established and emerging online mental health programs systematically along dimensions of treatment intensity and associated student autonomy. Program intensity can be either stepped up or down depending on level of client need. Because monitoring is configured to give both provider and client feedback on progress, the model empowers clients to participate actively in care options, decisions, and delivery. Not only is stepped care designed to be more efficient than traditional counseling services, early observations suggest it improves outcomes and access, including the elimination of service waitlists. This paper describes the new model in detail and outlines implementation experiences at 3 North American universities. While the experiences implementing the model have been positive, there is a need for development of technology that would facilitate more thorough evaluation. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Improving the Patient Experience by Implementing an ICU Diary for Those at Risk of Post-intensive Care Syndrome.

PubMed

Blair, K Taylor A; Eccleston, Sarah D; Binder, Hannah M; McCarthy, Mary S

2017-03-01

The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay. In this paper we describe our efforts to implement an ICU diary and solicit feedback on its role in fostering teamwork and communication between patients, family members, and ICU staff. Next steps will involve a PICS follow-up clinic where trained staff will coordinate specialty referrals and perform long-term monitoring of mental health and other quality of life outcomes.

Cyanotoxin occurrence associated with cyanoHAB events on ...

EPA Pesticide Factsheets

A monitoring approach combining wet chemistry and high frequency (HF) water quality sensors was employed to improve our understanding of the ecology of an inland reservoir with a history of cyanoHAB events. The study was conducted with samples collected from Lake Harsha, is a multi-use reservoir in southwest OH that has experienced an increase in cyanoHAB frequency and intensity. Nutrient, algal taxa, chlorophyll-a, and physico-chemical data have been collected on the lake since 2010 at three week intervals. Beginning in 2014 in cooperation with Clermont County Drinking Water Division, a high frequency (HF) monitoring program was implemented to complement the tri-weekly data and provide DWTP operators time-relevant information regarding source water quality. HF data included in-vivo fluorescence and physico-chemical parameters and were collected at two locations. These data, coupled with microcystin (MC) analyses demonstrated the utility of HF data for tracking the cyanoHAB status of the reservoir. It was also apparent that MC concentrations were potentially underestimated as MC sampling did not coincide with bloom peaks indicated by the HF data. To better characterize the cyanobacterial population and both intracellular and extracellular MC production, an intensive sampling regime was implemented in 2015 and 2016 including LC-MSMS analysis of select MC congeners and a total MC surrogate, cylindrospermopsin, and anatoxin-a, MC ELISA quantification, molecular (i.

Diabetes Guidelines May Delay Timely Adjustments During Treatment and Might Contribute to Clinical Inertia

PubMed Central

Zanella, Maria Teresa

2014-01-01

Abstract Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases. PMID:24892463

Diabetes guidelines may delay timely adjustments during treatment and might contribute to clinical inertia.

PubMed

Pimazoni-Netto, Augusto; Zanella, Maria Teresa

2014-11-01

Clinical inertia and poor knowledge by many physicians play an important role in delaying diabetes control. Among other guidelines, the Position Statement of the American Diabetes Association/European Association for the Study of Diabetes on Management of Hyperglycemia in Type 2 Diabetes is a respected guideline with high impact on this subject in terms of influencing physicians in the definition of strategic approach to overcome poor glycemic control. But, on the other hand, it carries a recommendation that might contribute to clinical inertia because it can delay the needed implementation of more vigorous, intensive, and effective strategies to overcome poor glycemic control within a reasonable time frame during the evolution of the disease. The same is true with other respected algorithms from different diabetes associations. Together with pharmacological interventions, diabetes education and more intensive blood glucose monitoring in the initial phases after the diagnosis are key strategies for the effective control of diabetes. The main reason why a faster glycemic control should be implemented in an effective and safe way is to boost the confidence and the compliance of the patient to the recommendations of the diabetes care team. Better and faster results in glycemic control can only be safely achieved with educational strategies, structured self-monitoring of blood glucose, and adequate pharmacological therapy in the majority of cases.

Introduction of blended learning in a master program: Developing an integrative mixed method evaluation framework.

PubMed

Chmiel, Aviva S; Shaha, Maya; Schneider, Daniel K

2017-01-01

The aim of this research is to develop a comprehensive evaluation framework involving all actors in a higher education blended learning (BL) program. BL evaluation usually either focuses on students, faculty, technological or institutional aspects. Currently, no validated comprehensive monitoring tool exists that can support introduction and further implementation of BL in a higher education context. Starting from established evaluation principles and standards, concepts that were to be evaluated were firstly identified and grouped. In a second step, related BL evaluation tools referring to students, faculty and institutional level were selected. This allowed setting up and implementing an evaluation framework to monitor the introduction of BL during two succeeding recurrences of the program. The results of the evaluation allowed documenting strengths and weaknesses of the BL format in a comprehensive way, involving all actors. It has led to improvements at program, faculty and course level. The evaluation process and the reporting of the results proved to be demanding in time and personal resources. The evaluation framework allows measuring the most significant dimensions influencing the success of a BL implementation at program level. However, this comprehensive evaluation is resource intensive. Further steps will be to refine the framework towards a sustainable and transferable BL monitoring tool that finds a balance between comprehensiveness and efficiency. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis

PubMed Central

Bosworth, Hayden B.; Bove, Alfred; Bray, Emma P.; Earle, Kenneth; Godwin, Marshall; Green, Beverly B.; Hebert, Paul; Kantola, Ilkka; Leiva, Alfonso; Mant, Jonathan; Margolis, Karen L.; McLaughlin, Mary Ann; Ogedegbe, Olugbenga; Qamar, Nashat; Varis, Juha; Verberk, Willem J.

2017-01-01

Background Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Methods and findings Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes—change in mean clinic or ambulatory BP and proportion controlled below target at 12 months—were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (−3.2 mmHg, [95% CI −4.9, −1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (−1.0 mmHg [−3.3, 1.2]), to a 6.1 mmHg (−9.0, −3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic −0.2 mmHg [−2.2, 1.8]; ambulatory 1.1 mmHg [−0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies. Conclusions Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions. PMID:28926573

A virtual image chain for perceived image quality of medical display

NASA Astrophysics Data System (ADS)

Marchessoux, Cédric; Jung, Jürgen

2006-03-01

This paper describes a virtual image chain for medical display (project VICTOR: granted in the 5th framework program by European commission). The chain starts from raw data of an image digitizer (CR, DR) or synthetic patterns and covers image enhancement (MUSICA by Agfa) and both display possibilities, hardcopy (film on viewing box) and softcopy (monitor). Key feature of the chain is a complete image wise approach. A first prototype is implemented in an object-oriented software platform. The display chain consists of several modules. Raw images are either taken from scanners (CR-DR) or from a pattern generator, in which characteristics of DR- CR systems are introduced by their MTF and their dose-dependent Poisson noise. The image undergoes image enhancement and comes to display. For soft display, color and monochrome monitors are used in the simulation. The image is down-sampled. The non-linear response of a color monitor is taken into account by the GOG or S-curve model, whereas the Standard Gray-Scale-Display-Function (DICOM) is used for monochrome display. The MTF of the monitor is applied on the image in intensity levels. For hardcopy display, the combination of film, printer, lightbox and viewing condition is modeled. The image is up-sampled and the DICOM-GSDF or a Kanamori Look-Up-Table is applied. An anisotropic model for the MTF of the printer is applied on the image in intensity levels. The density-dependent color (XYZ) of the hardcopy film is introduced by Look-Up-tables. Finally a Human Visual System Model is applied to the intensity images (XYZ in terms of cd/m2) in order to eliminate nonvisible differences. Comparison leads to visible differences, which are quantified by higher order image quality metrics. A specific image viewer is used for the visualization of the intensity image and the visual difference maps.

A continuous glucose monitoring and problem-solving intervention to change physical activity behavior in women with type 2 diabetes: a pilot study.

PubMed

Allen, Nancy; Whittemore, Robin; Melkus, Gail

2011-11-01

Diabetes technology has the potential to provide useful data for theory-based behavioral counseling. The aims of this study are to evaluate the feasibility, acceptability, and preliminary efficacy of a continuous glucose monitoring and problem-solving counseling intervention to change physical activity (PA) behavior in women with type 2 diabetes. Women (n=29) with type 2 diabetes were randomly assigned to one of two treatment conditions: continuous glucose counseling and problem-solving skills or continuous glucose monitoring counseling and general diabetes education. Feasibility data were obtained on intervention dose, implementation, and satisfaction. Preliminary efficacy data were collected at baseline and 12 weeks on the following measures: PA amount and intensity, diet, problem-solving skills, self-efficacy for PA, depression, hemogoloin A1c, weight, and blood pressure. Demographic and implementation variables were described using frequency distributions and summary statistics. Satisfaction data were analyzed using Wilcoxon rank. Differences between groups were analyzed using linear mixed-modeling. Women were mostly white/non-Latina with a mean age of 53 years, a 6.5-year history of diabetes, and suboptimal glycemic control. Continuous glucose monitoring plus problem-solving group participants had significantly greater problem-solving skills and had greater, although not statistically significant, dietary adherence, moderate activity minutes, weight loss, and higher intervention satisfaction pre- to post-intervention than did participants in the continuous glucose monitoring plus education group. A continuous glucose monitoring plus problem-solving intervention was feasible and acceptable, and participants had greater problem-solving skills than continuous glucose monitoring plus education group participants.

Establishing a Multidisciplinary Head and Neck Clinical Pathway: An Implementation Evaluation and Audit of Dysphagia-Related Services and Outcomes.

PubMed

Messing, Barbara Pisano; Ward, Elizabeth C; Lazarus, Cathy; Ryniak, Keri; Kim, Melissa; Silinonte, Jessica; Gold, Dorothy; Thompson, Carol B; Pitman, Karen T; Blanco, Ray; Sobel, Ryan; Harrer, Karen; Ulmer, Karen; Neuner, Geoffrey; Patel, Kruti; Tang, Mei; Lee, Gregory

2018-06-19

Head and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n = 63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to implementing and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (< 15%) to 24 months. Collection of clinician/patient outcome tools was good during treatment, but lower post-treatment. Dysphagia outcomes were good and comparable to prior published data. The pathway provided patients with access to regular supportive care and provided staff opportunities to provide early and ongoing dysphagia monitoring and management. However, implementing and sustaining a HNC pathway is complex, requiring significant staff resources, financial investment, and perseverance. Regular audits are necessary to monitor the quality of the pathway.

Development and implementation of sepsis alert systems

PubMed Central

Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian W.; Herasevich, Vitaly

2016-01-01

Synopsis/Summary Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Important barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload & alert fatigue, due to suboptimal alert performance. Outside the ICU, additional barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Currently available evidence does not support routine use of sepsis alert systems in clinical practice. However, continuous improvement in both the afferent (data availability and accuracy of detection algorithms) and efferent (evidence-based decision support and smoother integration into clinical workflow) limbs of sepsis alert systems will help translate theoretical advantages into measurable patient benefit. PMID:27229639

[The characteristics of medical technologies in emergency medical care hospital].

PubMed

Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

2013-01-01

The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey

PubMed Central

Hannan, Amanda L; Hing, Wayne; Climstein, Mike; Coombes, Jeff S; Furness, James; Jayasinghe, Rohan; Byrnes, Joshua

2018-01-01

Purpose This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT). Methods A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally. Results A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6–8 weeks (49%) at moderate intensity (54%) for 46–60 min (62%), and serviced 101–500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions. Conclusion There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes. PMID:29750058

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

Implementing a pressure ulcer prevention bundle in an adult intensive care.

PubMed

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements. Copyright © 2016 Elsevier Ltd. All rights reserved.

Coma Patient Monitoring System Using Image Processing

NASA Astrophysics Data System (ADS)

Sankalp, Meenu

2011-12-01

COMA PATIENT MONITORING SYSTEM provides high quality healthcare services in the near future. To provide more convenient and comprehensive medical monitoring in big hospitals since it is tough job for medical personnel to monitor each patient for 24 hours.. The latest development in patient monitoring system can be used in Intensive Care Unit (ICU), Critical Care Unit (CCU), and Emergency Rooms of hospital. During treatment, the patient monitor is continuously monitoring the coma patient to transmit the important information. Also in the emergency cases, doctor are able to monitor patient condition efficiently to reduce time consumption, thus it provides more effective healthcare system. So due to importance of patient monitoring system, the continuous monitoring of the coma patient can be simplified. This paper investigates about the effects seen in the patient using "Coma Patient Monitoring System" which is a very advanced product related to physical changes in body movement of the patient and gives Warning in form of alarm and display on the LCD in less than one second time. It also passes a sms to a person sitting at the distant place if there exists any movement in any body part of the patient. The model for the system uses Keil software for the software implementation of the developed system.

Investigating the application of motion accelerometers as a sleep monitoring technique and the clinical burden of the intensive care environment on sleep quality: study protocol for a prospective observational study in Australia

PubMed Central

Currie, Marian J; Huang, Hsin-Chia Carol; Litton, Edward; Wibrow, Bradley; Lopez, Violeta; Haren, Frank Van

2018-01-01

Introduction Sleep is a state of quiescence that facilitates the significant restorative processes that enhance individuals’ physiological and psychological well-being. Patients admitted to the intensive care unit (ICU) experience substantial sleep disturbance. Despite the biological importance of sleep, sleep monitoring does not form part of standard clinical care for critically ill patients. There exists an unmet need to assess the feasibility and accuracy of a range of sleep assessment techniques that have the potential to allow widespread implementation of sleep monitoring in the ICU. Key measures The coprimary outcome measures of this study are to: determine the accuracy and feasibility of motion accelerometer monitoring (ie, actigraphy) and subjective assessments of sleep (nursing-based observations and patient self-reports) to the gold standard of sleep monitoring (ie, polysomnography) in evaluating sleep continuity and disturbance. The secondary outcome measures of the study will include: (1) the association between sleep disturbance and environmental factors (eg, noise, light and clinical interactions) and (2) to describe the sleep architecture of intensive care patients. Methods and analysis A prospective, single centre observational design with a within subjects’ assessment of sleep monitoring techniques. The sample will comprise 80 adults (aged 18 years or more) inclusive of ventilated and non-ventilated patients, admitted to a tertiary ICU with a Richmond Agitation-Sedation Scale score between +2 (agitated) and −3 (moderate sedation) and an anticipated length of stay >24 hours. Patients’ sleep quality, total sleep time and sleep fragmentations will be continuously monitored for 24 hours using polysomnography and actigraphy. Behavioural assessments (nursing observations) and patients’ self-reports of sleep quality will be assessed during the 24-hour period using the Richards-Campbell Sleep Questionnaire, subjective sleepiness evaluated via the Karolinska Sleepiness Scale, along with a prehospital discharge survey regarding patients’ perception of sleep quality and disturbing factors using the Little Sleep Questionnaire will be undertaken. Associations between sleep disturbance, noise and light levels, and the frequency of clinical interactions will also be investigated. Sound and luminance levels will be recorded at 1 s epochs via Extech SDL600 and SDL400 monitoring devices. Clinical interactions will be logged via the electronic patient record system Metavision which documents patient monitoring and clinical care. Ethics and dissemination The relevant institutions have approved the study protocol and consent procedures. The findings of the study will contribute to the understanding of sleep disturbance, and the ability to implement sleep monitoring methods within ICUs. Understanding the contribution of a clinical environment on sleep disturbance may provide insight into the need to address clinical environmental issues that may positively influence patient outcomes, and could dispel notions that the environment is a primary factor in sleep disturbance. The research findings will be disseminated via presentations at national and international conferences, proceedings and published articles in peer-reviewed journals. Trial registration number ACTRN12615000945527; Pre-results. PMID:29358448

Investigating the application of motion accelerometers as a sleep monitoring technique and the clinical burden of the intensive care environment on sleep quality: study protocol for a prospective observational study in Australia.

PubMed

Delaney, Lori J; Currie, Marian J; Huang, Hsin-Chia Carol; Litton, Edward; Wibrow, Bradley; Lopez, Violeta; Haren, Frank Van

2018-01-21

Sleep is a state of quiescence that facilitates the significant restorative processes that enhance individuals' physiological and psychological well-being. Patients admitted to the intensive care unit (ICU) experience substantial sleep disturbance. Despite the biological importance of sleep, sleep monitoring does not form part of standard clinical care for critically ill patients. There exists an unmet need to assess the feasibility and accuracy of a range of sleep assessment techniques that have the potential to allow widespread implementation of sleep monitoring in the ICU. The coprimary outcome measures of this study are to: determine the accuracy and feasibility of motion accelerometer monitoring (ie, actigraphy) and subjective assessments of sleep (nursing-based observations and patient self-reports) to the gold standard of sleep monitoring (ie, polysomnography) in evaluating sleep continuity and disturbance. The secondary outcome measures of the study will include: (1) the association between sleep disturbance and environmental factors (eg, noise, light and clinical interactions) and (2) to describe the sleep architecture of intensive care patients. A prospective, single centre observational design with a within subjects' assessment of sleep monitoring techniques. The sample will comprise 80 adults (aged 18 years or more) inclusive of ventilated and non-ventilated patients, admitted to a tertiary ICU with a Richmond Agitation-Sedation Scale score between +2 (agitated) and -3 (moderate sedation) and an anticipated length of stay >24 hours. Patients' sleep quality, total sleep time and sleep fragmentations will be continuously monitored for 24 hours using polysomnography and actigraphy. Behavioural assessments (nursing observations) and patients' self-reports of sleep quality will be assessed during the 24-hour period using the Richards-Campbell Sleep Questionnaire, subjective sleepiness evaluated via the Karolinska Sleepiness Scale, along with a prehospital discharge survey regarding patients' perception of sleep quality and disturbing factors using the Little Sleep Questionnaire will be undertaken. Associations between sleep disturbance, noise and light levels, and the frequency of clinical interactions will also be investigated. Sound and luminance levels will be recorded at 1 s epochs via Extech SDL600 and SDL400 monitoring devices. Clinical interactions will be logged via the electronic patient record system Metavision which documents patient monitoring and clinical care. The relevant institutions have approved the study protocol and consent procedures. The findings of the study will contribute to the understanding of sleep disturbance, and the ability to implement sleep monitoring methods within ICUs. Understanding the contribution of a clinical environment on sleep disturbance may provide insight into the need to address clinical environmental issues that may positively influence patient outcomes, and could dispel notions that the environment is a primary factor in sleep disturbance. The research findings will be disseminated via presentations at national and international conferences, proceedings and published articles in peer-reviewed journals. ACTRN12615000945527; Pre-results. © 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.

Laser Physics and Laser Techniques

DTIC Science & Technology

1989-06-01

modulated surface, taking full account of the po- pIe growth on different surfaces. Mechanisms to be con - larization properties of the incident wave and...grazing- occurring for grating periods close to the Rayleigh con - angle condition for both linear and stimulated Wood’s ditions A = X/01 ± sin 0...implement 3 I since one can then monitor the ripple intensity versus 400 S00 00 S00 number of repeated shots at low repetition rate and con - A*tAtG

A light intensity monitoring method based on fiber Bragg grating sensing technology and BP neural network

NASA Astrophysics Data System (ADS)

Li, Lu-Ming; Zhu, Qian; Zhang, Zhi-Guo; Cai, Zhi-Min; Liao, Zhi-Jun; Hu, Zhen-Yan

2017-04-01

In this paper, a light intensity monitoring method based on FBG is proposed. The method establishes a light intensity monitoring model with cantilever beam structure and BP neural network algorithm, which is based on fiber grating sensing technology. The accuracy of the model can meet the requirements of engineering project and it can monitor light intensity in real time. The experimental results show that the method has good stability and high sensitivity.

Intensive versus conventional blood pressure monitoring in a general practice population. The Blood Pressure Reduction in Danish General Practice trial: a randomized controlled parallel group trial.

PubMed

Klarskov, Pia; Bang, Lia E; Schultz-Larsen, Peter; Gregers Petersen, Hans; Benee Olsen, David; Berg, Ronan M G; Abrahamsen, Henrik; Wiinberg, Niels

2018-01-17

To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. Randomized controlled parallel group trial with 12-month follow-up. One hundred and ten general practices in all regions of Denmark. One thousand forty-eight patients with essential hypertension. Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent home blood pressure monitoring and 24-hour ambulatory blood pressure monitoring. Mean day- and night-time systolic and diastolic 24-hour ambulatory blood pressure. Change in systolic and diastolic office blood pressure and change in cardiovascular risk profile. Of the patients, 515 (49%) were allocated to the usual group, and 533 (51%) to the intensive group. The reductions in day- and night-time 24-hour ambulatory blood pressure were similar (usual group: 4.6 ± 13.5/2.8 ± 82 mmHg; intensive group: 5.6 ± 13.0/3.5 ± 8.2 mmHg; P = 0.27/P = 0.20). Cardiovascular risk scores were reduced in both groups at follow-up, but more so in the intensive than in the usual group (P = 0.02). An intensive blood pressure monitoring strategy led to a similar blood pressure reduction to conventional monitoring. However, the intensive strategy appeared to improve patients' cardiovascular risk profile through other effects than a reduction of blood pressure. Clinical Trials NCT00244660. © The Author 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

National Satellite Forest Monitoring systems for REDD+

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.

2012-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme assists developing countries to prepare and implement national REDD+ strategies. For the monitoring, reporting and verification, FAO supports the countries to develop national satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV) of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost- effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the support to UN-REDD pilot countries in this capacity building effort is the training of technical forest people and IT persons from interested REDD+ countries, and to set- up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The support with the National Forest Monitoring System will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of the system for DRC and PNG has been launched in Durban, South Africa during COP 17 and in 2012 Paraguay, Viet Nam and Zambia will be launched in Doha, Qatar at COP 18. The access to high-quality satellite data for these countries is crucial for the set-up.

Monitoring low density avian populations: An example using Mountain Plovers

USGS Publications Warehouse

Dreitz, V.J.; Lukacs, P.M.; Knopf, F.L.

2006-01-01

Declines in avian populations highlight a need for rigorous, broad-scale monitoring programs to document trends in avian populations that occur in low densities across expansive landscapes. Accounting for the spatial variation and variation in detection probability inherent to monitoring programs is thought to be effort-intensive and time-consuming. We determined the feasibility of the analytical method developed by Royle and Nichols (2003), which uses presence-absence (detection-non-detection) field data, to estimate abundance of Mountain Plovers (Charadrius montanus) per sampling unit in agricultural fields, grassland, and prairie dog habitat in eastern Colorado. Field methods were easy to implement and results suggest that the analytical method provides valuable insight into population patterning among habitats. Mountain Plover abundance was highest in prairie dog habitat, slightly lower in agricultural fields, and substantially lower in grassland. These results provided valuable insight to focus future research into Mountain Plover ecology and conservation. ?? The Cooper Ornithological Society 2006.

SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT

PubMed Central

Halliburton, Sandra S.; Abbara, Suhny; Chen, Marcus Y.; Gentry, Ralph; Mahesh, Mahadevappa; Raff, Gilbert L.; Shaw, Leslee J.; Hausleiter, Jörg

2012-01-01

Over the last few years, computed tomography (CT) has developed into a standard clinical test for a variety of cardiovascular conditions. The emergence of cardiovascular CT during a period of dramatic increase in radiation exposure to the population from medical procedures and heightened concern about the subsequent potential cancer risk has led to intense scrutiny of the radiation burden of this new technique. This has hastened the development and implementation of dose reduction tools and prompted closer monitoring of patient dose. In an effort to aid the cardiovascular CT community in incorporating patient-centered radiation dose optimization and monitoring strategies into standard practice, the Society of Cardiovascular Computed Tomography has produced a guideline document to review available data and provide recommendations regarding interpretation of radiation dose indices and predictors of risk, appropriate use of scanner acquisition modes and settings, development of algorithms for dose optimization, and establishment of procedures for dose monitoring. PMID:21723512

Vehicle monitoring under Vehicular Ad-Hoc Networks (VANET) parameters employing illumination invariant correlation filters for the Pakistan motorway police

NASA Astrophysics Data System (ADS)

Gardezi, A.; Umer, T.; Butt, F.; Young, R. C. D.; Chatwin, C. R.

2016-04-01

A spatial domain optimal trade-off Maximum Average Correlation Height (SPOT-MACH) filter has been previously developed and shown to have advantages over frequency domain implementations in that it can be made locally adaptive to spatial variations in the input image background clutter and normalised for local intensity changes. The main concern for using the SPOT-MACH is its computationally intensive nature. However in the past enhancements techniques were proposed for the SPOT-MACH to make its execution time comparable to its frequency domain counterpart. In this paper a novel approach is discussed which uses VANET parameters coupled with the SPOT-MACH in order to minimise the extensive processing of the large video dataset acquired from the Pakistan motorways surveillance system. The use of VANET parameters gives us an estimation criterion of the flow of traffic on the Pakistan motorway network and acts as a precursor to the training algorithm. The use of VANET in this scenario would contribute heavily towards the computational complexity minimization of the proposed monitoring system.

bpshape wk4: a computer program that implements a physiological model for analyzing the shape of blood pressure waveforms

NASA Technical Reports Server (NTRS)

Ocasio, W. C.; Rigney, D. R.; Clark, K. P.; Mark, R. G.; Goldberger, A. L. (Principal Investigator)

1993-01-01

We describe the theory and computer implementation of a newly-derived mathematical model for analyzing the shape of blood pressure waveforms. Input to the program consists of an ECG signal, plus a single continuous channel of peripheral blood pressure, which is often obtained invasively from an indwelling catheter during intensive-care monitoring or non-invasively from a tonometer. Output from the program includes a set of parameter estimates, made for every heart beat. Parameters of the model can be interpreted in terms of the capacitance of large arteries, the capacitance of peripheral arteries, the inertance of blood flow, the peripheral resistance, and arterial pressure due to basal vascular tone. Aortic flow due to contraction of the left ventricle is represented by a forcing function in the form of a descending ramp, the area under which represents the stroke volume. Differential equations describing the model are solved by the method of Laplace transforms, permitting rapid parameter estimation by the Levenberg-Marquardt algorithm. Parameter estimates and their confidence intervals are given in six examples, which are chosen to represent a variety of pressure waveforms that are observed during intensive-care monitoring. The examples demonstrate that some of the parameters may fluctuate markedly from beat to beat. Our program will find application in projects that are intended to correlate the details of the blood pressure waveform with other physiological variables, pathological conditions, and the effects of interventions.

Toward real-time temperature monitoring in fat and aqueous tissue during magnetic resonance-guided high-intensity focused ultrasound using a three-dimensional proton resonance frequency T1 method.

PubMed

Diakite, Mahamadou; Odéen, Henrik; Todd, Nick; Payne, Allison; Parker, Dennis L

2014-07-01

To present a three-dimensional (3D) segmented echoplanar imaging (EPI) pulse sequence implementation that provides simultaneously the proton resonance frequency shift temperature of aqueous tissue and the longitudinal relaxation time (T1 ) of fat during thermal ablation. The hybrid sequence was implemented by combining a 3D segmented flyback EPI sequence, the extended two-point Dixon fat and water separation, and the double flip angle T1 mapping techniques. High-intensity focused ultrasound (HIFU) heating experiments were performed at three different acoustic powers on excised human breast fat embedded in ex vivo porcine muscle. Furthermore, T1 calibrations with temperature in four different excised breast fat samples were performed, yielding an estimate of the average and variation of dT1 /dT across subjects. The water only images were used to mask the complex original data before computing the proton resonance frequency shift. T1 values were calculated from the fat-only images. The relative temperature coefficients were found in five fat tissue samples from different patients and ranged from 1.2% to 2.6%/°C. The results demonstrate the capability of real-time simultaneous temperature mapping in aqueous tissue and T1 mapping in fat during HIFU ablation, providing a potential tool for treatment monitoring in organs with large fat content, such as the breast. Copyright © 2013 Wiley Periodicals, Inc.

Optimization of real-time acoustical and mechanical monitoring of high intensity focused ultrasound (HIFU) treatment using harmonic motion imaging for high focused ultrasound (HMIFU).

PubMed

Hou, Gary Y; Marquet, Fabrice; Wang, Shutao; Konofagou, Elisa E

2013-01-01

Harmonic Motion Imaging (HMI) for Focused Ultrasound (HMIFU) is a recently developed high-intensity focused ultrasound (HIFU) treatment monitoring method with feasibilities demonstrated in silica, in vitro and in vivo. Its principle is based on emission of an Amplitude-modulated therapeutic ultrasound beam utilizing a therapeutic transducer to induce an oscillatory radiation force while tracking the focal tissue mechanical response during the HIFU treatment using a confocally-aligned diagnostic transducer. In order to translate towards the clinical implementation of HMIFU, a complete assessment study is required in order to investigate the optimal radiation force threshold for reliable monitoring the local tissue mechanical property changes, i.e., the estimation HMIFU displacement under thermal, acoustical, and mechanical effects within focal medium (i.e., boiling, cavitation, and nonlinearity) using biological specimen. In this study, HMIFU technique is applied on HIFU treatment monitoring on freshly excised ex vivo canine liver specimens. In order to perform the multi-characteristic assessment, the diagnostic transducer was operated as either a pulse-echo imager or Passive Cavitation Detector (PCD) to assess the acoustic and mechanical response, while a bare-wire thermocouple was used to monitor the focal temperature change. As the acoustic power of HIFU treatment was ranged from 2.3 to 11.4 W, robust HMI displacement was observed across the entire range. Moreover, an optimized range for high quality displacement monitoring was found to be between 3.6 to 5.2W, where displacement showed an increase followed by significant decrease, indicating a stiffening of focal medium due to thermal lesion formation, while the correlation coefficient was maintained above 0.95.

Use of adherence monitors as part of a team approach to control clonal spread of multidrug-resistant Acinetobacter baumannii in a research hospital

PubMed Central

Palmore, Tara N.; Michelin, Angela V.; Bordner, MaryAnn; Odom, Robin T.; Stock, Frida; Sinaii, Ninet; Fedorko, Daniel; Murray, Patrick R.; Henderson, David K.

2016-01-01

Background Multidrug-resistant Acinetobacter baumannii (MDRAB) is difficult to treat and eradicate. Several reports describe isolation and environmental cleaning strategies that controlled hospital MDRAB outbreaks. Such interventions were insufficient to interrupt MDRAB transmission in two intensive care unit-based outbreaks in our hospital. We describe strategies that were associated with termination of MDRAB outbreaks at the NIH Clinical Center. Methods In response to MDRAB outbreaks in 2007 and 2009, we implemented multiple interventions, including stakeholder meetings, enhanced isolation precautions, active microbial surveillance, cohorting, and extensive environmental cleaning. We conducted a case-control study to analyze risk factors for acquiring MDRAB. In each outbreak, infection control adherence monitors were placed in MDRAB cohort areas to observe and correct staff infection control behavior. Results Between May 2007 and December 2009, 63 patients acquired nosocomial MDRAB; 57 (90%) acquired one or more of four outbreak strains. Of 347 environmental cultures, only 2 grew outbreak strains of MDRAB from areas other than MDRAB patient rooms. Adherence monitors recorded 1330 isolation room entries in 2007, of which 8% required interventions. In 2009, around-the-clock monitors recorded 4892 staff observations, including 127 (2.6%) instances of nonadherence with precautions requiring 68 interventions (1.4%). Physicians were responsible for more violations than other staff (58% of hand hygiene violations and 37% of violations relating to gown and glove use). Each outbreak terminated in temporal association with initiation of adherence monitoring. Conclusions Although labor-intensive, adherence monitoring may be useful as part of a multifaceted strategy to limit nosocomial transmission of MDRAB. PMID:22080654

ATP bioluminescence: Surface hygiene monitoring in milk preparation room of neonatal intensive care unit

NASA Astrophysics Data System (ADS)

Mohamad, Mahirah; Ishak, Shareena; Jaafar, Rohana; Sani, Norrakiah Abdullah

2018-04-01

ATP Bioluminescence application and standard microbiological analyses were used to evaluate the cleanliness of milk contact surfaces and non-milk contact surfaces in milk preparation room of neonatal intensive care unit (NICU) of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A total of 44 samples including the breast pump, milk bottle, milk bottle screw top and screw ring, teats, measuring cups, waterless warmer, refrigerator, dishwasher and pasteurizer inner wall were tested on May 2017. 3M Clean and Trace Hygiene Monitoring (UXL100 ATP Test swabs) and the bioluminescence reader Clean-Trace NG Luminometer (3M) were used to measure the Relative Light Unit (RLU) and microbiological analysis using 3M Quick Swab and 3MTM PetrifilmTM for enumeration of aerobic count, Staphylococcus aureus, Enterobacteriaceae, coliform and detection of Escherichia coli (CFU /100cm2 or utensil/item). The RLU values were from 11 to 194 and passed the ATP benchmark for intensive care unit (ICU), < 250 RLU as recommended. Aerobic colony count was only found in waterless warmer (0.05±0.01 mean log CFU/warmer). None of S. aureus, Enterobacteriaceae, E. coli and coliform was detected in all samples. A weak correlation was found between bioluminescence measurements RLU and the microbiological analysis (CFU). However, the use of ATP bioluminescence in monitoring milk preparation room cleanliness can be a useful method for assessing rapidly the surface hygiene as well as to verify the Sanitation Standard Operating Procedure (SSOP) prior to implementation of Hazard Analysis and Critical Control Points (HACCP) in milk preparation room.

Implementation of electronic medical records requires more than new software: Lessons on integrating and managing health technologies from Mbarara, Uganda.

PubMed

Madore, Amy; Rosenberg, Julie; Muyindike, Winnie R; Bangsberg, David R; Bwana, Mwebesa B; Martin, Jeffrey N; Kanyesigye, Michael; Weintraub, Rebecca

2015-12-01

Implementation lessons: • Technology alone does not necessarily lead to improvement in health service delivery, in contrast to the common assumption that advanced technology goes hand in hand with progress. • Implementation of electronic medical record (EMR) systems is a complex, resource-intensive process that, in addition to software, hardware, and human resource investments, requires careful planning, change management skills, adaptability, and continuous engagement of stakeholders. • Research requirements and goals must be balanced with service delivery needs when determining how much information is essential to collect and who should be interfacing with the EMR system. • EMR systems require ongoing monitoring and regular updates to ensure they are responsive to evolving clinical use cases and research questions. • High-quality data and analyses are essential for EMRs to deliver value to providers, researchers, and patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Successful prevention of ventilator-associated pneumonia in an intensive care setting.

PubMed

Marra, Alexandre R; Cal, Ruy Guilherme Rodrigues; Silva, Cláudia Vallone; Caserta, Raquel Afonso; Paes, Angela Tavares; Moura, Denis Faria; dos Santos, Oscar Fernando Pavão; Edmond, Michael B; Durão, Marcelino Souza

2009-10-01

Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P=.05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.

Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

PubMed

Gabbay, Uri; Bukchin, Michael

2009-01-01

Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity. The real challenge will be to develop planning systems and implement corrective interventions such as dynamic and flexible daily staffing, which will face difficulties and barriers. The paper fulfils the need for workforce utilization evaluation. A simple method using available data for daily staffing appropriateness evaluation, which is easy to implement and operate, is presented. The statistical process control method enables intra-ward evaluation, while standardization by converting crude into relative measures enables inter-ward analysis. The staffing indicator definitions enable performance evaluation. This original study uses statistical process control to develop simple standardization methods and applies straightforward statistical tools. This method is not limited to crude measures, rather it uses weighted workload measures such as nursing acuity or weighted nurse level (i.e. grade/band).

Mechanical design control and implementation of a new movable intensity profile beamline monitor for the TRIUMF parity experiment 497

NASA Astrophysics Data System (ADS)

Ries, Thomas C.

1995-05-01

Two new movable beam intensity profile monitors have been installed into the TRIUMF Parity Experiment 497 Beamlines. Each unit serves two functions. Firstly, the beam median position, in a plane normal to the beam, is detected by split plate Secondary Emission Monitors. This information is used to lock the beam into the position of the movable monitor to within a few μm's via high band width ferrite core steering magnets operating in tandem in a closed loop servo feedback control system. Secondly, the beam profile and intensity is detected via a multi-wire secondary emission non-movable monitor, where the data provides high precision values regarding centroidal positions and profiles. The centroid position of the beam is statistically determined to an accuracy of ±10 μm from a data record length of 1 second. The design of each device adheres to strict standards of mechanically rigid construction. The split plate SEM accuracy and repeatability is better than 15 μm with an absolute resolution limit of 0.4 μm. Maximum travel is 2 inches in the vertical plane. Since the device is mechanically modular and both degrees of freedom are combined into a single mechanical unit, fast and easy handling is possible for maintenance in radioactive areas. The actuators are dc servo motors with tachometers driven by linear servo power amplifiers. These amplifiers are used in lieu of pulse width modulated amps to eliminate noise produced by the switching circuits. Position sensing is done by variable reluctance type absolute rotary encoders providing 16 bit resolution over the full range of travel. Positioning is done manually using a self centring potentiometer on the control panel that provides a ± velocity command signal to the power amplifiers. This configuration ensures good controllability over a very large range of positioning speeds hence making 0.4 μm incremental positioning possible, as well as, fast relocations over large relative distances. The precision movement and jitter was measured in the laboratory. Examples will be given of the monitor use with beam.

TU-EF-210-03: Real-Time Ablation Monitoring and Lesion Quantification Using Harmonic Motion Imaging

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

Konofagou, E.

2015-06-15

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less

Intensive Monitoring of Urine Output Is Associated With Increased Detection of Acute Kidney Injury and Improved Outcomes.

PubMed

Jin, Kui; Murugan, Raghavan; Sileanu, Florentina E; Foldes, Emily; Priyanka, Priyanka; Clermont, Gilles; Kellum, John A

2017-11-01

Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI. This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008. Intensive UO monitoring was defined as hourly recordings and no gaps > 3 hours for the first 48 hours after ICU admission. Intensive monitoring for UO was conducted in 4,049 patients (26%), and we found significantly higher rates of AKI (OR, 1.22; P < .001) in these patients. After adjustment for age and severity of illness, intensive UO monitoring was associated with improved survival but only among patients experiencing AKI. With or without AKI, patients with intensive monitoring also had less cumulative fluid volume (2.98 L vs 3.78 L; P < .001) and less fluid overload (2.49% vs 5.68%; P < .001) over the first 72 hours of ICU stay. In this large ICU population, intensive monitoring of UO was associated with improved detection of AKI and reduced 30-day mortality in patients experiencing AKI, as well as less fluid overload for all patients. Our results should help inform clinical decisions and ICU policy about frequency of monitoring of UO, especially for patients at high risk of AKI or fluid overload, or both. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients.

PubMed

Donovan, Elizabeth A; Manta, Christine J; Goldsack, Jennifer C; Collins, Michelle L

2016-01-01

Under value-based purchasing, Medicare withholds reimbursements for hospital-acquired pressure ulcer occurrence and rewards hospitals that meet performance standards. With little evidence of a validated prevention process, nurse managers are challenged to find evidence-based interventions. The aim of this study was to reduce the unit-acquired pressure ulcer (UAPU) rate on targeted intensive care and step-down units by 15% using Lean Six Sigma (LSS) methodology. An interdisciplinary team designed a pilot program using LSS methodology to test 4 interventions: standardized documentation, equipment monitoring, patient out-of-bed-to-chair monitoring, and a rounding checklist. During the pilot, the UAPU rate decreased from 4.4% to 2.8%, exceeding the goal of a 15% reduction. The rate remained below the goal through the program control phase at 2.9%, demonstrating a statistically significant reduction after intervention implementation. The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.

Artificial intelligence applications in the intensive care unit.

PubMed

Hanson, C W; Marshall, B E

2001-02-01

To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.

Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record.

PubMed

Yi, Stella S; Tabaei, Bahman P; Angell, Sonia Y; Rapin, Anne; Buck, Michael D; Pagano, William G; Maselli, Frank J; Simmons, Alvaro; Chamany, Shadi

2015-03-01

Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources. The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91). Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself. http://clinicaltrials.gov. Unique Identifier: NCT01123577. © 2015 American Heart Association, Inc.

The North American Amphibian Monitoring Program. [abstract

USGS Publications Warehouse

Griffin, J.

1998-01-01

The North American Amphibian Monitoring Program has been under development for the past three years. The monitoring strategy for NAAMP has five main prongs: terrestrial salamander surveys, calling surveys, aquatic surveys, western surveys, and atlassing. Of these five, calling surveys were selected as one of the first implementation priorities due to their friendliness to volunteers of varying knowledge levels, relative low cost, and the fact that several groups had already pioneered the techniques involved. While some states and provinces had implemented calling surveys prior to NAAMP, like WI and IL, most states and provinces had little or no history of state/provincewide amphibian monitoring. Thus, the majority of calling survey programs were initiated in the past two years. To assess the progress of this pilot phase, a program review was conducted on the status of the NAAMP calling survey program, and the results of that review will be presented at the meeting. Topics to be discussed include: who is doing what where, extent of route coverage, the continuing random route discussions, quality assurance, strengths and weaknesses of calling surveys, reliability of data, and directions for the future. In addition, a brief overview of the DISPro project will be included. DISPro is a new amphibian monitoring program in National Parks, funded by the Demonstration of Intensive Sites Program (DISPro) through the EPA and NPS. It will begin this year at Big Bend and Shenandoah National Parks. The purpose of the DISPro Amphibian Project will be to investigate relationships between environmental factors and stressors and the distribution, abundance, and health of amphibians in these National Parks. At each Park, amphibian long-term monitoring protocols will be tested, distributions and abundance of amphibians will be mapped, and field research experiments will be conducted to examine stressor effects on amphibians (e.g., ultraviolet radiation, contaminants, acidification).

Investigation of contact acoustic nonlinearities on metal and composite airframe structures via intensity based health monitoring.

PubMed

Romano, P Q; Conlon, S C; Smith, E C

2013-01-01

Nonlinear structural intensity (NSI) and nonlinear structural surface intensity (NSSI) based damage detection techniques were improved and extended to metal and composite airframe structures. In this study, the measurement of NSI maps at sub-harmonic frequencies was completed to provide enhanced understanding of the energy flow characteristics associated with the damage induced contact acoustic nonlinearity mechanism. Important results include NSI source localization visualization at ultra-subharmonic (nf/2) frequencies, and damage detection results utilizing structural surface intensity in the nonlinear domain. A detection metric relying on modulated wave spectroscopy was developed and implemented using the NSSI feature. The data fusion of the intensity formulation provided a distinct advantage, as both the single interrogation frequency NSSI and its modulated wave extension (NSSI-MW) exhibited considerably higher sensitivities to damage than using single-sensor (strain or acceleration) nonlinear detection metrics. The active intensity based techniques were also extended to composite materials, and results show both NSSI and NSSI-MW can be used to detect damage in the bond line of an integrally stiffened composite plate structure with high sensitivity. Initial damage detection measurements made on an OH-58 tailboom (Penn State Applied Research Laboratory, State College, PA) indicate the techniques can be transitioned to complex airframe structures achieving high detection sensitivities with minimal sensors and actuators.

[Using TRM to Enhance the Accuracy of Ventilator-Associated Pneumonia Preventive Measures Implemented by Neonatal Intensive Care Unit Medical Staffs].

PubMed

Huang, Yu-Ting; Huang, Chao-Ya; Su, Hsiu-Ya; Ma, Chen-Te

2018-06-01

Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the neonatal intensive care unit (NICU). The average VAP infection density was 4.7‰ in our unit between June and August 2015. The results of a status survey indicated that in-service education lacked specialization, leading to inadequate awareness among staffs regarding the proper care of newborns with VAP and a lack of related care guides. This, in turn, resulted in inconsistencies in care measures for newborns with VAP. To improve the accuracy of implementation of preventive measures for VAP among medical staffs and reduce the density of VAP infections in the NICU. Conduct a literature search and adopt medical team resources management methods; establish effective team communication; establish monitoring mechanisms and incentives; establish mandatory in-service specialization education contents and a VAP preventive care guide exclusively for newborns as a reference for medical staffs during care execution; install additional equipment and aids and set reminders to ensure the implementation of VAP preventive measures. The accuracy rate of preventive measure execution by medical staffs improved from 70.1% to 97.9% and the VAP infection density in the NICU decreased from 4.7‰ to 0.52‰. Team integration effectively improved the accuracy of implementation of VAP-prevention measures, reduced the density of VAP infections, enhanced quality of care, and ensured that newborns received care that was more in line with specialization needs.

Key ingredients for implementing intensive outpatient programs within patient-centered medical homes: A literature review and qualitative analysis.

PubMed

Breland, Jessica Y; Asch, Steven M; Slightam, Cindie; Wong, Ava; Zulman, Donna M

2016-03-01

Intensive outpatient programs aim to transform care while conserving resources for high-need, high-cost patients, but little is known about factors that influence their implementation within patient-centered medical homes (PCMHs). In this mixed-methods study, we reviewed the literature to identify factors affecting intensive outpatient program implementation, then used semi-structured interviews to determine how these factors influenced the implementation of an intensive outpatient program within the Veterans Affairs' (VA) PCMH. Interviewees included facility leadership and clinical staff who were involved in a pilot Intensive Management Patient Aligned Care Team (ImPACT) intervention for high-need, high-cost VA PCMH patents. We classified implementation factors in the literature review and qualitative analysis using the Consolidated Framework for Implementation Research (CFIR). The literature review (n=9 studies) and analyses of interviews (n=15) revealed key implementation factors in three CFIR domains. First, the Inner Setting (i.e., the organizational and PCMH environment), mostly enabled implementation through a culture of innovation, good networks and communication, and positive tension for change. Second, Characteristics of Individuals, including creativity, flexibility, and interpersonal skills, allowed program staff to augment existing PCMH services. Finally, certain Intervention Characteristics (e.g., adaptability) enabled implementation, while others (e.g., complexity) generated implementation barriers. Resources and structural features common to PCMHs can facilitate implementation of intensive outpatient programs, but program success is also dependent on staff creativity and flexibility, and intervention adaptations to meet patient and organizational needs. Established PCMHs likely provide resources and environments that permit accelerated implementation of intensive outpatient programs. V. Published by Elsevier Inc.

Wavefront image sensor chip

PubMed Central

Cui, Xiquan; Ren, Jian; Tearney, Guillermo J.; Yang, Changhuei

2010-01-01

We report the implementation of an image sensor chip, termed wavefront image sensor chip (WIS), that can measure both intensity/amplitude and phase front variations of a light wave separately and quantitatively. By monitoring the tightly confined transmitted light spots through a circular aperture grid in a high Fresnel number regime, we can measure both intensity and phase front variations with a high sampling density (11 µm) and high sensitivity (the sensitivity of normalized phase gradient measurement is 0.1 mrad under the typical working condition). By using WIS in a standard microscope, we can collect both bright-field (transmitted light intensity) and normalized phase gradient images. Our experiments further demonstrate that the normalized phase gradient images of polystyrene microspheres, unstained and stained starfish embryos, and strongly birefringent potato starch granules are improved versions of their corresponding differential interference contrast (DIC) microscope images in that they are artifact-free and quantitative. Besides phase microscopy, WIS can benefit machine recognition, object ranging, and texture assessment for a variety of applications. PMID:20721059

Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels.

PubMed

Walder, B; Francioli, D; Meyer, J J; Lançon, M; Romand, J A

2000-07-01

Because of around-the-clock activities, environmental noise and light are among the many causes of sleep disturbance in an intensive care unit (ICU). The implementation of guidelines may potentially change behavior rules and improve sleep quality. A prospective interventional study, observing the effects of simple nighttime guidelines on light and noise levels in an ICU. A modern surgical ICU, subdivided into six identical three-bed rooms. Critically ill adult patients. Between two observation periods, five guidelines were implemented to decrease both light and noise during the night shift in the patient's room. Light levels and noise levels were obtained using a luxmeter and a sound level meter [A-weighted decibels (dB) scale] and were monitored continuously from 11 pm to 5 am both before (period P1) and after (period P2) the implementation of guidelines. Similar patient's gravity and nursing workload scores were observed between P1 and P2. A low mean (<5 Lux) and maximal light level were measured during both P1 and P2. The implementation of guidelines lowered mean light disturbance intensity with a greater variability of light during P2. All noise levels were high and corresponded more to a quiet office for noise level equivalents and to a busy restaurant for peak noise levels during both P1 and P2. Guidelines decreased the noise level equivalent (P1, 51.3 dB; P2, 48.3 dB), peak noise level (P1, 74.9 dB; P2, 70.8 dB), and the number of acoustic identified alarms (P1, 22.1 dB; P2, 15.8 dB) during P2. The night light levels were low during both periods, and lowering the light levels induced a greater variation of light, which may impair sleep quality. All measured noise levels were high during both periods, which could contribute to sleep disturbance, and the implementation of guidelines significantly lowers some important noise levels. The background noise level was unchanged.

The start-up phase of the national satellite forest monitoring systems for DRC and PNG: a joint venture between FAO and INPE

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD Team Forestry Department

2011-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme, a partnership between UNEP, FAO and UNDP, assists developing countries to prepare and implement national REDD+ strategies. Designed collaboratively by a broad range of stakeholders, national UN-REDD Programmes are informed by the technical expertise of FAO, UNDP and UNEP. For the monitoring, reporting and verification, FAO supports the countries to develop satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV)of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism, also following the COP 16 decisions in Cancun last year. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost-effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the start-up phase for DRC and Papua New Guinea (PNG) in this capacity building effort is the training of technical forest people and IT persons from these two interested REDD+ countries, and to set-up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The start-up phase of the National Forest Monitoring System for DRC and PNG will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of these syste,s will be launched in Durban, South Africa during COP 17 and is presented here.

An extended multivariate framework for drought monitoring in Mexico

NASA Astrophysics Data System (ADS)

Real-Rangel, Roberto; Pedrozo-Acuña, Adrián; Breña-Naranjo, Agustín; Alcocer-Yamanaka, Víctor

2017-04-01

Around the world, monitoring natural hazards, such as droughts, represents a critical task in risk assessment and management plans. A reliable drought monitoring system allows to identify regions affected by these phenomena so that early response measures can be implemented. In Mexico, this activity is performed using Mexico's Drought Monitor, which is based on a similar methodology as the United States Drought Monitor and the North American Drought Monitor. The main feature of these monitoring systems is the combination of ground-based and remote sensing observations that is ultimately validated by local experts. However, in Mexico in situ records of variables such as precipitation and streamflow are often scarce, or even null, in many regions of the country. Another issue that adds uncertainty in drought monitoring is the arbitrary weight given to each analyzed variable. This study aims at providing an operational framework for drought monitoring in Mexico, based on univariate and multivariate nonparametric standardized indexes proposed in recent studies. Furthermore, the framework has been extended by taking into account the Enhanced Vegetation Index (EVI) for the drought severity assessment. The analyzed variables used for computing the drought indexes are mainly derived from remote sensing (MODIS) and land surface models datasets (NASA MERRA-2). A qualitative evaluation of the results shows that the indexes used are capable of adequately describes the intensity and spatial distribution of past drought documented events.

Temperature-dependent MR signals in cortical bone: potential for monitoring temperature changes during high-intensity focused ultrasound treatment in bone.

PubMed

Ramsay, Elizabeth; Mougenot, Charles; Kazem, Mohammad; Laetsch, Theodore W; Chopra, Rajiv

2015-10-01

Because existing magnetic resonance thermometry techniques do not provide temperature information within bone, high-intensity focused ultrasound (HIFU) exposures in bone are monitored using temperature changes in adjacent soft tissues. In this study, the potential to monitor temperature changes in cortical bone using a short TE gradient echo sequence is evaluated. The feasibility of this proposed method was initially evaluated by measuring the temperature dependence of the gradient echo signal during cooling of cortical bone samples implanted with fiber-optic temperature sensors. A subsequent experiment involved heating a cortical bone sample using a clinical MR-HIFU system. A consistent relationship between temperature change and the change in magnitude signal was observed within and between cortical bone samples. For the two-dimensional gradient echo sequence implemented in this study, a least-squares linear fit determined the percentage change in signal to be (0.90 ± 0.01)%/°C. This relationship was used to estimate temperature changes observed in the HIFU experiment and these temperatures agreed well with those measured from an implanted fiber-optic sensor. This method appears capable of displaying changes related to temperature in cortical bone and could improve the safety of MR-HIFU treatments. Further investigations into the sensitivity of the technique in vivo are warranted. © 2014 Wiley Periodicals, Inc.

Design and Implementation of the National Seismic Monitoring Network in the Kingdom of Bhutan

NASA Astrophysics Data System (ADS)

Ohmi, S.; Inoue, H.; Chophel, J.; Pelgay, P.; Drukpa, D.

2017-12-01

Bhutan-Himalayan district is located along the plate collision zone between Indian and Eurasian plates, which is one of the most seismically active region in the world. Recent earthquakes such as M7.8 Gorkha Nepal earthquake in April 25, 2015 and M6.7 Imphal, India earthquake in January 3, 2016 are examples of felt earthquakes in Bhutan. However, there is no permanent seismic monitoring system ever established in Bhutan, whose territory is in the center of the Bhutan-Himalayan region. We started establishing permanent seismic monitoring network of minimum requirements and intensity meter network over the nation. The former is composed of six (6) observation stations in Bhutan with short period weak motion and strong motion seismometers as well as three (3) broad-band seismometers, and the latter is composed of twenty intensity meters located in every provincial government office. Obtained data are transmitted to the central processing system in the DGM office in Thimphu in real time. In this project, DGM will construct seismic vault with their own budget which is approved as the World Bank project, and Japan team assists the DGM for site survey of observation site, designing the observation vault, and designing the data telemetry system as well as providing instruments for the observation such as seismometers and digitizers. We already started the operation of the six (6) weak motion stations as well as twenty (20) intensity meter stations. Additionally, the RIMES (Regional Integrated Multi-hazard Early Warning System for Africa and Asia) is also providing eight (8) weak motion stations and we are keeping close communication to operate them as one single seismic monitoring network composed of fourteen (14) stations. This network will be definitely utilized for not only for seismic disaster mitigation of the country but also for studying the seismotectonics in the Bhutan-Himalayan region which is not yet precisely revealed due to the lack of observation data in the past.

Environmental, political, and economic determinants of water quality monitoring in Europe

NASA Astrophysics Data System (ADS)

Beck, Lucas; Bernauer, Thomas; Kalbhenn, Anna

2010-11-01

Effective monitoring is essential for effective pollution control in national and international water systems. To what extent are countries' monitoring choices driven by environmental criteria, as they should be? And to what extent are they also influenced by other factors, such as political and economic conditions? To address these questions, we describe and explain the evolution of one of the most important international environmental monitoring networks in Europe, the one for water quality, in the time period 1965-2004. We develop a geographic information system that contains information on the location of several thousand active monitoring stations in Europe. Using multivariate statistics, we then examine whether and to what extent the spatial and temporal clustering of monitoring intensity is driven by environmental, political, and economic factors. The results show that monitoring intensity is higher in river basins exposed to greater environmental pressure. However, political and economic factors also play a strong role in monitoring decisions: democracy, income, and peer pressure are conducive to monitoring intensity, and monitoring intensity generally increases over time. Moreover, even though monitoring is more intense in international upstream-downstream settings, we observe only a weak bias toward more monitoring downstream of international borders. In contrast, negative effects of European Union (EU) membership and runup to the EU's Water Framework Directive are potential reasons for concern. Our results strongly suggest that international coordination and standardization of water quality monitoring should be intensified. It will be interesting to apply our analytical approach also to other national and international monitoring networks, for instance, the U.S. National Water-Quality Assessment Program or the European Monitoring and Evaluation Program for air pollution.

A comparison of methods to assess long-term changes in Sonoran Desert vegetation

USGS Publications Warehouse

Munson, S.M.; Webb, R.H.; Hubbard, J.A.

2011-01-01

Knowledge about the condition of vegetation cover and composition is critical for assessing the structure and function of ecosystems. To effectively quantify the impacts of a rapidly changing environment, methods to track long-term trends of vegetation must be precise, repeatable, and time- and cost-efficient. Measuring vegetation cover and composition in arid and semiarid regions is especially challenging because vegetation is typically sparse, discontinuous, and individual plants are widely spaced. To meet the goal of long-term vegetation monitoring in the Sonoran Desert and other arid and semiarid regions, we determined how estimates of plant species, total vegetation, and soil cover obtained using a widely-implemented monitoring protocol compared to a more time- and resource-intensive plant census. We also assessed how well this protocol tracked changes in cover through 82 years compared to the plant census. Results from the monitoring protocol were comparable to those from the plant census, despite low and variable plant species cover. Importantly, this monitoring protocol could be used as a rapid, "off-the shelf" tool for assessing land degradation (or desertification) in arid and semiarid ecosystems.

[Surface Cleaning and Disinfection in the Hospital. Improvement by Objective Monitoring and Intervention].

PubMed

Woltering, R; Hoffmann, G; Isermann, J; Heudorf, U

2016-11-01

Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11-67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2-48.3; p<0.05), with differences between the hospitals (20-95%). The largest increase was achieved in hospital wards (+45%; CI 29.2-60.8; p<0.05). Improvements in operating theatres (+22.9%; CI 10.9-56.7) and intensive care units (+5.6%; CI 25.8-36.9) were statistically not significant. Conclusions: The monitoring of cleaning and disinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures. © Georg Thieme Verlag KG Stuttgart · New York.

New and improved apparatus and method for monitoring the intensities of charged-particle beams

DOEpatents

Varma, M.N.; Baum, J.W.

1981-01-16

Charged particle beam monitoring means are disposed in the path of a charged particle beam in an experimental device. The monitoring means comprise a beam monitoring component which is operable to prevent passage of a portion of beam, while concomitantly permitting passage of another portion thereof for incidence in an experimental chamber, and providing a signal (I/sub m/) indicative of the intensity of the beam portion which is not passed. Caibration means are disposed in the experimental chamber in the path of the said another beam portion and are operable to provide a signal (I/sub f/) indicative of the intensity thereof. Means are provided to determine the ratio (R) between said signals whereby, after suitable calibration, the calibration means may be removed from the experimental chamber and the intensity of the said another beam portion determined by monitoring of the monitoring means signal, per se.

Automated detection of inaccurate and imprecise transitions in peptide quantification by multiple reaction monitoring mass spectrometry.

PubMed

Abbatiello, Susan E; Mani, D R; Keshishian, Hasmik; Carr, Steven A

2010-02-01

Multiple reaction monitoring mass spectrometry (MRM-MS) of peptides with stable isotope-labeled internal standards (SISs) is increasingly being used to develop quantitative assays for proteins in complex biological matrices. These assays can be highly precise and quantitative, but the frequent occurrence of interferences requires that MRM-MS data be manually reviewed, a time-intensive process subject to human error. We developed an algorithm that identifies inaccurate transition data based on the presence of interfering signal or inconsistent recovery among replicate samples. The algorithm objectively evaluates MRM-MS data with 2 orthogonal approaches. First, it compares the relative product ion intensities of the analyte peptide to those of the SIS peptide and uses a t-test to determine if they are significantly different. A CV is then calculated from the ratio of the analyte peak area to the SIS peak area from the sample replicates. The algorithm identified problematic transitions and achieved accuracies of 94%-100%, with a sensitivity and specificity of 83%-100% for correct identification of errant transitions. The algorithm was robust when challenged with multiple types of interferences and problematic transitions. This algorithm for automated detection of inaccurate and imprecise transitions (AuDIT) in MRM-MS data reduces the time required for manual and subjective inspection of data, improves the overall accuracy of data analysis, and is easily implemented into the standard data-analysis work flow. AuDIT currently works with results exported from MRM-MS data-processing software packages and may be implemented as an analysis tool within such software.

Automated Detection of Inaccurate and Imprecise Transitions in Peptide Quantification by Multiple Reaction Monitoring Mass Spectrometry

PubMed Central

Abbatiello, Susan E.; Mani, D. R.; Keshishian, Hasmik; Carr, Steven A.

2010-01-01

BACKGROUND Multiple reaction monitoring mass spectrometry (MRM-MS) of peptides with stable isotope–labeled internal standards (SISs) is increasingly being used to develop quantitative assays for proteins in complex biological matrices. These assays can be highly precise and quantitative, but the frequent occurrence of interferences requires that MRM-MS data be manually reviewed, a time-intensive process subject to human error. We developed an algorithm that identifies inaccurate transition data based on the presence of interfering signal or inconsistent recovery among replicate samples. METHODS The algorithm objectively evaluates MRM-MS data with 2 orthogonal approaches. First, it compares the relative product ion intensities of the analyte peptide to those of the SIS peptide and uses a t-test to determine if they are significantly different. A CV is then calculated from the ratio of the analyte peak area to the SIS peak area from the sample replicates. RESULTS The algorithm identified problematic transitions and achieved accuracies of 94%–100%, with a sensitivity and specificity of 83%–100% for correct identification of errant transitions. The algorithm was robust when challenged with multiple types of interferences and problematic transitions. CONCLUSIONS This algorithm for automated detection of inaccurate and imprecise transitions (AuDIT) in MRM-MS data reduces the time required for manual and subjective inspection of data, improves the overall accuracy of data analysis, and is easily implemented into the standard data-analysis work flow. AuDIT currently works with results exported from MRM-MS data-processing software packages and may be implemented as an analysis tool within such software. PMID:20022980

Trend in proportions of missed children during polio supplementary immunization activities in the African Region: evidence from independent monitoring data 2010-2012.

PubMed

Okeibunor, Joseph; Gasasira, Alex; Mihigo, Richard; Salla, Mbaye; Poy, Alain; Orkeh, Godwin; Shaba, Keith; Nshimirimana, Deo

2014-02-19

This is a comparative analysis of independent monitoring data collected between 2010 and 2012, following the implementation of supplementary immunization activities (SIAs) in countries in the three sub regional blocs of World Health Organization in the African Region. The sub regional blocs are Central Africa, West Africa, East and Southern Africa. In addition to the support for SIAs, the Central and West African blocs, threatened with importation and re-establishment of polio transmission received intensive coordination through weekly teleconferences. The later, East and Southern African bloc with low polio threats was not engaged in the intensive coordination through teleconferences. The key indicator of the success of SIAs is the proportion of children missed during SIAs. The results showed that generally there was a decrease in the proportion of children missed during SIAs in the region, from 7.94% in 2010 to 5.95% in 2012. However, the decrease was mainly in the Central and West African blocs. The East and Southern African bloc had countries with as much as 25% missed children. In West Africa and Central Africa, where more coordinated SIAs were conducted, there were progressive and consistent drops, from close to 20-10% at the maximum. At the country and local levels, steps were undertaken to ameliorate situation of low immunization uptake. Wherever an area is observed to have low coverage, local investigations were conducted to understand reasons for low coverage, plans to improve coverage are made and implemented in a coordinated manner. Lessons learned from close monitoring of polio eradication SIAs are will be applied to other campaigns being conducted in the African Region to accelerate control of other vaccine preventable diseases including cerebrospinal meningitis A, measles and yellow fever. Copyright © 2013 Elsevier Ltd. All rights reserved.

Designing the method for optical in vitro monitoring of the cell-mediated scaffold technology for bone regeneration based on laser-induced fluorescence spectroscopy

NASA Astrophysics Data System (ADS)

Larionov, P. M.; Maslov, N. A.; Papaeva, E. O.; Tereshchenko, V. P.; Khlestkin, V. K.; Bogachev, S. S.; Proskurina, A. S.; Titov, A. T.; Filipenko, M. L.; Pavlov, V. V.; Kudrov, G. A.; Orishich, A. M.

2016-08-01

One of the main unsolved problems in traumatology and orthopedics is reconstruction of critical-sized segmental bone defects. We believe that implementation of noninvasive monitoring of the bioengineering stages for cell-mediated bone scaffold by laser-induced fluorescence (LIF) can become a positive aspect in mastering this technique. An electrospun scaffold model (parameters: 10 wt. % polycaprolactone; 5% wt type A gelatin; mean fiber diameter 877.1 ± 169.1, and contact angle 45.3°) seeded with BHK IR cell culture (182 ± 38 cells/mm2) was used to show the principal possibility of differentiating between the scaffold seeded and unseeded with cells. First of all, the fluorescence spectra of the cell-seeded scaffold contain a peak at 305 nm for the excitation range of 230-290 nm, which can be used to differentiate between the samples. An increase in fluorescence intensity of the cell-seeded scaffold in the range of 400- 580 nm upon excitation at 230-340 nm is also noticeable. The wavelength of 250 nm is characterized by high signal intensity and is most suitable for differentiation between the samples.

On the Relevancy of Efficient, Integrated Computer and Network Monitoring in HEP Distributed Online Environment

NASA Astrophysics Data System (ADS)

Carvalho, D.; Gavillet, Ph.; Delgado, V.; Albert, J. N.; Bellas, N.; Javello, J.; Miere, Y.; Ruffinoni, D.; Smith, G.

Large Scientific Equipments are controlled by Computer Systems whose complexity is growing driven, on the one hand by the volume and variety of the information, its distributed nature, the sophistication of its treatment and, on the other hand by the fast evolution of the computer and network market. Some people call them genetically Large-Scale Distributed Data Intensive Information Systems or Distributed Computer Control Systems (DCCS) for those systems dealing more with real time control. Taking advantage of (or forced by) the distributed architecture, the tasks are more and more often implemented as Client-Server applications. In this framework the monitoring of the computer nodes, the communications network and the applications becomes of primary importance for ensuring the safe running and guaranteed performance of the system. With the future generation of HEP experiments, such as those at the LHC in view, it is proposed to integrate the various functions of DCCS monitoring into one general purpose Multi-layer System.

Clinician-Driven Design of VitalPAD–An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit

PubMed Central

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings. PMID:29552425

Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit.

PubMed

Flohr, Luisa; Beaudry, Shaylene; Johnson, K Taneille; West, Nicholas; Burns, Catherine M; Ansermino, J Mark; Dumont, Guy A; Wensley, David; Skippen, Peter; Gorges, Matthias

2018-01-01

The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD , to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.

Artificial-intelligence-based hospital-acquired infection control.

PubMed

Adlassnig, Klaus-Peter; Blacky, Alexander; Koller, Walter

2009-01-01

Nosocomial or hospital-acquired infections (NIs) are a frequent complication in hospitalized patients. The growing availability of computerized patient records in hospitals permits automated identification and extended monitoring for signs of NIs. A fuzzy- and knowledge-based system to identify and monitor NIs at intensive care units (ICUs) according to the European Surveillance System HELICS (NI definitions derived from the Centers of Disease Control and Prevention (CDC) criteria) was developed and put into operation at the Vienna General Hospital. This system, named Moni, for monitoring of nosocomial infections contains medical knowledge packages (MKPs) to identify and monitor various infections of the bloodstream, pneumonia, urinary tract infections, and central venous catheter-associated infections. The MKPs consist of medical logic modules (MLMs) in Arden syntax, a medical knowledge representation scheme, whose definition is part of the HL7 standards. These MLM packages together with the Arden software are well suited to be incorporated in medical information systems such as hospital information or intensive-care patient data management systems, or in web-based applications. In terms of method, Moni contains an extended data-to-symbol conversion with several layers of abstraction, until the top level defining NIs according to HELICS is reached. All included medical concepts such as "normal", "increased", "decreased", or similar ones are formally modeled by fuzzy sets, and fuzzy logic is used to process the interpretations of the clinically observed and measured patient data through an inference network. The currently implemented cockpit surveillance connects 96 ICU beds with Moni and offers the hospital's infection control department a hitherto unparalleled NI infection survey.

Emotional intensity influences pre-implementation and implementation of distraction and reappraisal

PubMed Central

Shafir, Roni; Schwartz, Naama; Blechert, Jens

2015-01-01

Although emotional intensity powerfully challenges regulatory strategies, its influence remains largely unexplored in affective-neuroscience. Accordingly, the present study addressed the moderating role of emotional intensity in two regulatory stages—implementation (during regulation) and pre-implementation (prior to regulation), of two major cognitive regulatory strategies—distraction and reappraisal. According to our framework, because distraction implementation involves early attentional disengagement from emotional information before it gathers force, in high-intensity it should be more effective in the short-term, relative to reappraisal, which modulates emotional processing only at a late semantic meaning phase. Supporting findings showed that in high (but not low) intensity, distraction implementation resulted in stronger modulation of negative experience, reduced neural emotional processing (centro-parietal late positive potential, LPP), with suggestive evidence for less cognitive effort (frontal-LPP), relative to reappraisal. Related pre-implementation findings confirmed that anticipating regulation of high-intensity stimuli resulted in distraction (over reappraisal) preference. In contrast, anticipating regulation of low-intensity stimuli resulted in reappraisal (over distraction) preference, which is most beneficial for long-term adaptation. Furthermore, anticipating cognitively demanding regulation, either in cases of regulating counter to these preferences or via the more effortful strategy of reappraisal, enhanced neural attentional resource allocation (Stimulus Preceding Negativity). Broad implications are discussed. PMID:25700568

R & D of a Gas-Filled RF Beam Profile Monitor for Intense Neutrino Beam Experiments

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

Yonehara, K.; Backfish, M.; Moretti, A.

We report the R&D of a novel radiation-robust hadron beam profile monitor based on a gas-filled RF cavity for intense neutrino beam experiments. An equivalent RF circuit model was made and simulated to optimize the RF parameter in a wide beam intensity range. As a result, the maximum acceptable beam intensity in the monitor is significantly increased by using a low-quality factor RF cavity. The plan for the demonstration test is set up to prepare for future neutrino beam experiments.

Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility (ABCDE) Bundle

PubMed Central

Balas, Michele C.; Vasilevskis, Eduard E.; Olsen, Keith M.; Schmid, Kendra K.; Shostrom, Valerie; Cohen, Marlene Z.; Peitz, Gregory; Gannon, David E.; Sisson, Joseph; Sullivan, James; Stothert, Joseph C.; Lazure, Julie; Nuss, Suzanne L.; Jawa, Randeep S.; Freihaut, Frank; Ely, E. Wesley; Burke, William J.

2014-01-01

Objective The debilitating and persistent effects of intensive care unit (ICU)-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle into everyday practice. Design Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012. Setting Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center. Patients Two hundred ninety-six patients (146 pre- and 150 post-bundle implementation), age ≥ 19 years, managed by the institutions’ medical or surgical critical care service. Interventions ABCDE bundle. Measurements For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between ABCDE bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Main Results Patients in the post-implementation period spent three more days breathing without mechanical assistance than did those in the pre-implementation period (median [IQR], 24 [7 to 26] vs. 21 [0 to 25]; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the ABCDE bundle experienced a near halving of the odds of delirium (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (OR, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates. Conclusions Critically ill patients managed with the ABCDE bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care. PMID:24394627

Incorporating deliverable monitor unit constraints into spot intensity optimization in intensity modulated proton therapy treatment planning

PubMed Central

Cao, Wenhua; Lim, Gino; Li, Xiaoqiang; Li, Yupeng; Zhu, X. Ronald; Zhang, Xiaodong

2014-01-01

The purpose of this study is to investigate the feasibility and impact of incorporating deliverable monitor unit (MU) constraints into spot intensity optimization in intensity modulated proton therapy (IMPT) treatment planning. The current treatment planning system (TPS) for IMPT disregards deliverable MU constraints in the spot intensity optimization (SIO) routine. It performs a post-processing procedure on an optimized plan to enforce deliverable MU values that are required by the spot scanning proton delivery system. This procedure can create a significant dose distribution deviation between the optimized and post-processed deliverable plans, especially when small spot spacings are used. In this study, we introduce a two-stage linear programming (LP) approach to optimize spot intensities and constrain deliverable MU values simultaneously, i.e., a deliverable spot intensity optimization (DSIO) model. Thus, the post-processing procedure is eliminated and the associated optimized plan deterioration can be avoided. Four prostate cancer cases at our institution were selected for study and two parallel opposed beam angles were planned for all cases. A quadratic programming (QP) based model without MU constraints, i.e., a conventional spot intensity optimization (CSIO) model, was also implemented to emulate the commercial TPS. Plans optimized by both the DSIO and CSIO models were evaluated for five different settings of spot spacing from 3 mm to 7 mm. For all spot spacings, the DSIO-optimized plans yielded better uniformity for the target dose coverage and critical structure sparing than did the CSIO-optimized plans. With reduced spot spacings, more significant improvements in target dose uniformity and critical structure sparing were observed in the DSIO- than in the CSIO-optimized plans. Additionally, better sparing of the rectum and bladder was achieved when reduced spacings were used for the DSIO-optimized plans. The proposed DSIO approach ensures the deliverability of optimized IMPT plans that take into account MU constraints. This eliminates the post-processing procedure required by the TPS as well as the resultant deteriorating effect on ultimate dose distributions. This approach therefore allows IMPT plans to adopt all possible spot spacings optimally. Moreover, dosimetric benefits can be achieved using smaller spot spacings. PMID:23835656

Temporal Informative Analysis in Smart-ICU Monitoring: M-HealthCare Perspective.

PubMed

Bhatia, Munish; Sood, Sandeep K

2016-08-01

The rapid introduction of Internet of Things (IoT) Technology has boosted the service deliverance aspects of health sector in terms of m-health, and remote patient monitoring. IoT Technology is not only capable of sensing the acute details of sensitive events from wider perspectives, but it also provides a means to deliver services in time sensitive and efficient manner. Henceforth, IoT Technology has been efficiently adopted in different fields of the healthcare domain. In this paper, a framework for IoT based patient monitoring in Intensive Care Unit (ICU) is presented to enhance the deliverance of curative services. Though ICUs remained a center of attraction for high quality care among researchers, still number of studies have depicted the vulnerability to a patient's life during ICU stay. The work presented in this study addresses such concerns in terms of efficient monitoring of various events (and anomalies) with temporal associations, followed by time sensitive alert generation procedure. In order to validate the system, it was deployed in 3 ICU room facilities for 30 days in which nearly 81 patients were monitored during their ICU stay. The results obtained after implementation depicts that IoT equipped ICUs are more efficient in monitoring sensitive events as compared to manual monitoring and traditional Tele-ICU monitoring. Moreover, the adopted methodology for alert generation with information presentation further enhances the utility of the system.

Usefulness of a Perceived Exertion Scale for Monitoring Exercise Intensity in Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

Stanish, Heidi I.; Aucoin, Michael

2007-01-01

In order to gain physical fitness and health, exercise must be performed at a sufficient level of intensity. Exercise intensity can be monitored with rated perceived exertion (RPE) scales to promote safe and effective programming. The usefulness of the Children's OMNI Scale as a subjective measure of intensity for adults with intellectual…

[Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit].

PubMed

Álvarez Maldonado, Pablo; Cueto Robledo, Guillermo; Cicero Sabido, Raúl

2015-04-01

To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). A prospective, comparative, longitudinal and interventional study was carried out. The RICU of Hospital General de México (Mexico). All patients admitted to the RICU from March 2012 to March 2013. An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP). NPE, reintubation and VAP ratios. A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5). Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-11-15

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Adaptive runtime for a multiprocessing API

DOEpatents

Antao, Samuel F.; Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

2016-10-11

A computer-implemented method includes selecting a runtime for executing a program. The runtime includes a first combination of feature implementations, where each feature implementation implements a feature of an application programming interface (API). Execution of the program is monitored, and the execution uses the runtime. Monitor data is generated based on the monitoring. A second combination of feature implementations are selected, by a computer processor, where the selection is based at least in part on the monitor data. The runtime is modified by activating the second combination of feature implementations to replace the first combination of feature implementations.

Heart Rate Monitoring in Team Sports-A Conceptual Framework for Contextualizing Heart Rate Measures for Training and Recovery Prescription.

PubMed

Schneider, Christoph; Hanakam, Florian; Wiewelhove, Thimo; Döweling, Alexander; Kellmann, Michael; Meyer, Tim; Pfeiffer, Mark; Ferrauti, Alexander

2018-01-01

A comprehensive monitoring of fitness, fatigue, and performance is crucial for understanding an athlete's individual responses to training to optimize the scheduling of training and recovery strategies. Resting and exercise-related heart rate measures have received growing interest in recent decades and are considered potentially useful within multivariate response monitoring, as they provide non-invasive and time-efficient insights into the status of the autonomic nervous system (ANS) and aerobic fitness. In team sports, the practical implementation of athlete monitoring systems poses a particular challenge due to the complex and multidimensional structure of game demands and player and team performance, as well as logistic reasons, such as the typically large number of players and busy training and competition schedules. In this regard, exercise-related heart rate measures are likely the most applicable markers, as they can be routinely assessed during warm-ups using short (3-5 min) submaximal exercise protocols for an entire squad with common chest strap-based team monitoring devices. However, a comprehensive and meaningful monitoring of the training process requires the accurate separation of various types of responses, such as strain, recovery, and adaptation, which may all affect heart rate measures. Therefore, additional information on the training context (such as the training phase, training load, and intensity distribution) combined with multivariate analysis, which includes markers of (perceived) wellness and fatigue, should be considered when interpreting changes in heart rate indices. The aim of this article is to outline current limitations of heart rate monitoring, discuss methodological considerations of univariate and multivariate approaches, illustrate the influence of different analytical concepts on assessing meaningful changes in heart rate responses, and provide case examples for contextualizing heart rate measures using simple heuristics. To overcome current knowledge deficits and methodological inconsistencies, future investigations should systematically evaluate the validity and usefulness of the various approaches available to guide and improve the implementation of decision-support systems in (team) sports practice.

Heart Rate Monitoring in Team Sports—A Conceptual Framework for Contextualizing Heart Rate Measures for Training and Recovery Prescription

PubMed Central

Schneider, Christoph; Hanakam, Florian; Wiewelhove, Thimo; Döweling, Alexander; Kellmann, Michael; Meyer, Tim; Pfeiffer, Mark; Ferrauti, Alexander

2018-01-01

A comprehensive monitoring of fitness, fatigue, and performance is crucial for understanding an athlete's individual responses to training to optimize the scheduling of training and recovery strategies. Resting and exercise-related heart rate measures have received growing interest in recent decades and are considered potentially useful within multivariate response monitoring, as they provide non-invasive and time-efficient insights into the status of the autonomic nervous system (ANS) and aerobic fitness. In team sports, the practical implementation of athlete monitoring systems poses a particular challenge due to the complex and multidimensional structure of game demands and player and team performance, as well as logistic reasons, such as the typically large number of players and busy training and competition schedules. In this regard, exercise-related heart rate measures are likely the most applicable markers, as they can be routinely assessed during warm-ups using short (3–5 min) submaximal exercise protocols for an entire squad with common chest strap-based team monitoring devices. However, a comprehensive and meaningful monitoring of the training process requires the accurate separation of various types of responses, such as strain, recovery, and adaptation, which may all affect heart rate measures. Therefore, additional information on the training context (such as the training phase, training load, and intensity distribution) combined with multivariate analysis, which includes markers of (perceived) wellness and fatigue, should be considered when interpreting changes in heart rate indices. The aim of this article is to outline current limitations of heart rate monitoring, discuss methodological considerations of univariate and multivariate approaches, illustrate the influence of different analytical concepts on assessing meaningful changes in heart rate responses, and provide case examples for contextualizing heart rate measures using simple heuristics. To overcome current knowledge deficits and methodological inconsistencies, future investigations should systematically evaluate the validity and usefulness of the various approaches available to guide and improve the implementation of decision-support systems in (team) sports practice. PMID:29904351

Monitoring the lesion formation during histotripsy treatment using shear wave imaging

NASA Astrophysics Data System (ADS)

Arnal, Bastien; Lee, Wei-Ning; Pernot, Mathieu; Fink, Mathias; Tanter, Mickael

2012-11-01

Monitoring the lesion formation induced by histotripsy has mainly relied on the quantitative change in backscatter intensity using ultrasound B-mode imaging. However, how the mechanical properties of the histotripsy-treated tissue region alter during the procedure is yet to be fully investigated. We thus proposed here to monitor such a therapeutic process based on shear modulus estimated by shear wave imaging (SWI). In the therapeutic procedure, a single-element piezo-composite focused transducer (Imasonic, Besançon, France) with a center frequency of 660 kHz, a focal length of 45 mm, and an fnumber of 1 was driven by a function generator (AFG 3101, Tektronix, Beaverton, OR) and a gated RF power amplifier (GA-2500A, RITEC Inc., USA) to generate ultrasound histotripsy pulses. Histotripsy pulses were delivered for 20 seconds and then followed by a 30-second pause and a rapid monitoring step. Such a treatment and monitoring scheme was repeated for 10 mins. Both the reference measurement and monitoring were realized by SWI, where plane shear waves were generated by an 8 MHz linear array probe connected to a prototype ultrasound scanner, and acquired at a frame rate of 10000 Hz. Shear modulus was estimated and mapped in 2D through a time-of-flight algorithm. Gelatin (8%)-agar (2%) phantoms and ex-vivo porcine liver samples were tested. Regions of interests (ROI's) of 2 mm-by-2 mm in both untreated and treated regions were selected to compute the contrast-to-noise ratio (CNR). In all three scenarios where different PD's and PRF's were implemented, during the first 100 seconds of the treatment, 50% decrease in the shear modulus within the histotripsy-targeted zone was already observed, and the CNR of the shear modulus increased by 18 dB. In contrast, the backscatter intensity began to reduce and the corresponding CNR was found to increase by 6 dB only after 120 seconds of treatment. The results demonstrated that SWI can map quantitatively the change of mechanical properties during histotripsy treatment. Moreover, the shear modulus estimated by SWI was a more sensitive indicator of the lesion formation than the backscatter intensity obtained from B-mode at the early stage of the histotripsy treatment. In-vitro experiments on liver samples have also been carried out.

Coevolution of Information Sharing and Implementation of Evidence-Based Practices Among North American Tobacco Cessation Quitlines

PubMed Central

Saul, Jessie E.; Lemaire, Robin H.; Valente, Thomas W.; Leischow, Scott J.

2015-01-01

Objectives. We examined the coevolution of information sharing and implementation of evidence-based practices among US and Canadian tobacco cessation quitlines within the North American Quitline Consortium (NAQC). Methods. Web-based surveys were used to collect data from key respondents representing each of 74 participating funders of NAQC quitlines during the summer and fall of 2009, 2010, and 2011. We used stochastic actor-based models to estimate changes in information sharing and practice implementation in the NAQC network. Results. Funders were more likely to share information within their own country and with funders that contracted with the same service provider. Funders contracting with larger service providers shared less information but implemented significantly more practices. Funders connected to larger numbers of tobacco control researchers more often received information from other funders. Intensity of ties to the NAQC network administrative organization did not influence funders’ decisions to share information or implement practices. Conclusions. Our findings show the importance of monitoring the NAQC network over time. We recommend increased cross-border information sharing and sharing of information between funders contracting with different and smaller service providers. PMID:26180993

Apparatus and method for monitoring the intensities of charged particle beams

DOEpatents

Varma, Matesh N.; Baum, John W.

1982-11-02

Charged particle beam monitoring means (40) are disposed in the path of a charged particle beam (44) in an experimental device (10). The monitoring means comprise a beam monitoring component (42) which is operable to prevent passage of a portion of beam (44), while concomitantly permitting passage of another portion thereof (46) for incidence in an experimental chamber (18), and providing a signal (I.sub.m) indicative of the intensity of the beam portion which is not passed. Calibration means (36) are disposed in the experimental chamber in the path of the said another beam portion and are operable to provide a signal (I.sub.f) indicative of the intensity thereof. Means (41 and 43) are provided to determine the ratio (R) between said signals whereby, after suitable calibration, the calibration means may be removed from the experimental chamber and the intensity of the said another beam portion determined by monitoring of the monitoring means signal, per se.

Information Technology in Critical Care: Review of Monitoring and Data Acquisition Systems for Patient Care and Research

PubMed Central

De Georgia, Michael A.; Kaffashi, Farhad; Jacono, Frank J.; Loparo, Kenneth A.

2015-01-01

There is a broad consensus that 21st century health care will require intensive use of information technology to acquire and analyze data and then manage and disseminate information extracted from the data. No area is more data intensive than the intensive care unit. While there have been major improvements in intensive care monitoring, the medical industry, for the most part, has not incorporated many of the advances in computer science, biomedical engineering, signal processing, and mathematics that many other industries have embraced. Acquiring, synchronizing, integrating, and analyzing patient data remain frustratingly difficult because of incompatibilities among monitoring equipment, proprietary limitations from industry, and the absence of standard data formatting. In this paper, we will review the history of computers in the intensive care unit along with commonly used monitoring and data acquisition systems, both those commercially available and those being developed for research purposes. PMID:25734185

Information technology in critical care: review of monitoring and data acquisition systems for patient care and research.

PubMed

De Georgia, Michael A; Kaffashi, Farhad; Jacono, Frank J; Loparo, Kenneth A

2015-01-01

There is a broad consensus that 21st century health care will require intensive use of information technology to acquire and analyze data and then manage and disseminate information extracted from the data. No area is more data intensive than the intensive care unit. While there have been major improvements in intensive care monitoring, the medical industry, for the most part, has not incorporated many of the advances in computer science, biomedical engineering, signal processing, and mathematics that many other industries have embraced. Acquiring, synchronizing, integrating, and analyzing patient data remain frustratingly difficult because of incompatibilities among monitoring equipment, proprietary limitations from industry, and the absence of standard data formatting. In this paper, we will review the history of computers in the intensive care unit along with commonly used monitoring and data acquisition systems, both those commercially available and those being developed for research purposes.

Development of the Internet-Enabled System for Exercise Telerehabilitation and Cardiovascular Training.

PubMed

Dedov, Vadim N; Dedova, Irina V

2015-07-01

Sustained exercise training could significantly improve patient rehabilitation and management of noncommunicable diseases in the community. This study aimed to develop a universal telecare system for delivery of exercise rehabilitation and cardiovascular training services at home. An innovative bilateral leg training device was equipped with an electronic system for the ongoing measurement of training activities with the device. A single-item parameter reflecting the intensity of training was monitored using several modern telecommunication technologies. According to the application protocol, eight volunteers first tried the device for 30-60 min to determine their personal training capacity. Then, they were provided with equipment to use at home for 4 weeks. Adherence to daily training was assessed by the number of training days per week, training intensity, and duration of training sessions. The system provided reliable recording of training activities with the device using (1) long-term data logging without an ongoing connection to the computer, (2) wireless monitoring and recording of training activities on a stand-alone computer, and (3) a secure cloud-based monitoring over the Internet connection using electronic devices, including smartphones. Overall analysis of recordings and phone feedbacks to participants took only approximately 5 h for the duration of study. This study, although of a pilot nature, described the comprehensive exercise telerehabilitation system integrating mobile training equipment with personalized training protocols and remote monitoring. A single-item electronic parameter of the system usage facilitated time-effective data management. Wireless connection allowed various locations of device application and several monitoring arrangements ranging from real-time monitoring to long-term recording of exercise activities. A cloud-based software platform enabled management of multiple users at distance. Implementation of this model may facilitate both accessibility and availability of personalized exercise telerehabilitation services. Further studies would validate it in the clinical and healthcare environment.

Low Cost Plastic Optical Fiber Pressure Sensor Embedded in Mattress for Vital Signal Monitoring.

PubMed

Sartiano, Demetrio; Sales, Salvador

2017-12-13

The aim of this paper is to report the design of a low-cost plastic optical fiber (POF) pressure sensor, embedded in a mattress. We report the design of a multipoint sensor, a cheap alternative to the most common fiber sensors. The sensor is implemented using Arduino board, standard LEDs for optical communication in POF (λ = 645 nm) and a silicon light sensor. The Super ESKA ® plastic fibers were used to implement the fiber intensity sensor, arranged in a 4 × 4 matrix. During the breathing cycles, the force transmitted from the lungs to the thorax is in the order of tens of Newtons, and the respiration rate is of one breath every 2-5 s (0.2-0.5 Hz). The sensor has a resolution of force applied on a single point of 2.2-4.5%/N on the normalized voltage output, and a bandwidth of 10 Hz, it is then suitable to monitor the respiration movements. Another issue to be addressed is the presence of hysteresis over load cycles. The sensor was loaded cyclically to estimate the drift of the system, and the hysteresis was found to be negligible.

Improved perception of communication and compliance with a revised, intensive care unit-specific bedside communication sheet.

PubMed

Aponte-Patel, Linda; Sen, Anita

2015-01-01

Although many pediatric intensive care units (PICUs) use beside communication sheets (BCSs) to highlight daily goals, the optimal format is unknown. A site-specific BCS could improve both PICU communication and compliance completing the BCS. Via written survey, PICU staff at an academic children's hospital provided recommendations for improving and revising an existing BCS. Pre- and post-BCS revision, PICU staff were polled regarding PICU communication and BCS effectiveness, and daily compliance for completing the BCS was monitored. After implementation of the revised BCS, staff reporting "excellent" or "very good" day-to-day communication within the PICU increased from 57% to 77% (P = .02). Compliance for completing the BCS also increased significantly (75% vs 83%, P = .03). Introduction of a focused and concise BCS tailored to a specific PICU leads to improved perceptions of communication by PICU staff and increased compliance completing the daily BCS. © The Author(s) 2014.

Pulse-resolved intensity measurements at a hard X-ray FEL using semi-transparent diamond detectors

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

Roth, Thomas; Freund, Wolfgang; Boesenberg, Ulrike

Solid-state ionization chambers are presented based on thin diamond crystals that allow pulse-resolved intensity measurements at a hard X-ray free-electron laser (FEL), up to the 4.5 MHz repetition rate that will become available at the European XFEL. Due to the small X-ray absorption of diamond the thin detectors are semi-transparent which eases their use as non-invasive monitoring devices in the beam. FELs are characterized by strong pulse-to-pulse intensity fluctuations due to the self-amplified spontaneous emission (SASE) process and in many experiments it is mandatory to monitor the intensity of each individual pulse. Two diamond detectors with different electrode materials, berylliummore » and graphite, were tested as intensity monitors at the XCS endstation of the Linac Coherent Light Source (LCLS) using the pink SASE beam at 9 keV. The performance is compared with LCLS standard monitors that detect X-rays backscattered from thin SiN foils placed in the beam. In conclusion, the graphite detector can also be used as a beam position monitor although with rather coarse resolution.« less

Pulse-resolved intensity measurements at a hard X-ray FEL using semi-transparent diamond detectors

DOE PAGES

Roth, Thomas; Freund, Wolfgang; Boesenberg, Ulrike; ...

2018-01-01

Solid-state ionization chambers are presented based on thin diamond crystals that allow pulse-resolved intensity measurements at a hard X-ray free-electron laser (FEL), up to the 4.5 MHz repetition rate that will become available at the European XFEL. Due to the small X-ray absorption of diamond the thin detectors are semi-transparent which eases their use as non-invasive monitoring devices in the beam. FELs are characterized by strong pulse-to-pulse intensity fluctuations due to the self-amplified spontaneous emission (SASE) process and in many experiments it is mandatory to monitor the intensity of each individual pulse. Two diamond detectors with different electrode materials, berylliummore » and graphite, were tested as intensity monitors at the XCS endstation of the Linac Coherent Light Source (LCLS) using the pink SASE beam at 9 keV. The performance is compared with LCLS standard monitors that detect X-rays backscattered from thin SiN foils placed in the beam. In conclusion, the graphite detector can also be used as a beam position monitor although with rather coarse resolution.« less

TU-EF-210-01: HIFU, Drug Delivery, and Immunotherapy

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

Ferrara, K.

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less

MR thermometry analysis program for laser- or high-intensity focused ultrasound (HIFU)-induced heating at a clinical MR scanner

NASA Astrophysics Data System (ADS)

Kim, Eun Ju; Jeong, Kiyoung; Oh, Seung Jae; Kim, Daehong; Park, Eun Hae; Lee, Young Han; Suh, Jin-Suck

2014-12-01

Magnetic resonance (MR) thermometry is a noninvasive method for monitoring local temperature change during thermal therapy. In this study, a MR temperature analysis program was established for a laser with gold nanorods (GNRs) and high-intensity focused ultrasound (HIFU)-induced heating MR thermometry. The MR temperature map was reconstructed using the water proton resonance frequency (PRF) method. The temperature-sensitive phase difference was acquired by using complex number subtraction instead of direct phase subtraction in order to avoid another phase unwrapping process. A temperature map-analyzing program was developed and implemented in IDL (Interactive Data Language) for effective temperature monitoring. This one program was applied to two different heating devices at a clinical MR scanner. All images were acquired with the fast spoiled gradient echo (fSPGR) pulse sequence on a 3.0 T GE Discovery MR750 scanner with an 8-channel knee array coil or with a home-built small surface coil. The analyzed temperature values were confirmed by using values simultaneously measured with an optical temperature probe (R2 = 0.996). The temperature change in small samples induced by a laser or by HIFU was analyzed by using a raw data, that consisted of complex numbers. This study shows that our MR thermometry analysis program can be used for thermal therapy study with a laser or HIFU at a clinical MR scanner. It can also be applied to temperature monitoring for any other thermal therapy based on the PRF method.

TU-EF-210-04: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy

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

Farahani, K.

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less

TU-EF-210-00: Therapeutic Strategies and Image Guidance

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

NONE

2015-06-15

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less

TU-EF-210-02: MRg Hyperthermia

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

Chopra, R.

2015-06-15

The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imagingmore » Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.« less

Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates.

PubMed

Wozney, Lori; Newton, Amanda S; Gehring, Nicole D; Bennett, Kathryn; Huguet, Anna; Hartling, Lisa; Dyson, Michele P; McGrath, Patrick

2017-06-02

The use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care. From September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data. Key informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment. This study provides previously unavailable information about key informant perspectives on eMental Health care implementation. The themes that emerged, namely the need to intensify intersectoral research, measure/monitor readiness to implement, define cost-utility benchmarks, raise awareness about available technologies, and test assumptions that 'proven' technologies will be easily integrated can inform the design and evaluation of eMental Health care implementation models.

Improving the implementation of marine monitoring in the northeast Atlantic.

PubMed

Turrell, W R

2018-03-01

Marine monitoring in the northeast Atlantic is delivered within identifiable monitoring themes, established through time and defined by the geographical area and policy drivers they serve, the sampling methodologies they use, their assessment methodologies, their funding and governance structures and the people or organisations involved in their implementation. Within a monitoring theme, essential components for effective monitoring are governance, strategy and work plan, sampling protocols, quality assurance, and data and assessment structures. This simple framework is used to analyse two monitoring theme case studies; national ecosystem health monitoring, and regional fish stock monitoring. Such essential component analyses, within marine monitoring themes, can help improve monitoring implementation by identifying gaps and overlaps. Once monitoring themes are recognised, explicitly defined and streamlined, travel towards integrated monitoring may be made easier as the current lack of clarity in thematic marine monitoring implementation is one barrier to integration at both national and regional scales. Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.

More frequent, more costly? Health economic modelling aspects of monitoring glaucoma patients in England.

PubMed

Boodhna, Trishal; Crabb, David P

2016-10-22

Chronic open angle glaucoma (COAG) is an age-related eye disease causing irreversible loss of visual field (VF). Health service delivery for COAG is challenging given the large number of diagnosed patients requiring lifelong periodic monitoring by hospital eye services. Yet frequent examination better determines disease worsening and speed of VF loss under treatment. We examine the cost-effectiveness of increasing frequency of VF examinations during follow-up using a health economic model. Two different VF monitoring schemes defined as current practice (annual VF testing) and proposed practice (three VF tests per year in the first 2 years after diagnosis) were examined. A purpose written health economic Markov model is used to test the hypothesis that cost effectiveness improves by implementing proposed practice on groups of patients stratified by age and severity of COAG. Further, a new component of the model, estimating costs of visual impairment, was added. Results were derived from a simulated cohort of 10000 patients with quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) used as main outcome measures. An ICER of £21,392 per QALY was derived for proposed practice improving to a value of £11,382 once savings for prevented visual impairment was added to the model. Proposed practice was more cost-effective in younger patients. Proposed practice for patients with advanced disease at diagnosis generated ICERs > £60,000 per QALY; these cases would likely be on the most intensive treatment pathway making clinical information on speed of VF loss redundant. Sensitivity analysis indicated results to be robust in relation to hypothetical willingness to pay threshold identified by national guidelines, although greatest uncertainty was allied to estimates of implementation and visual impairment costs. Increasing VF monitoring at the earliest stages of follow-up for COAG appears to be cost-effective depending on reasonable assumptions about implementation costs. Our health economic model highlights benefits of stratifying patients to more or less monitoring based on age and stage of disease at diagnosis; a prospective study is needed to prove these findings. Further, this works highlights gaps in knowledge about long term costs of visual impairment.

Validity of physical activity monitors for assessing lower intensity activity in adults.

PubMed

Calabró, M Andrés; Lee, Jung-Min; Saint-Maurice, Pedro F; Yoo, Hyelim; Welk, Gregory J

2014-09-28

Accelerometers can provide accurate estimates of moderate-to-vigorous physical activity (MVPA). However, one of the limitations of these instruments is the inability to capture light activity within an acceptable range of error. The purpose of the present study was to determine the validity of different activity monitors for estimating energy expenditure (EE) of light intensity, semi-structured activities. Forty healthy participants wore a SenseWear Pro3 Armband (SWA, v.6.1), the SenseWear Mini, the Actiheart, ActiGraph, and ActivPAL monitors, while being monitored with a portable indirect calorimetry (IC). Participants engaged in a variety of low intensity activities but no formalized scripts or protocols were used during these periods. The Mini and SWA overestimated total EE on average by 1.0% and 4.0%, respectively, while the AH, the GT3X, and the AP underestimated total EE on average by 7.8%, 25.5%, and 22.2%, respectively. The pattern-recognition monitors yielded non-significant differences in EE estimates during the semi-structured period (p = 0.66, p = 0.27, and p = 0.21 for the Mini, SWA, and AH, respectively). The SenseWear Mini provided more accurate estimates of EE during light to moderate intensity semi-structured activities compared to other activity monitors. This monitor should be considered when there is interest in tracking low intensity activities in groups of individuals.

[Strategic patient safety action plan for the anesthesiology and intensive care service of Ukraine: basic modules and their components].

PubMed

Федосюк, Роман Н

In recent years, the problem of patient safety has become top-priority in further improvement of national healthcare systems in all developed countries. To develop a modular structure and a component composition of the strategic patient safety action plan for the anesthesiology and intensive care service of Ukraine as a part of the National Action Plan. Major domestic priorities, substantiated and made public by the author in previous works, are taken as the basis for the modular structuring of the action plan. Existing foreign prototypes, evaluated for the patient safety effectiveness and the potential for the adaptation to domestic conditions, as well as author's own innovations are offered for a component filling-up of each module. Eight modules - infectious safety, surgical safety, pharmaceutical safety, infrastructural safety, incident monitoring and reporting, education and training, research and awards - have been proposed. Individual components for each of the modules are selected from a variety of foreign prototypes and author's own developments. Inter-modular stratification of the components into short-term perspective tools and long-term perspective tools, depending on the amount of resources needed for their implementation, is carried out. The strategic patient safety action plan for the anesthesiology and intensive care service of Ukraine is the embodiment, within a particular specialty, of the wider National Action Plan developed by the First National Congress on Patient Safety (Kiev, 2012) on the initiative of the Council of Europe and aimed at the fulfillment of international obligations of Ukraine in the healthcare sector. Its implementation will contribute to enhancing the safety of anesthesia and intensive care services in Ukraine and further development of the specialty.

A label-free fiber-optic Turbidity Affinity Sensor (TAS) for continuous glucose monitoring.

PubMed

Dutt-Ballerstadt, Ralph; Evans, Colton; Pillai, Arun P; Gowda, Ashok

2014-11-15

In this paper, we describe the concept of a novel implantable fiber-optic Turbidity Affinity Sensor (TAS) and report on the findings of its in-vitro performance for continuous glucose monitoring. The sensing mechanism of the TAS is based on glucose-specific changes in light scattering (turbidity) of a hydrogel suspension consisting of small particles made of crosslinked dextran (Sephadex G100), and a glucose- and mannose-specific binding protein - Concanavalin A (ConA). The binding of ConA to Sephadex particles results in a significant turbidity increase that is much greater than the turbidity contribution by the individual components. The turbidity of the TAS was measured by determining the intensity of light passing through the suspension enclosed within a small semi-permeable hollow fiber (OD: 220 μm, membrane thickness: 20 μm, molecular weight cut-off: 10 kDa) using fiber optics. The intensity of measured light of the TAS was proportional to the glucose concentration over the concentration range from 50mg/dL to 400mg/dL in PBS and whole blood at 37°C (R>0.96). The response time was approximately 4 min. The stability of the glucose response of the TAS decreased only slightly (by 20%) over an 8-day study period at 37°C. In conclusion, this study demonstrated proof-of-concept of the TAS for interstitial glucose monitoring. Due to the large signal amplitude of the turbidity change, and the lack of need for wavelength-specific emission and excitation filters, a very small, robust and compact TAS device with an extremely short optical pathlength could be feasibly designed and implemented for in-vivo glucose monitoring in people with diabetes. Copyright © 2014 Elsevier B.V. All rights reserved.

Architecture for Adaptive Intelligent Systems

NASA Technical Reports Server (NTRS)

Hayes-Roth, Barbara

1993-01-01

We identify a class of niches to be occupied by 'adaptive intelligent systems (AISs)'. In contrast with niches occupied by typical AI agents, AIS niches present situations that vary dynamically along several key dimensions: different combinations of required tasks, different configurations of available resources, contextual conditions ranging from benign to stressful, and different performance criteria. We present a small class hierarchy of AIS niches that exhibit these dimensions of variability and describe a particular AIS niche, ICU (intensive care unit) patient monitoring, which we use for illustration throughout the paper. We have designed and implemented an agent architecture that supports all of different kinds of adaptation by exploiting a single underlying theoretical concept: An agent dynamically constructs explicit control plans to guide its choices among situation-triggered behaviors. We illustrate the architecture and its support for adaptation with examples from Guardian, an experimental agent for ICU monitoring.

Monitoring and guidance of HIFU beams with dual-mode ultrasound arrays.

PubMed

Ballard, John R; Casper, Andrew J; Ebbini, Emad S

2009-01-01

We present experimental results illustrating the unique advantages of dual-mode array (DMUA) systems in monitoring and guidance of high intensity focused ultrasound (HIFU) lesion formation. DMUAs offer a unique paradigm in image-guided surgery; one in which images obtained using the same therapeutic transducer provide feedback for: 1) refocusing the array in the presence of strongly scattering objects, e.g. the ribs, 2) temperature change at the intended location of the HIFU focus, and 3) changes in the echogenicity of the tissue in response to therapeutic HIFU. These forms of feedback have been demonstrated in vitro in preparation for the design and implementation of a real-time system for imaging and therapy with DMUAs. The results clearly demonstrate that DMUA image feedback is spatially accurate and provide sufficient spatial and contrast resolution for identification of high contrast objects like the ribs and significant blood vessels in the path of the HIFU beam.

Successive approximation algorithm for beam-position-monitor-based LHC collimator alignment

NASA Astrophysics Data System (ADS)

Valentino, Gianluca; Nosych, Andriy A.; Bruce, Roderik; Gasior, Marek; Mirarchi, Daniele; Redaelli, Stefano; Salvachua, Belen; Wollmann, Daniel

2014-02-01

Collimators with embedded beam position monitor (BPM) button electrodes will be installed in the Large Hadron Collider (LHC) during the current long shutdown period. For the subsequent operation, BPMs will allow the collimator jaws to be kept centered around the beam orbit. In this manner, a better beam cleaning efficiency and machine protection can be provided at unprecedented higher beam energies and intensities. A collimator alignment algorithm is proposed to center the jaws automatically around the beam. The algorithm is based on successive approximation and takes into account a correction of the nonlinear BPM sensitivity to beam displacement and an asymmetry of the electronic channels processing the BPM electrode signals. A software implementation was tested with a prototype collimator in the Super Proton Synchrotron. This paper presents results of the tests along with some considerations for eventual operation in the LHC.

On-line Monitoring Device for High-voltage Switch Cabinet Partial Discharge Based on Pulse Current Method

NASA Astrophysics Data System (ADS)

Y Tao, S.; Zhang, X. Z.; Cai, H. W.; Li, P.; Feng, Y.; Zhang, T. C.; Li, J.; Wang, W. S.; Zhang, X. K.

2017-12-01

The pulse current method for partial discharge detection is generally applied in type testing and other off-line tests of electrical equipment at delivery. After intensive analysis of the present situation and existing problems of partial discharge detection in switch cabinets, this paper designed the circuit principle and signal extraction method for partial discharge on-line detection based on a high-voltage presence indicating systems (VPIS), established a high voltage switch cabinet partial discharge on-line detection circuit based on the pulse current method, developed background software integrated with real-time monitoring, judging and analyzing functions, carried out a real discharge simulation test on a real-type partial discharge defect simulation platform of a 10KV switch cabinet, and verified the sensitivity and validity of the high-voltage switch cabinet partial discharge on-line monitoring device based on the pulse current method. The study presented in this paper is of great significance for switch cabinet maintenance and theoretical study on pulse current method on-line detection, and has provided a good implementation method for partial discharge on-line monitoring devices for 10KV distribution network equipment.

Estuarine water quality in parks of the Northeast Coastal and Barrier Network: Development and early implementation of vital signs estuarine nutrient-enrichment monitoring, 2003-06

USGS Publications Warehouse

Kopp, Blaine S.; Nielsen, Martha; Glisic, Dejan; Neckles, Hilary A.

2009-01-01

This report documents results of pilot tests of a protocol for monitoring estuarine nutrient enrichment for the Vital Signs Monitoring Program of the National Park Service Northeast Coastal and Barrier Network. Data collected from four parks during protocol development in 2003-06 are presented: Gateway National Recreation Area, Colonial National Historic Park, Fire Island National Seashore, and Assateague Island National Seashore. The monitoring approach incorporates several spatial and temporal designs to address questions at a hierarchy of scales. Indicators of estuarine response to nutrient enrichment were sampled using a probability design within park estuaries during a late-summer index period. Monitoring variables consisted of dissolved-oxygen concentration, chlorophyll a concentration, water temperature, salinity, attenuation of downwelling photosynthetically available radiation (PAR), and turbidity. The statistical sampling design allowed the condition of unsampled locations to be inferred from the distribution of data from a set of randomly positioned "probability" stations. A subset of sampling stations was sampled repeatedly during the index period, and stations were not rerandomized in subsequent years. These "trend stations" allowed us to examine temporal variability within the index period, and to improve the sensitivity of the monitoring protocol to detecting change through time. Additionally, one index site in each park was equipped for continuous monitoring throughout the index period. Thus, the protocol includes elements of probabilistic and targeted spatial sampling, and the temporal intensity ranges from snapshot assessments to continuous monitoring.

Recent advances in electronic nose techniques for monitoring of fermentation process.

PubMed

Jiang, Hui; Zhang, Hang; Chen, Quansheng; Mei, Congli; Liu, Guohai

2015-12-01

Microbial fermentation process is often sensitive to even slight changes of conditions that may result in unacceptable end-product quality. Thus, the monitoring of the process is critical for discovering unfavorable deviations as early as possible and taking the appropriate measures. However, the use of traditional analytical techniques is often time-consuming and labor-intensive. In this sense, the most effective way of developing rapid, accurate and relatively economical method for quality assurance in microbial fermentation process is the use of novel chemical sensor systems. Electronic nose techniques have particular advantages in non-invasive monitoring of microbial fermentation process. Therefore, in this review, we present an overview of the most important contributions dealing with the quality control in microbial fermentation process using the electronic nose techniques. After a brief description of the fundamentals of the sensor techniques, some examples of potential applications of electronic nose techniques monitoring are provided, including the implementation of control strategies and the combination with other monitoring tools (i.e. sensor fusion). Finally, on the basis of the review, the electronic nose techniques are critically commented, and its strengths and weaknesses being highlighted. In addition, on the basis of the observed trends, we also propose the technical challenges and future outlook for the electronic nose techniques.

A difference-matrix metaheuristic for intensity map segmentation in step-and-shoot IMRT delivery.

PubMed

Gunawardena, Athula D A; D'Souza, Warren D; Goadrich, Laura D; Meyer, Robert R; Sorensen, Kelly J; Naqvi, Shahid A; Shi, Leyuan

2006-05-21

At an intermediate stage of radiation treatment planning for IMRT, most commercial treatment planning systems for IMRT generate intensity maps that describe the grid of beamlet intensities for each beam angle. Intensity map segmentation of the matrix of individual beamlet intensities into a set of MLC apertures and corresponding intensities is then required in order to produce an actual radiation delivery plan for clinical use. Mathematically, this is a very difficult combinatorial optimization problem, especially when mechanical limitations of the MLC lead to many constraints on aperture shape, and setup times for apertures make the number of apertures an important factor in overall treatment time. We have developed, implemented and tested on clinical cases a metaheuristic (that is, a method that provides a framework to guide the repeated application of another heuristic) that efficiently generates very high-quality (low aperture number) segmentations. Our computational results demonstrate that the number of beam apertures and monitor units in the treatment plans resulting from our approach is significantly smaller than the corresponding values for treatment plans generated by the heuristics embedded in a widely use commercial system. We also contrast the excellent results of our fast and robust metaheuristic with results from an 'exact' method, branch-and-cut, which attempts to construct optimal solutions, but, within clinically acceptable time limits, generally fails to produce good solutions, especially for intensity maps with more than five intensity levels. Finally, we show that in no instance is there a clinically significant change of quality associated with our more efficient plans.

Compliance Groundwater Monitoring of Nonpoint Sources - Emerging Approaches

NASA Astrophysics Data System (ADS)

Harter, T.

2008-12-01

Groundwater monitoring networks are typically designed for regulatory compliance of discharges from industrial sites. There, the quality of first encountered (shallow-most) groundwater is of key importance. Network design criteria have been developed for purposes of determining whether an actual or potential, permitted or incidental waste discharge has had or will have a degrading effect on groundwater quality. The fundamental underlying paradigm is that such discharge (if it occurs) will form a distinct contamination plume. Networks that guide (post-contamination) mitigation efforts are designed to capture the shape and dynamics of existing, finite-scale plumes. In general, these networks extend over areas less than one to ten hectare. In recent years, regulatory programs such as the EU Nitrate Directive and the U.S. Clean Water Act have forced regulatory agencies to also control groundwater contamination from non-incidental, recharging, non-point sources, particularly agricultural sources (fertilizer, pesticides, animal waste application, biosolids application). Sources and contamination from these sources can stretch over several tens, hundreds, or even thousands of square kilometers with no distinct plumes. A key question in implementing monitoring programs at the local, regional, and national level is, whether groundwater monitoring can be effectively used as a landowner compliance tool, as is currently done at point-source sites. We compare the efficiency of such traditional site-specific compliance networks in nonpoint source regulation with various designs of regional nonpoint source monitoring networks that could be used for compliance monitoring. We discuss advantages and disadvantages of the site vs. regional monitoring approaches with respect to effectively protecting groundwater resources impacted by nonpoint sources: Site-networks provide a tool to enforce compliance by an individual landowner. But the nonpoint source character of the contamination and its typically large spatial extend requires extensive networks at an individual site to accurately and fairly monitor individual compliance. In contrast, regional networks seemingly fail to hold individual landowners accountable. But regional networks can effectively monitor large-scale impacts and water quality trends; and thus inform regulatory programs that enforce management practices tied to nonpoint source pollution. Regional monitoring networks for compliance purposes can face significant challenges in the implementation due to a regulatory and legal landscape that is exclusively structured to address point sources and individual liability, and due to the non-intensive nature of a regional monitoring program (lack of control of hot spots; lack of accountability of individual landowners).

[Surgical treatment of secondary peritonitis: A continuing problem. German version].

PubMed

van Ruler, O; Boermeester, M A

2016-01-01

Secondary peritonitis remains associated with high mortality and morbidity rates. Treatment of secondary peritonitis is still challenging even in the era of modern medicine. Surgical intervention for source control remains the cornerstone of treatment besides adequate antimicrobial therapy and when necessary intensive medical care measures and resuscitation. A randomized clinical trial showed that relaparotomy on demand (ROD) after initial emergency surgery was the preferred treatment strategy, irrespective of the severity and extent of peritonitis. The effective and safe use of ROD requires intensive monitoring of the patient in a setting where diagnostic tests and decision making about relaparotomy are guaranteed round the clock. The lack of knowledge on timely and adequate patient selection, together with the lack of use of easy but reliable monitoring tools seem to hamper full implementation of ROD. The accuracy of the relaparotomy decision tool is reasonable for prediction of the formation of peritonitis and necessary selection of patients for computed tomography (CT). The value of CT in the early postoperative phase is unclear. Future research and innovative technologies should focus on the additive value of CT after surgical treatment for secondary peritonitis and on the further optimization of bedside prediction tools to enhance adequate patient selection for interventions in a multidisciplinary setting.

Traceability in Patient Healthcare through the Integration of RFID Technology in an ICU in a Hospital.

PubMed

Martínez Pérez, María; Dafonte, Carlos; Gómez, Ángel

2018-05-19

Patient safety is a principal concern for health professionals in the care process and it is, therefore, necessary to provide information management systems to each unit of the hospital, capable of tracking patients and medication to reduce the occurrence of adverse events and therefore increase the quality of care received by patients during their stay in hospital. This work presents a tool for the Intensive Care Unit (ICU), a key service with special characteristics, which computerises and tracks admissions, care plans, vital monitoring, the prescription and medication administration process for patients in this service. To achieve this, it is essential that innovative and cutting-edge technologies are implemented such as Near Field Communication (NFC) technology which is now being implemented in diverse environments bringing a range of benefits to the tasks for which it is employed.

Community-based measles mortality surveillance in two districts of Katanga Province, Democratic Republic of Congo.

PubMed

N'goran, Alexandra A; Ilunga, Ngoie; Coldiron, Matthew E; Grais, Rebecca F; Porten, Klaudia

2013-12-17

Mortality due to measles is often under-reported. Traditional methods of measuring mortality can be time and resource-intensive. We describe the implementation of a community-based method to monitor measles mortality. Using standardized questionnaires in the midst of a measles outbreak, a community-based network of volunteers recorded a much larger number of deaths (376) than deaths recorded in health centres (27). Deaths were predominantly (93.5%) among children aged less than 5 years; 54.5% of measles deaths reported antecedent measles vaccination. In this setting, the number of deaths due to measles reported in community-based surveillance was much higher than deaths reported in health centres. Lack of reliable population data and incomplete coverage of the surveillance system make it impossible to calculate overall attack rates and cause-specific mortality rates. Similar systems could be rapidly implemented in other difficult outbreak settings.

Implementing liquid biopsies into clinical decision making for cancer immunotherapy

PubMed Central

Quandt, Dagmar; Zucht, Hans Dieter; Amann, Arno; Wulf-Goldenberg, Anne; Borrebaeck, Carl; Cannarile, Michael; Lambrechts, Diether; Oberacher, Herbert; Garrett, James; Nayak, Tapan; Kazinski, Michael; Massie, Charles; Schwarzenbach, Heidi; Maio, Michele; Prins, Robert; Wendik, Björn; Hockett, Richard; Enderle, Daniel; Noerholm, Mikkel; Hendriks, Hans; Zwierzina, Heinz; Seliger, Barbara

2017-01-01

During the last decade, novel immunotherapeutic strategies, in particular antibodies directed against immune checkpoint inhibitors, have revolutionized the treatment of different malignancies leading to an improved survival of patients. Identification of immune-related biomarkers for diagnosis, prognosis, monitoring of immune responses and selection of patients for specific cancer immunotherapies is urgently required and therefore areas of intensive research. Easily accessible samples in particular liquid biopsies (body fluids), such as blood, saliva or urine, are preferred for serial tumor biopsies. Although monitoring of immune and tumor responses prior, during and post immunotherapy has led to significant advances of patients’ outcome, valid and stable prognostic biomarkers are still missing. This might be due to the limited capacity of the technologies employed, reproducibility of results as well as assay stability and validation of results. Therefore solid approaches to assess immune regulation and modulation as well as to follow up the nature of the tumor in liquid biopsies are urgently required to discover valuable and relevant biomarkers including sample preparation, timing of the collection and the type of liquid samples. This article summarizes our knowledge of the well-known liquid material in a new context as liquid biopsy and focuses on collection and assay requirements for the analysis and the technical developments that allow the implementation of different high-throughput assays to detect alterations at the genetic and immunologic level, which could be used for monitoring treatment efficiency, acquired therapy resistance mechanisms and the prognostic value of the liquid biopsies. PMID:28501851

Implementing liquid biopsies into clinical decision making for cancer immunotherapy.

PubMed

Quandt, Dagmar; Dieter Zucht, Hans; Amann, Arno; Wulf-Goldenberg, Anne; Borrebaeck, Carl; Cannarile, Michael; Lambrechts, Diether; Oberacher, Herbert; Garrett, James; Nayak, Tapan; Kazinski, Michael; Massie, Charles; Schwarzenbach, Heidi; Maio, Michele; Prins, Robert; Wendik, Björn; Hockett, Richard; Enderle, Daniel; Noerholm, Mikkel; Hendriks, Hans; Zwierzina, Heinz; Seliger, Barbara

2017-07-18

During the last decade, novel immunotherapeutic strategies, in particular antibodies directed against immune checkpoint inhibitors, have revolutionized the treatment of different malignancies leading to an improved survival of patients. Identification of immune-related biomarkers for diagnosis, prognosis, monitoring of immune responses and selection of patients for specific cancer immunotherapies is urgently required and therefore areas of intensive research. Easily accessible samples in particular liquid biopsies (body fluids), such as blood, saliva or urine, are preferred for serial tumor biopsies.Although monitoring of immune and tumor responses prior, during and post immunotherapy has led to significant advances of patients' outcome, valid and stable prognostic biomarkers are still missing. This might be due to the limited capacity of the technologies employed, reproducibility of results as well as assay stability and validation of results. Therefore solid approaches to assess immune regulation and modulation as well as to follow up the nature of the tumor in liquid biopsies are urgently required to discover valuable and relevant biomarkers including sample preparation, timing of the collection and the type of liquid samples. This article summarizes our knowledge of the well-known liquid material in a new context as liquid biopsy and focuses on collection and assay requirements for the analysis and the technical developments that allow the implementation of different high-throughput assays to detect alterations at the genetic and immunologic level, which could be used for monitoring treatment efficiency, acquired therapy resistance mechanisms and the prognostic value of the liquid biopsies.

How do working-memory-related demand, reasoning ability and aversive reinforcement modulate conflict monitoring?

PubMed Central

Leue, Anja; Weber, Bernd; Beauducel, André

2014-01-01

Conflict monitoring is a process of stimulus evaluation and a pre-requisite for subsequent recruitment of cognitive control and behavioral adaptations. This study investigated how experimentally manipulated working-memory-related cognitive demand and aversive reinforcement modulate individual differences of conflict monitoring intensity and behavioral adjustments. Individual differences were assessed by means of an anxiety-related trait dimension (trait-BIS) and by means of reasoning abilities—a core determinant of intelligence. Moreover, we investigated the special role of verbal reasoning ability and figural reasoning ability for the modulation of the conflict monitoring intensity. Ninety participants performed a go/nogo task with four conditions each comprising a combination of low vs. high working-memory-related cognitive demand and low vs. high aversive reinforcement. No effect of aversive reinforcement was observed for the N2 amplitude. The fronto-central nogo N2 amplitude was more pronounced for high demand vs. low demand suggesting that cognitive demand served as an aversive costly event. Higher total reasoning abilities were associated with more intense conflict monitoring and shorter response times with increasing aversive reinforcement (defined as verbal error-feedback vs. monetary loss). Individuals with higher trait-BIS scores demonstrated a more intense conflict monitoring even in conditions with low aversive reinforcement and also a more cautious responding (i.e., response times slowing) with increasing aversive reinforcement indicating a focus on negative feedback prevention. The findings provide evidence for the conflict monitoring theory and suggest that working-memory-related demand overrules the impact of aversive reinforcement on conflict monitoring intensity. Reasoning abilities and anxiety-related traits go along with an intensification of conflict monitoring but differences in the flexibility of behavioral adjustment. PMID:24782739

Empowering Teachers with Low-Intensity Strategies to Support Instruction: Self-Monitoring in an Elementary Resource Classroom

ERIC Educational Resources Information Center

Ennis, Robin Parks; Lane, Kathleen Lynne; Oakes, Wendy Peia

2018-01-01

Self-monitoring is a low-intensity strategy teachers can use to support instruction in classrooms across the grade span in various instructional settings and content areas. This study extended the knowledge base by examining the effectiveness of self-monitoring through a systematic replication with three students with specific learning…

Optical chaos and hybrid WDM/TDM based large capacity quasi-distributed sensing network with real-time fiber fault monitoring.

PubMed

Luo, Yiyang; Xia, Li; Xu, Zhilin; Yu, Can; Sun, Qizhen; Li, Wei; Huang, Di; Liu, Deming

2015-02-09

An optical chaos and hybrid wavelength division multiplexing/time division multiplexing (WDM/TDM) based large capacity quasi-distributed sensing network with real-time fiber fault monitoring is proposed. Chirped fiber Bragg grating (CFBG) intensity demodulation is adopted to improve the dynamic range of the measurements. Compared with the traditional sensing interrogation methods in time, radio frequency and optical wavelength domains, the measurand sensing and the precise locating of the proposed sensing network can be simultaneously interrogated by the relative amplitude change (RAC) and the time delay of the correlation peak in the cross-correlation spectrum. Assisted with the WDM/TDM technology, hundreds of sensing units could be potentially multiplexed in the multiple sensing fiber lines. Based on the proof-of-concept experiment for axial strain measurement with three sensing fiber lines, the strain sensitivity up to 0.14% RAC/με and the precise locating of the sensors are achieved. Significantly, real-time fiber fault monitoring in the three sensing fiber lines is also implemented with a spatial resolution of 2.8 cm.

Ambient intelligence for monitoring and research in clinical neurophysiology and medicine: the MIMERICA* project and prototype.

PubMed

Pignolo, L; Riganello, F; Dolce, G; Sannita, W G

2013-04-01

Ambient Intelligence (AmI) provides extended but unobtrusive sensing and computing devices and ubiquitous networking for human/environment interaction. It is a new paradigm in information technology compliant with the international Integrating Healthcare Enterprise board (IHE) and eHealth HL7 technological standards in the functional integration of biomedical domotics and informatics in hospital and home care. AmI allows real-time automatic recording of biological/medical information and environmental data. It is extensively applicable to patient monitoring, medicine and neuroscience research, which require large biomedical data sets; for example, in the study of spontaneous or condition-dependent variability or chronobiology. In this respect, AML is equivalent to a traditional laboratory for data collection and processing, with minimal dedicated equipment, staff, and costs; it benefits from the integration of artificial intelligence technology with traditional/innovative sensors to monitor clinical or functional parameters. A prototype AmI platform (MIMERICA*) has been implemented and is operated in a semi-intensive unit for the vegetative and minimally conscious states, to investigate the spontaneous or environment-related fluctuations of physiological parameters in these conditions.

A new and highly selective turn-on fluorescent sensor with fast response time for the monitoring of cadmium ions in cosmetic, and health product samples

NASA Astrophysics Data System (ADS)

Khani, Rouhollah; Ghiamati, Ebrahim; Boroujerdi, Ramin; Rezaeifard, Abdolreza; Zaryabi, Mohadeseh Hosseinpour

2016-06-01

Cadmium (Cd) which is an extremely toxic could be found in many products like plastics, fossil fuel combustion, cosmetics, water resources, and wastewaters. It is capable of causing serious environmental and health problems such as lung, prostate, renal cancers and the other disorders. So, the development of a sensor to continually monitor cadmium is considerably demanding. Tetrakis(4-nitrophenyl)porphyrin, T(4-NO2-P)P, was synthesized and used as a new and highly selective fluorescent probe for monitoring cadmium ions in the "turn-on" mode. There was a linear relationship between fluorescence intensity and the concentration of Cd(II) in the range of 1.0 × 10- 6 to 1.0 × 10- 5 mol L- 1 with a detection limit of 0.276 μM. To examine the most important parameters involved and their interactions in the sensor optimization procedure, a four-factor central composite design (CCD) combined with response surface modeling (RSM) was implemented. The practical applicability of the developed sensor was investigated using real cosmetic, and personal care samples.

A Self-Referenced Optical Intensity Sensor Network Using POFBGs for Biomedical Applications

PubMed Central

Moraleda, Alberto Tapetado; Montero, David Sánchez; Webb, David J.; García, Carmen Vázquez

2014-01-01

This work bridges the gap between the remote interrogation of multiple optical sensors and the advantages of using inherently biocompatible low-cost polymer optical fiber (POF)-based photonic sensing. A novel hybrid sensor network combining both silica fiber Bragg gratings (FBG) and polymer FBGs (POFBG) is analyzed. The topology is compatible with WDM networks so multiple remote sensors can be addressed providing high scalability. A central monitoring unit with virtual data processing is implemented, which could be remotely located up to units of km away. The feasibility of the proposed solution for potential medical environments and biomedical applications is shown. PMID:25615736

A self-referenced optical intensity sensor network using POFBGs for biomedical applications.

PubMed

Tapetado Moraleda, Alberto; Sánchez Montero, David; Webb, David J; Vázquez García, Carmen

2014-12-12

This work bridges the gap between the remote interrogation of multiple optical sensors and the advantages of using inherently biocompatible low-cost polymer optical fiber (POF)-based photonic sensing. A novel hybrid sensor network combining both silica fiber Bragg gratings (FBG) and polymer FBGs (POFBG) is analyzed. The topology is compatible with WDM networks so multiple remote sensors can be addressed providing high scalability. A central monitoring unit with virtual data processing is implemented, which could be remotely located up to units of km away. The feasibility of the proposed solution for potential medical environments and biomedical applications is shown.

Program Helps Generate And Manage Graphics

NASA Technical Reports Server (NTRS)

Truong, L. V.

1994-01-01

Living Color Frame Maker (LCFM) computer program generates computer-graphics frames. Graphical frames saved as text files, in readable and disclosed format, easily retrieved and manipulated by user programs for wide range of real-time visual information applications. LCFM implemented in frame-based expert system for visual aids in management of systems. Monitoring, diagnosis, and/or control, diagrams of circuits or systems brought to "life" by use of designated video colors and intensities to symbolize status of hardware components (via real-time feedback from sensors). Status of systems can be displayed. Written in C++ using Borland C++ 2.0 compiler for IBM PC-series computers and compatible computers running MS-DOS.

University students' cognitive performance under temperature cycles induced by direct load control events.

PubMed

Zhang, F; de Dear, R

2017-01-01

As one of the most common strategies for managing peak electricity demand, direct load control (DLC) of air-conditioners involves cycling the compressors on and off at predetermined intervals. In university lecture theaters, the implementation of DLC induces temperature cycles which might compromise university students' learning performance. In these experiments, university students' learning performance, represented by four cognitive skills of memory, concentration, reasoning, and planning, was closely monitored under DLC-induced temperature cycles and control conditions simulated in a climate chamber. In Experiment 1 with a cooling set point temperature of 22°C, subjects' cognitive performance was relatively stable or even slightly promoted by the mild heat intensity and short heat exposure resulting from temperature cycles; in Experiment 2 with a cooling set point of 24°C, subjects' reasoning and planning performance observed a trend of decline at the higher heat intensity and longer heat exposure. Results confirm that simpler cognitive tasks are less susceptible to temperature effects than more complex tasks; the effect of thermal variations on cognitive performance follows an extended-U relationship with performance being relatively stable across a range of temperatures. DLC appears to be feasible in university lecture theaters if DLC algorithms are implemented judiciously. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

An adaptive environmental effects monitoring framework for assessing the influences of liquid effluents on benthos, water and sediments in aquatic receiving environments.

PubMed

Somers, Keith M; Kilgour, Bruce W; Munkittrick, Kelly R; Arciszewski, Tim J

2018-05-16

Environmental effects monitoring (EEM) has been traditionally used to evaluate the effects of existing facilities discharging liquid effluents into natural receiving waters in Canada. EEM also has the potential to provide feedback to an ongoing project in an adaptive management context, and can inform the design of future projects. EEM, consequently, can and should also be used to test the predictions of effects related to new projects. Despite EEM's potential for widespread applicability, challenges related to the effective implementation of EEM include the use of appropriate study designs, as well as to the adoption of tiers for increasing or decreasing monitoring intensity. Herein we describe a template for designing and implementing a six-tiered EEM program that utilizes information from the project-planning and pre-development baseline data collection stages to build on forecasts from the initial environmental impact assessment project-design stage, and feeds into an adaptive management process. Movement between the six EEM tiers is based on the exceedance of Baseline Monitoring Triggers, Forecast Triggers and Management Triggers at various stages in the EEM process. To distinguish these types of triggers, we review the historical development of numeric and narrative triggers as applied to chemical (water and sediment) and biological (plankton, benthos, fish) endpoints. We also provide an overview of historical study design issues and discuss how the six EEM tiers and associated triggers influence the temporal-spatial experimental design options and how the information gained through EEM could be used in an adaptive management context. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The cost of illness attributable to diabetic foot and cost-effectiveness of secondary prevention in Peru.

PubMed

Cárdenas, María Kathia; Mirelman, Andrew J; Galvin, Cooper J; Lazo-Porras, María; Pinto, Miguel; Miranda, J Jaime; Gilman, Robert H

2015-10-26

Diabetes mellitus is a public health challenge worldwide, and roughly 25% of patients with diabetes in developing countries will develop at least one foot ulcer during their lifetime. The gravest outcome of an ulcerated foot is amputation, leading to premature death and larger economic costs. This study aimed to estimate the economic costs of diabetic foot in high-risk patients in Peru in 2012 and to model the cost-effectiveness of a year-long preventive strategy for foot ulceration including: sub-optimal care (baseline), standard care as recommended by the International Diabetes Federation, and standard care plus daily self-monitoring of foot temperature. A decision tree model using a population prevalence-based approach was used to calculate the costs and the incremental cost-effectiveness ratio (ICER). Outcome measures were deaths and major amputations, uncertainty was tested with a one-way sensitivity analysis. The direct costs for prevention and management with sub-optimal care for high-risk diabetics is around US$74.5 million dollars in a single year, which decreases to US$71.8 million for standard care and increases to US$96.8 million for standard care plus temperature monitoring. The implementation of a standard care strategy would avert 791 deaths and is cost-saving in comparison to sub-optimal care. For standard care plus temperature monitoring compared to sub-optimal care the ICER rises to US$16,124 per death averted and averts 1,385 deaths. Diabetic foot complications are highly costly and largely preventable in Peru. The implementation of a standard care strategy would lead to net savings and avert deaths over a one-year period. More intensive prevention strategies such as incorporating temperature monitoring may also be cost-effective.

Comprehensive in-hospital monitoring in acute heart failure: applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

PubMed

Harjola, Veli-Pekka; Parissis, John; Brunner-La Rocca, Hans-Peter; Čelutkienė, Jelena; Chioncel, Ovidiu; Collins, Sean P; De Backer, Daniel; Filippatos, Gerasimos S; Gayat, Etienne; Hill, Loreena; Lainscak, Mitja; Lassus, Johan; Masip, Josep; Mebazaa, Alexandre; Miró, Òscar; Mortara, Andrea; Mueller, Christian; Mullens, Wilfried; Nieminen, Markku S; Rudiger, Alain; Ruschitzka, Frank; Seferovic, Petar M; Sionis, Alessandro; Vieillard-Baron, Antoine; Weinstein, Jean Marc; de Boer, Rudolf A; Crespo Leiro, Maria G; Piepoli, Massimo; Riley, Jillian P

2018-04-30

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure. © 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.

Fourier Transform Infrared Spectroscopy (FT-IR) and Simple Algorithm Analysis for Rapid and Non-Destructive Assessment of Developmental Cotton Fibers.

PubMed

Liu, Yongliang; Kim, Hee-Jin

2017-06-22

With cotton fiber growth or maturation, cellulose content in cotton fibers markedly increases. Traditional chemical methods have been developed to determine cellulose content, but it is time-consuming and labor-intensive, mostly owing to the slow hydrolysis process of fiber cellulose components. As one approach, the attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy technique has also been utilized to monitor cotton cellulose formation, by implementing various spectral interpretation strategies of both multivariate principal component analysis (PCA) and 1-, 2- or 3-band/-variable intensity or intensity ratios. The main objective of this study was to compare the correlations between cellulose content determined by chemical analysis and ATR FT-IR spectral indices acquired by the reported procedures, among developmental Texas Marker-1 (TM-1) and immature fiber ( im ) mutant cotton fibers. It was observed that the R value, CI IR , and the integrated intensity of the 895 cm -1 band exhibited strong and linear relationships with cellulose content. The results have demonstrated the suitability and utility of ATR FT-IR spectroscopy, combined with a simple algorithm analysis, in assessing cotton fiber cellulose content, maturity, and crystallinity in a manner which is rapid, routine, and non-destructive.

Section summary: Institutional context, drivers and detectability in REDD+ implementation

Treesearch

Patricia Manley

2013-01-01

REDD+ and Forest DegradationREDD+ implementation requires two key steps: (1) establish a reference emission level or reference level (RL); and (2) monitor performance against the reference level (RL). A monitoring system must be able to monitor the performance of implementing action plans to reduce emissions....

Implementing Intensive Intervention: Lessons Learned from the Field

ERIC Educational Resources Information Center

National Center on Intensive Intervention, 2013

2013-01-01

The National Center on Intensive Intervention (NCII) has a mission to build district and school capacity to implement intensive intervention that will improve reading, mathematics, and behavioral outcomes for students with disabilities in Grades K-12 who have severe and persistent learning and/or behavioral problems. The purpose of this document…

Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle.

PubMed

Morandi, Alessandro; Piva, Simone; Ely, E Wesley; Myatra, Sheila Nainan; Salluh, Jorge I F; Amare, Dawit; Azoulay, Elie; Bellelli, Giuseppe; Csomos, Akos; Fan, Eddy; Fagoni, Nazzareno; Girard, Timothy D; Heras La Calle, Gabriel; Inoue, Shigeaki; Lim, Chae-Man; Kaps, Rafael; Kotfis, Katarzyna; Koh, Younsuck; Misango, David; Pandharipande, Pratik P; Permpikul, Chairat; Cheng Tan, Cheng; Wang, Dong-Xin; Sharshar, Tarek; Shehabi, Yahya; Skrobik, Yoanna; Singh, Jeffrey M; Slooter, Arjen; Smith, Martin; Tsuruta, Ryosuke; Latronico, Nicola

2017-11-01

To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines. Worldwide online survey. Intensive care. A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle. There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits. The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.

Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

PubMed

Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

2018-03-20

No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

Sparse matrix beamforming and image reconstruction for real-time 2D HIFU monitoring using Harmonic Motion Imaging for Focused Ultrasound (HMIFU) with in vitro validation

PubMed Central

Hou, Gary Y.; Provost, Jean; Grondin, Julien; Wang, Shutao; Marquet, Fabrice; Bunting, Ethan; Konofagou, Elisa E.

2015-01-01

Harmonic Motion Imaging for Focused Ultrasound (HMIFU) is a recently developed High-Intensity Focused Ultrasound (HIFU) treatment monitoring method. HMIFU utilizes an Amplitude-Modulated (fAM = 25 Hz) HIFU beam to induce a localized focal oscillatory motion, which is simultaneously estimated and imaged by confocally-aligned imaging transducer. HMIFU feasibilities have been previously shown in silico, in vitro, and in vivo in 1-D or 2-D monitoring of HIFU treatment. The objective of this study is to develop and show the feasibility of a novel fast beamforming algorithm for image reconstruction using GPU-based sparse-matrix operation with real-time feedback. In this study, the algorithm was implemented onto a fully integrated, clinically relevant HMIFU system composed of a 93-element HIFU transducer (fcenter = 4.5MHz) and coaxially-aligned 64-element phased array (fcenter = 2.5MHz) for displacement excitation and motion estimation, respectively. A single transmit beam with divergent beam transmit was used while fast beamforming was implemented using a GPU-based delay-and-sum method and a sparse-matrix operation. Axial HMI displacements were then estimated from the RF signals using a 1-D normalized cross-correlation method and streamed to a graphic user interface. The present work developed and implemented a sparse matrix beamforming onto a fully-integrated, clinically relevant system, which can stream displacement images up to 15 Hz using a GPU-based processing, an increase of 100 fold in rate of streaming displacement images compared to conventional CPU-based conventional beamforming and reconstruction processing. The achieved feedback rate is also currently the fastest and only approach that does not require interrupting the HIFU treatment amongst the acoustic radiation force based HIFU imaging techniques. Results in phantom experiments showed reproducible displacement imaging, and monitoring of twenty two in vitro HIFU treatments using the new 2D system showed a consistent average focal displacement decrease of 46.7±14.6% during lesion formation. Complementary focal temperature monitoring also indicated an average rate of displacement increase and decrease with focal temperature at 0.84±1.15 %/ °C, and 2.03± 0.93%/ °C, respectively. These results reinforce the HMIFU capability of estimating and monitoring stiffness related changes in real time. Current ongoing studies include clinical translation of the presented system for monitoring of HIFU treatment for breast and pancreatic tumor applications. PMID:24960528

[A MODEL OF COMPREHENSIVE CARE FOR COMPLEX CHRONIC PATIENT. EXPERIENCE OF A TERRITORY].

PubMed

Torres, Montserrat; Fabrellas, Núria; Solà, Montserrat; Rubio Merchán, Antonia; Camañes Garcia, Neus; Berlanga, Sofía

2015-03-01

The Increase in life expectancy has brought an increase in chronic diseases. The evolution of chronic disease is the cause of several organic and systemic dysfunctions, leading to physical and mental limitations that determine the need for some aid to perform basic vital tasks. Primary health care has a key role in the monitoring of fragility, chronicity, and complexity of population. However, in order to address properly high complexity diseases it is necessary to know and coordinate the different resources existing inside the territory. THE DEVELOPMENT OF THE MODEL FOR ACTION: THE IMPLEMENTATIONS OF A FUNCTIONAL UNIT. The Primary Health Care must ensure equity, accessibility, longitudinally, and continuity of care, bearing in mind that health outcomes must be optimal. There are several health care providers in the Delta del Llobregat SAP, so it was implemented a strategic plan focused on the coordination and/or the reconciliation of all the devices involved in the assistance in order to provide comprehensive attention to the patient. The patients included in this program were to be identified as CCP (Complex chronic Patient), in an evolved and tributary phase of intensive follow-up. CONCLUSIONS. The identification ofpatients listed as CCP and at clinical risk allows a comprehensive monitoring in order to prevent exacerbations and overuse of unscheduled hospital resources.

A feasability study of color flow doppler vectorization for automated blood flow monitoring.

PubMed

Schorer, R; Badoual, A; Bastide, B; Vandebrouck, A; Licker, M; Sage, D

2017-12-01

An ongoing issue in vascular medicine is the measure of the blood flow. Catheterization remains the gold standard measurement method, although non-invasive techniques are an area of intense research. We hereby present a computational method for real-time measurement of the blood flow from color flow Doppler data, with a focus on simplicity and monitoring instead of diagnostics. We then analyze the performance of a proof-of-principle software implementation. We imagined a geometrical model geared towards blood flow computation from a color flow Doppler signal, and we developed a software implementation requiring only a standard diagnostic ultrasound device. Detection performance was evaluated by computing flow and its determinants (flow speed, vessel area, and ultrasound beam angle of incidence) on purposely designed synthetic and phantom-based arterial flow simulations. Flow was appropriately detected in all cases. Errors on synthetic images ranged from nonexistent to substantial depending on experimental conditions. Mean errors on measurements from our phantom flow simulation ranged from 1.2 to 40.2% for angle estimation, and from 3.2 to 25.3% for real-time flow estimation. This study is a proof of concept showing that accurate measurement can be done from automated color flow Doppler signal extraction, providing the industry the opportunity for further optimization using raw ultrasound data.

Absolute dose calculations for Monte Carlo simulations of radiotherapy beams.

PubMed

Popescu, I A; Shaw, C P; Zavgorodni, S F; Beckham, W A

2005-07-21

Monte Carlo (MC) simulations have traditionally been used for single field relative comparisons with experimental data or commercial treatment planning systems (TPS). However, clinical treatment plans commonly involve more than one field. Since the contribution of each field must be accurately quantified, multiple field MC simulations are only possible by employing absolute dosimetry. Therefore, we have developed a rigorous calibration method that allows the incorporation of monitor units (MU) in MC simulations. This absolute dosimetry formalism can be easily implemented by any BEAMnrc/DOSXYZnrc user, and applies to any configuration of open and blocked fields, including intensity-modulated radiation therapy (IMRT) plans. Our approach involves the relationship between the dose scored in the monitor ionization chamber of a radiotherapy linear accelerator (linac), the number of initial particles incident on the target, and the field size. We found that for a 10 x 10 cm2 field of a 6 MV photon beam, 1 MU corresponds, in our model, to 8.129 x 10(13) +/- 1.0% electrons incident on the target and a total dose of 20.87 cGy +/- 1.0% in the monitor chambers of the virtual linac. We present an extensive experimental verification of our MC results for open and intensity-modulated fields, including a dynamic 7-field IMRT plan simulated on the CT data sets of a cylindrical phantom and of a Rando anthropomorphic phantom, which were validated by measurements using ionization chambers and thermoluminescent dosimeters (TLD). Our simulation results are in excellent agreement with experiment, with percentage differences of less than 2%, in general, demonstrating the accuracy of our Monte Carlo absolute dose calculations.

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

Southworth, G.R.; Loar, J.M.; Ryon, M.G.

Ecological studies of the Bear Creek watershed, which drains the area surrounding several Oak Ridge Y-12 Plant waste disposal facilities, were initiated in May 1984 and are continuing at present. These studies consisted of an initial, detailed characterization of the benthic invertebrate and fish communities in Bear Creek, and they were followed by a presently ongoing monitoring phase that involves reduced sampling intensities. The characterization phase utilized two approaches: (1) instream sampling of benthic invertebrate and fish communities in Bear Creek to identify spatial and temporal patterns in distribution and abundance and (2) laboratory bioassays on water samples from Bearmore » Creek and selected tributaries to identify potential sources of toxicity to biota. The monitoring phase of the ecological program relates to the long-term goals of identifying and prioritizing contaminant sources and assessing the effectiveness of remedial actions. It continues activities of the characterization phase at less frequent intervals. The Bear Greek Valley is a watershed that drains the area surrounding several closed Oak Ridge Y-12 Plant waste disposal facilities. Past waste disposal practices in Bear Creek Valley resulted in contamination of Bear Creek and consequent ecological damage. Extensive remedial actions have been proposed at waste sites, and some of the have been implemented or are now underway. The proposed study plan consists of an initial, detailed characterization of the benthic invertebrate and fish communities in Bear Creek in the first year followed by a reduction in sampling intensity during the monitoring phase of the plan. The results of sampling conducted from May 1984 through early 1989 are presented in this report.« less

[A contribution safety on using low molecular weight heparin in patients with renal failure].

PubMed

Gea Rodríguez, E; Barral Viñals, N; Manso Mardones, P; Indo Berges, O

2004-01-01

1. To promote safe and appropriate use of low molecular weight heparins in patients with renal failure. 2. To analyze results from a pharmaceutical intervention program. Data from a prospective, 16-month study are presented. The entire adult population of a general hospital with 41,792 stays/year is included. An intensive monitoring program for low molecular weight heparin prescriptions in patients with renal failure is implemented. This program identifies patients using a computerized unit dose system, and is aided by a software able to calculate creatinine clearance using the Cockroft-Gault formula from an interphase between laboratory, pharmacy and admissions data, and by an algorithm to establish a recommended pharmaceutical intervention according to renal failure severity and low molecular weight heparin indication, either with prophylactic or therapeutic purposes. In all, 221 patients were identified, corresponding to 2.9% of admitted patients and 25.5% of patients with renal failure. Answers were assessable for 128 patients (61%). Extent of program acceptance according to physician-accepted pharmaceutical interventions was proportional to renal failure severity and therapy intensiveness. An acceptance of 70% was obtained for treatments with clearance < 30 mL/min, of 41.8% for treatments with 30-60 mL/min, of 31.5% for prophylaxis, and of 21.4% for low-risk patients. 1. Program repercussions improve prescription safety. 2. Scarce literature and a belief in low molecular weight heparin safety account for responses regarding pharmaceutical intervention. 3. Integrated computerized systems are essential for the implementation of intensive pharmaceutical care programs.

Impact of Video Self-Monitoring with Graduated Training on Implementation of Embedded Instructional Learning Trials

ERIC Educational Resources Information Center

Bishop, Crystal D.; Snyder, Patricia A.; Crow, Robert E.

2015-01-01

We used a multi-component single-subject experimental design across three preschool teachers to examine the effects of video self-monitoring with graduated training and feedback on the accuracy with which teachers monitored their implementation of embedded instructional learning trials. We also examined changes in teachers' implementation of…

Remote monitoring technologies for the prevention of metabolic syndrome: the Diabetes and Technology for Increased Activity (DaTA) study.

PubMed

Stuckey, Melanie; Fulkerson, Robyn; Read, Emily; Russell-Minda, Elizabeth; Munoz, Claudio; Kleinstiver, Peter; Petrella, Robert

2011-07-01

Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting. © 2011 Diabetes Technology Society.

Remote Monitoring Technologies for the Prevention of Metabolic Syndrome: The Diabetes and Technology for Increased Activity (DaTA) Study

PubMed Central

Stuckey, Melanie; Fulkerson, Robyn; Read, Emily; Russell-Minda, Elizabeth; Munoz, Claudio; Kleinstiver, Peter; Petrella, Robert

2011-01-01

Objectives Remote monitoring technologies are ideally suited for rural communities with limited access to health care. In an 8-week pilot study, we examined the feasibility of implementing and conducting a technology-intensive intervention in an underserviced rural setting. Our goal was to test the utility of self-monitoring technologies, physical activity, and education as tools to manage health indicators for the development of the cardiovascular complications (CVCs) of type 2 diabetes. Research Design and Methods The Diabetes and Technology for Increased Activity study was an open single-center study conducted in a community-based research setting. All 24 participants were provided with a Blackberry™ Smartphone, blood pressure monitor, glucometer, and pedometer. Smartphones transmitted measurements and survey results to the database, interfaced participants with the clinical team, and allowed for self-monitoring. Results Outcomes were improved body composition, improved markers of CVC risk factors, increased daily exercise, and interest in or awareness of lifestyle changes that impact health outcomes. Participants had excellent compliance for measurements, as self-monitoring provided a sense of security that improved from week 4 to week 8. Conclusions Our team gained substantial insight into the operational requirements of technology-facilitated health care, including redefined hours of service; data reporting, management, and access protocols; and the utility of real-time clinical measures by remote monitoring. We developed an understanding of knowledge translation strategies as well as successful motivational and educational tools. Importantly, remote monitoring technology was found to be feasible and accepted in a rural setting. PMID:21880237

Cost efficiency and reimbursement of remote monitoring: a US perspective.

PubMed

Slotwiner, David; Wilkoff, Bruce

2013-06-01

Demographic and technological changes are driving increased utilization of cardiac implantable electronic devices (CIEDs) remote monitoring. In the USA, fee-for-service model of healthcare delivery, services rendered are valued based upon time, intensity, and technical or practice expense costs. As a consequence of this perspective, and to contain spending, Medicare has grouped physician services into families. Spending within each family of services must, by law, remain budget neutral. Cardiac implantable electronic devices monitoring services, remote and in-person, are grouped into one family. As the volume of services within this family increases, the individual encounters are destined to be discounted into ever decreasing portions. However, if the value of remote monitoring is demonstrated to extend beyond the previous boundaries of in-person interrogations, a rational request can be made to reconsider the relative value of remote monitoring. Outcome data supporting the value-added benefits of remote monitoring are rapidly accumulating, including (i) patient convenience, with reduced use of office services, (ii) equal safety compared with in-person evaluation, (iii) shorter detection time to actionable events (arrhythmias, cardiovascular disease progression, and device malfunction), (iv) reduced length of stay for hospitalizations, (v) reduced inappropriate shocks, (vi) increased battery longevity, and (vii) a relative reduction in the risk of death. Fully automatic wireless technology, only recently widely implemented, will add considerable clinical efficiencies and further increase the value of remote monitoring. The U.S. challenge will be to appropriately define the relative value of CIEDs remote monitoring now that outcome data have demonstrated its value extends beyond in-person interrogation.

Safety and Effectiveness of Highly Active Antiretroviral Therapy in Treatment-Naïve HIV Patients: Preliminary Findings of a Cohort Event Monitoring Study in Belarus.

PubMed

Setkina, Svetlana; Dotsenko, Marina; Bondar, Sviatlana; Charnysh, Iryna; Kuchko, Alla; Kaznacheeva, Alena; Kozorez, Elena; Dodaleva, Alena; Rossa, Natalia

2015-04-01

Antiretroviral drugs have well-documented evidence-based favorable benefit-risk ratios. Although various studies have investigated and characterized the safety profile of antiretroviral medicines, there are a limited number of studies evaluating the safety of first-line antiretroviral therapy (ART) in patients with a specific co-morbidity. A cohort event monitoring (CEM) study of the safety and effectiveness of antiretroviral medicines in a target population that has a significant level of co-morbidities (chronic infectious diseases, peripheral blood cytopenias) was implemented. The aim was to evaluate the safety profile of the highly active ART (HAART) in the target population and subpopulations with risk factors, to optimize the monitoring and decision-making procedure for subgroups of patients with specific types of co-morbidity, and to implement a more vigilant approach to therapy management in risk groups of patients. Prospective observational CEM was implemented among HAART-naïve HIV-positive patients at four clinical sites from December 2012. Eligible patients were those starting first-line HAART. Close medical supervision of all enrolled patients, with regular clinical and laboratory monitoring, was provided by healthcare professionals within 1 year after commencement of therapy. Standardized forms were used for data collection on initial and subsequent visits. All objective or subjective deviations in condition (events) were assessed for a causal relationship with ART, and for severity, seriousness, reversibility, preventability, and pre-existing risk factors in the case of adverse drug reactions (ADRs). A total of 518 HAART-naïve HIV-positive patients were enrolled in the CEM study. Of these patients, 65% (337) experienced one or several ADRs related to one or more components of HAART. Most of the ADRs reported were non-serious, expected, common (very common), transient (correctable), or reversible. The most common were hematotoxic, hepatotoxic, and neurotoxic adverse reactions. In several cases, some types of toxicities, associated with zidovudine, efavirenz, and nevirapine, had a high level of severity, necessitating hospitalization and drug regimen or single-agent substitution. Severe cases of hematological, hepatobiliary, and psychiatric toxicities were associated with pre-existing risk factors. CEM is an effective tool for safety and effectiveness monitoring and could be successfully implemented for intensive study of important safety issues and for overcoming knowledge gaps regarding safety. In order to achieve a favorable benefit-risk ratio for HAART in the specific sections of the population with pre-existing risk factors for development of ART toxicities, more vigilant consideration and careful assessment before therapy is commenced and further regular monitoring of key laboratory parameters is required.

Improving IMRT delivery efficiency using intensity limits during inverse planning.

PubMed

Coselmon, Martha M; Moran, Jean M; Radawski, Jeffrey D; Fraass, Benedick A

2005-05-01

Inverse planned intensity modulated radiotherapy (IMRT) fields can be highly modulated due to the large number of degrees of freedom involved in the inverse planning process. Additional modulation typically results in a more optimal plan, although the clinical rewards may be small or offset by additional delivery complexity and/or increased dose from transmission and leakage. Increasing modulation decreases delivery efficiency, and may lead to plans that are more sensitive to geometrical uncertainties. The purpose of this work is to assess the use of maximum intensity limits in inverse IMRT planning as a simple way to increase delivery efficiency without significantly affecting plan quality. Nine clinical cases (three each for brain, prostate, and head/neck) were used to evaluate advantages and disadvantages of limiting maximum intensity to increase delivery efficiency. IMRT plans were generated using in-house protocol-based constraints and objectives for the brain and head/neck, and RTOG 9406 dose volume objectives in the prostate. Each case was optimized at a series of maximum intensity ratios (the product of the maximum intensity and the number of beams divided by the prescribed dose to the target volume), and evaluated in terms of clinical metrics, dose-volume histograms, monitor units (MU) required per fraction (SMLC and DMLC delivery), and intensity map variation (a measure of the beam modulation). In each site tested, it was possible to reduce total monitor units by constraining the maximum allowed intensity without compromising the clinical acceptability of the plan. Monitor unit reductions up to 38% were observed for SMLC delivery, while reductions up to 29% were achieved for DMLC delivery. In general, complicated geometries saw a smaller reduction in monitor units for both delivery types, although DMLC delivery required significantly more monitor units in all cases. Constraining the maximum intensity in an inverse IMRT plan is a simple way to improve delivery efficiency without compromising plan objectives.

Modular mechatronic system for stationary bicycles interfaced with virtual environment for rehabilitation.

PubMed

Ranky, Richard G; Sivak, Mark L; Lewis, Jeffrey A; Gade, Venkata K; Deutsch, Judith E; Mavroidis, Constantinos

2014-06-05

Cycling has been used in the rehabilitation of individuals with both chronic and post-surgical conditions. Among the challenges with implementing bicycling for rehabilitation is the recruitment of both extremities, in particular when one is weaker or less coordinated. Feedback embedded in virtual reality (VR) augmented cycling may serve to address the requirement for efficacious cycling; specifically recruitment of both extremities and exercising at a high intensity. In this paper a mechatronic rehabilitation bicycling system with an interactive virtual environment, called Virtual Reality Augmented Cycling Kit (VRACK), is presented. Novel hardware components embedded with sensors were implemented on a stationary exercise bicycle to monitor physiological and biomechanical parameters of participants while immersing them in an augmented reality simulation providing the user with visual, auditory and haptic feedback. This modular and adaptable system attaches to commercially-available stationary bicycle systems and interfaces with a personal computer for simulation and data acquisition processes. The complete bicycle system includes: a) handle bars based on hydraulic pressure sensors; b) pedals that monitor pedal kinematics with an inertial measurement unit (IMU) and forces on the pedals while providing vibratory feedback; c) off the shelf electronics to monitor heart rate and d) customized software for rehabilitation. Bench testing for the handle and pedal systems is presented for calibration of the sensors detecting force and angle. The modular mechatronic kit for exercise bicycles was tested in bench testing and human tests. Bench tests performed on the sensorized handle bars and the instrumented pedals validated the measurement accuracy of these components. Rider tests with the VRACK system focused on the pedal system and successfully monitored kinetic and kinematic parameters of the rider's lower extremities. The VRACK system, a virtual reality mechatronic bicycle rehabilitation modular system was designed to convert most bicycles in virtual reality (VR) cycles. Preliminary testing of the augmented reality bicycle system was successful in demonstrating that a modular mechatronic kit can monitor and record kinetic and kinematic parameters of several riders.

Environmental Monitoring using Measurements from Cellular Network Infrastructure

NASA Astrophysics Data System (ADS)

David, N.; Gao, O. H.

2015-12-01

Accurate measurements of atmospheric parameters at ground level are fundamentally essential for hazard warning, meteorological forecasting and for various applications in agriculture, hydrology, transportation and more. The accuracy of existing instruments, however, is often limited as a result of technical and practical constraints. Existing technologies such as satellite systems cover large areas but may experience lack of precision at near surface level. On the other hand, ground based in-situ sensors often suffer from low spatial representativity. In addition, these conventional monitoring instruments are costly to implement and maintain. At frequencies of tens of GHz, various atmospheric hydrometeors affect microwave beams, causing perturbations to radio signals. Consequently, commercial wireless links that constitute the infrastructure for data transport between cellular base stations can be considered as a built in environmental monitoring facility (Messer et al., Science, 2006). These microwave links are widely deployed worldwide at surface level altitudes and can provide measurements of various atmospheric phenomena. The implementation costs are minimal since the infrastructure is already situated in the field. This technique has been shown to be applicable for 2D rainfall monitoring (e.g. Overeem et al., PNAS, 2013; Liberman et al., AMT, 2014) and potentially for water vapor observations (David et al., ACP, 2009; Chwala et al., Atmos. Res., 2013). Moreover, it has been recently shown that the technology has strong potential for detection of fog and estimation of its intensity (David et al., JGR-Atmos., 2013; David et al., BAMS, 2014). The research conducted to this point forms the basis for the initiation of a research project in this newly emerging field at the School of Civil and Environmental Engineering of Cornell University. The presentation will provide insights into key capabilities of the novel approach. The potential to monitor various atmospheric phenomena using current and future planned frequencies of cellular network infrastructure will be introduced.

Development and implementation of a performance improvement project in adult intensive care units: overview of the Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study.

PubMed

Mangino, Julie E; Peyrani, Paula; Ford, Kimbal D; Kett, Daniel H; Zervos, Marcus J; Welch, Verna L; Scerpella, Ernesto G; Ramirez, Julio A

2011-01-01

In 2005 the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) published guidelines for managing hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and healthcare-associated pneumonia (HCAP). Although recommendations were evidence based, collective guidelines had not been validated in clinical practice and did not provide specific tools for local implementation. We initiated a performance improvement project designated Improving Medicine Through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) at four academic centers in the United States. Our objectives were to develop and implement the project, and to assess compliance with quality indicators in adults admitted to intensive care units (ICUs) with HAP, VAP, or HCAP. The project was conducted in three phases over 18 consecutive months beginning 1 February 2006: 1) a three-month planning period for literature review to create the consensus pathway for managing nosocomial pneumonia in these ICUs, a data collection form, quality performance indicators, and internet-based repository; 2) a six-month implementation period for customizing ATS/IDSA guidelines into center-specific guidelines via educational forums; and 3) a nine-month post-implementation period for continuing education and data collection. Data from the first two phases were combined (pre-implementation period) and compared with data from the post-implementation period. We developed a consensus pathway based on ATS/IDSA guidelines and customized it at the local level to accommodate formulary and microbiologic considerations. We implemented multimodal educational activities to teach ICU staff about the guidelines and continued education throughout post-implementation. We registered 432 patients (pre- vs post-implementation, 274 vs 158). Diagnostic criteria for nosocomial pneumonia were more likely to be met during post-implementation (247/257 (96.1%) vs 150/151 (99.3%); P = 0.06). Similarly, empiric antibiotics were more likely to be compliant with ATS/IDSA guidelines during post-implementation (79/257 (30.7%) vs 66/151 (43.7%); P = 0.01), an effect that was sustained over quarterly intervals (P = 0.0008). Between-period differences in compliance with obtaining cultures and use of de-escalation were not statistically significant. Developing a multi-center performance improvement project to operationalize ATS/IDSA guidelines for HAP, VAP, and HCAP is feasible with local consensus pathway directives for implementation and with quality indicators for monitoring compliance with guidelines.

40 CFR 52.346 - Air quality monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Air quality monitoring requirements. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.346 Air quality monitoring... VIII Administrator, the State submitted a revised Air Quality Monitoring State Implementation Plan. The...

40 CFR 52.346 - Air quality monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Air quality monitoring requirements. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.346 Air quality monitoring... VIII Administrator, the State submitted a revised Air Quality Monitoring State Implementation Plan. The...

40 CFR 52.346 - Air quality monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Air quality monitoring requirements. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.346 Air quality monitoring... VIII Administrator, the State submitted a revised Air Quality Monitoring State Implementation Plan. The...

40 CFR 52.346 - Air quality monitoring requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Air quality monitoring requirements. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.346 Air quality monitoring... VIII Administrator, the State submitted a revised Air Quality Monitoring State Implementation Plan. The...

40 CFR 52.346 - Air quality monitoring requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Air quality monitoring requirements. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Colorado § 52.346 Air quality monitoring... VIII Administrator, the State submitted a revised Air Quality Monitoring State Implementation Plan. The...

Glucose control and use of continuous glucose monitoring in the intensive care unit: a critical review.

PubMed

De Block, Christophe; Manuel-y-Keenoy, Begoña; Rogiers, Peter; Jorens, Philippe; Van Gaal, Luc

2008-08-01

Stress hyperglycemia recently became a major therapeutic target in the Intensive Care Unit (ICU) since it occurs in most critically ill patients and is associated with adverse outcome, including increased mortality. Intensive insulin therapy to achieve normoglycemia may reduce mortality, morbidity and the length of ICU and in-hospital stay. However, obtaining normoglycemia requires extensive efforts from the medical staff, including frequent glucose monitoring and adjustment of insulin dose. Current insulin titration is based upon discrete glucose measurements, which may miss fast changes in glycemia and which does not give a full picture of overall glycemic control. Recent evidence suggests that continuous monitoring of glucose levels may help to signal glycemic excursions and eventually to optimize insulin titration in the ICU. In this review we will summarise monitoring and treatment strategies to achieve normoglycemia in the ICU, with special emphasis on the possible advantages of continuous glucose monitoring.

Absolute laser-intensity measurement and online monitor calibration using a calorimeter at a soft X-ray free-electron laser beamline in SACLA

NASA Astrophysics Data System (ADS)

Tanaka, Takahiro; Kato, Masahiro; Saito, Norio; Owada, Shigeki; Tono, Kensuke; Yabashi, Makina; Ishikawa, Tetsuya

2018-06-01

This paper reports measurement of the absolute intensity of free-electron laser (FEL) and calibration of online intensity monitors for a brand-new FEL beamline BL1 at SPring-8 Angstrom Compact free-electron LAser (SACLA) in Japan. To measure the absolute intensity of FEL, we used a room-temperature calorimeter originally developed for FELs in the hard X-ray range. By using the calorimeter, we calibrated online intensity monitors of BL1, gas monitors (GMs), based on the photoionization of argon gas, in the photon energy range from 25 eV to 150 eV. A good correlation between signals obtained from the calorimeter and GMs was observed in the pulse energy range from 1 μJ to 100 μJ, where the upper limit is nearly equal to the maximum pulse energy at BL1. Moreover, the calibration result of the GMs, measured in terms of the spectral responsivity, demonstrates a characteristic photon-energy dependence owing to the occurrence of the Cooper minimum in the total ionization cross-section of argon gas. These results validate the feasibility of employing the room-temperature calorimeter in the measurement of absolute intensity of FELs over the specified photon energy range.

Integrated otpical monitoring of MEMS for closed-loop control

NASA Astrophysics Data System (ADS)

Dawson, Jeremy M.; Wang, Limin; McCormick, W. B.; Rittenhouse, S. A.; Famouri, Parviz F.; Hornak, Lawrence A.

2003-01-01

Robust control and failure assessment of MEMS employed in physically demanding, mission critical applications will allow for higher degrees of quality assurance in MEMS operation. Device fault detection and closed-loop control require detailed knowledge of the operational states of MEMS over the lifetime of the device, obtained by a means decoupled from the system. Preliminary through-wafer optical monitoring research efforts have shown that through-wafer optical probing is suitable for characterizing and monitoring the behavior of MEMS, and can be implemented in an integrated optical monitoring package for continuous in-situ device monitoring. This presentation will discuss research undertaken to establish integrated optical device metrology for closed-loop control of a MUMPS fabricated lateral harmonic oscillator. Successful linear closed-loop control results using a through-wafer optical microprobe position feedback signal will be presented. A theoretical optical output field intensity study of grating structures, fabricated on the shuttle of the resonator, was performed to improve the position resolution of the optical microprobe position signal. Through-wafer microprobe signals providing a positional resolution of 2 μm using grating structures will be shown, along with initial binary Fresnel diffractive optical microelement design layout, process development, and testing results. Progress in the design, fabrication, and test of integrated optical elements for multiple microprobe signal delivery and recovery will be discussed, as well as simulation of device system model parameter changes for failure assessment.

Use of shear waves for diagnosis and ablation monitoring of prostate cancer: a feasibility study

NASA Astrophysics Data System (ADS)

Gomez, A.; Rus, G.; Saffari, N.

2016-01-01

Prostate cancer remains as a major healthcare issue. Limitations in current diagnosis and treatment monitoring techniques imply that there is still a need for improvements. The efficacy of prostate cancer diagnosis is still low, generating under and over diagnoses. High intensity focused ultrasound ablation is an emerging treatment modality, which enables the noninvasive ablation of pathogenic tissue. Clinical trials are being carried out to evaluate its longterm efficacy as a focal treatment for prostate cancer. Successful treatment of prostate cancer using non-invasive modalities is critically dependent on accurate diagnostic means and is greatly benefited by a real-time monitoring system. While magnetic resonance imaging remains the gold standard for prostate imaging, its wider implementation for prostate cancer diagnosis remains prohibitively expensive. Conventional ultrasound is currently limited to guiding biopsy. Elastography techniques are emerging as a promising real-time imaging method, as cancer nodules are usually stiffer than adjacent healthy prostatic tissue. In this paper, a new transurethral approach is proposed, using shear waves for diagnosis and ablation monitoring of prostate cancer. A finite-difference time domain model is developed for studying the feasibility of the method, and an inverse problem technique based on genetic algorithms is proposed for reconstructing the location, size and stiffness parameters of the tumour. Preliminary results indicate that the use of shear waves for diagnosis and monitoring ablation of prostate cancer is feasible.

Implementation strategies for guidelines at ICUs: a systematic review.

PubMed

Jordan, Portia; Mpasa, Ferestas; Ten Ham-Baloyi, Wilma; Bowers, Candice

2017-05-08

Purpose The purpose of this paper is to critically analyze empirical studies related to the implementation strategies for clinical practice guidelines (CPGs) in intensive care units (ICUs). Design/methodology/approach A systematic review with a narrative synthesis adapted from Popay et al.'s method for a narrative synthesis was conducted. A search using CINAHL, Google Scholar, Academic search complete, Cochrane Register for Randomized Controlled Trials, MEDLINE via PUBMED and grey literature was conducted in 2014 and updated in 2016 (August). After reading the abstracts, titles and full-text articles, 11 ( n=11) research studies met the inclusion criteria. Findings After critical appraisal, using the Joanna Briggs Critical Appraisal Tools, eight randomized controlled trials conducted in adult and neonatal ICUs using implementation strategies remained. Popay et al.'s method for narrative synthesis was adapted and used to analyze and synthesize the data and formulate concluding statements. Included studies found that multi-faceted strategies appear to be more effective than single strategies. Strategies mostly used were printed educational materials, information/ sessions, audit, feedback, use of champion leaders, educational outreach visits, and computer or internet usage. Practical training, monitoring visits and grand rounds were less used. Practical implications Findings can be used by clinicians to implement the best combination of multi-faceted implementation strategies in the ICUs in order to enhance the optimal use of CPGs. Originality/value No systematic review was previously done on the implementation strategies that should be used best for optimal CPG implementation in the ICU.

Monitoring the Implementation of IDEA: Proceedings of the National Monitoring Conference (6th, Salt Lake City, Utah, October 2002).

ERIC Educational Resources Information Center

Tschantz, Jennifer

This document presents the proceedings of the sixth National Monitoring Conference concerned with implementation of the Individuals with Disabilities Education Act. Introductory material describes the purpose and background of the document and the federal monitoring of states, including the Continuous Improvement Monitoring Process (CIMP) and…

Tracking of cell nuclei for assessment of in vitro uptake kinetics in ultrasound-mediated drug delivery using fibered confocal fluorescence microscopy.

PubMed

Derieppe, Marc; de Senneville, Baudouin Denis; Kuijf, Hugo; Moonen, Chrit; Bos, Clemens

2014-10-01

Previously, we demonstrated the feasibility to monitor ultrasound-mediated uptake of a cell-impermeable model drug in real time with fibered confocal fluorescence microscopy. Here, we present a complete post-processing methodology, which corrects for cell displacements, to improve the accuracy of pharmacokinetic parameter estimation. Nucleus detection was performed based on the radial symmetry transform algorithm. Cell tracking used an iterative closest point approach. Pharmacokinetic parameters were calculated by fitting a two-compartment model to the time-intensity curves of individual cells. Cells were tracked successfully, improving time-intensity curve accuracy and pharmacokinetic parameter estimation. With tracking, 93 % of the 370 nuclei showed a fluorescence signal variation that was well-described by a two-compartment model. In addition, parameter distributions were narrower, thus increasing precision. Dedicated image analysis was implemented and enabled studying ultrasound-mediated model drug uptake kinetics in hundreds of cells per experiment, using fiber-based confocal fluorescence microscopy.

[Hemodynamic monitoring in the critically patient. Recomendations of the Cardiological Intensive Care and CPR Working Group of the Spanish Society of Intensive Care and Coronary Units].

PubMed

Ochagavía, A; Baigorri, F; Mesquida, J; Ayuela, J M; Ferrándiz, A; García, X; Monge, M I; Mateu, L; Sabatier, C; Clau-Terré, F; Vicho, R; Zapata, L; Maynar, J; Gil, A

2014-04-01

Hemodynamic monitoring offers valuable information on cardiovascular performance in the critically ill, and has become a fundamental tool in the diagnostic approach and in the therapy guidance of those patients presenting with tissue hypoperfusion. From introduction of the pulmonary artery catheter to the latest less invasive technologies, hemodynamic monitoring has been surrounded by many questions regarding its usefulness and its ultimate impact on patient prognosis. The Cardiological Intensive Care and CPR Working Group (GTCIC-RCP) of the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) has recently impulsed the development of an updating series in hemodynamic monitoring. Now, a final series of recommendations are presented in order to analyze essential issues in hemodynamics, with the purpose of becoming a useful tool for residents and critical care practitioners involved in the daily management of critically ill patients. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

PubMed

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Rock Burst Monitoring by Integrated Microseismic and Electromagnetic Radiation Methods

NASA Astrophysics Data System (ADS)

Li, Xuelong; Wang, Enyuan; Li, Zhonghui; Liu, Zhentang; Song, Dazhao; Qiu, Liming

2016-11-01

For this study, microseismic (MS) and electromagnetic radiation (EMR) monitoring systems were installed in a coal mine to monitor rock bursts. The MS system monitors coal or rock mass ruptures in the whole mine, whereas the EMR equipment monitors the coal or rock stress in a small area. By analysing the MS energy, number of MS events, and EMR intensity with respect to rock bursts, it has been shown that the energy and number of MS events present a "quiet period" 1-3 days before the rock burst. The data also show that the EMR intensity reaches a peak before the rock burst and this EMR intensity peak generally corresponds to the MS "quiet period". There is a positive correlation between stress and EMR intensity. Buckling failure of coal or rock depends on the rheological properties and occurs after the peak stress in the high-stress concentration areas in deep mines. The MS "quiet period" before the rock burst is caused by the heterogeneity of the coal and rock structures, the transfer of high stress into internal areas, locked patches, and self-organized criticality near the stress peak. This study increases our understanding of coal and rock instability in deep mines. Combining MS and EMR to monitor rock burst could improve prediction accuracy.

Improving Teaching Effectiveness: Implementation, Appendixes D and E. The Intensive Partnerships for Effective Teaching through 2013-2014

ERIC Educational Resources Information Center

Stecher, Brian M.; Garet, Michael S.; Hamilton, Laura S.; Steiner, Elizabeth D.; Robyn, Abby; Poirier, Jeffrey; Holtzman, Deborah; Fulbeck, Eleanor S.; Chambers, Jay; de los Reyes, Iliana Brodziak

2016-01-01

This document provides the final two appendixes for "Improving Teaching Effectiveness: Implementation. The Intensive Partnerships for Effective Teaching through 2013-2014" (ED580306). Appendix D provides detailed discussions of lever implementation for each site along with the detailed coded lever tables. Appendix E summarizes the…

Web Based GIS System For Monitoring the Implementation of County Integrated Development Plan a Case Study of Nandi County, Kenya.

NASA Astrophysics Data System (ADS)

Kurui, P. K.; Mutua, F.

2016-12-01

The paper seek to propose a conceptual framework of a way of monitoring and evaluating the implementation of the projects listed in the county integrated development plan by applying the use of the geospatial technologies with the focus being developing a web based GIS system in which the public can be able to track and monitor the progress of implementation of the projects in various parts of the county , although the guidelines developed by the ministry of devolution provides for the inclusion of the implementation monitoring and evaluation framework specifying projects to be implemented during the plan period and specification of veriable indicators it does not provide mechanisms for public participation during implementation and monitoring stage. This calls for a system that the public can interact with. The web based GIS system has been developed using the free open source softwares. Development projects have been categorized into; ongoing, completed and planned It can also be shown that a web based GIS system can be used as an important tool for monitoring the implementation of the CIDP due to its easy to use nature and supported by the fact that internet is easily accessed by the majority of the public making it a powerful tool for public participation.

Ethnic Monitoring and Its Uses in Colleges.

ERIC Educational Resources Information Center

Further Education Unit, London (England).

Colleges of further education in Great Britain have been involved in three recent initiatives in the implementation of ethnic monitoring: (1) a report on ethnic monitoring in postsecondary education; (2) two management training conferences on the implementation and uses of ethnic monitoring for representatives of further, adult, and higher…

Conceptual Design for the Amphibian Research and Monitoring Initiative (ARMI)

NASA Astrophysics Data System (ADS)

Battaglin, W. A.; Langtimm, C. A.; Adams, M. J.; Gallant, A. L.; James, D. L.

2001-12-01

In 2000, the President of the United States (US) and Congress directed Department of Interior (DOI) agencies to develop a program for monitoring trends in amphibian populations on DOI lands and to conduct research into causes of declines. The U.S. Geological Survey (USGS) was given lead responsibility for planning and implementing the Amphibian Research and Monitoring Initiative (ARMI) in cooperation with the National Park Service (NPS), Fish and Wildlife Service, and Bureau of Land Management. The program objectives are to (1) establish a network for monitoring the status and distribution of amphibian species on DOI lands; (2) identify and monitor environmental conditions known to affect amphibian populations; (3) conduct research on causes of amphibian population change and malformations; and (4) provide information to resource managers, policy makers, and the public in support of amphibian conservation. The ARMI program will integrate research efforts of USGS, other Federal, and non-federal herpetologists, hydrologists, and geographers across the Nation. ARMI will conduct a small number (~20) of intensive research efforts (for example, studies linking amphibian population changes to hydrologic conditions) and a larger number (~50) of more generalized inventory and monitoring studies encompassing broader areas such as NPS units. ARMI will coordinate with and try to augment other amphibian inventory studies such as the National Amphibian Atlas and the North American Amphibian Monitoring Program. ARMI will develop and test protocols for the standardized collection of amphibian data and provide a centrally managed database designed to simplify data entry, retrieval, and analysis. ARMI pilot projects are underway at locations across the US.

A process evaluation of a return-to-work intervention to improve Cooperation between Sick-listed employees and their Supervisors (COSS).

PubMed

Hoefsmit, Nicole; Boumans, Nicolle; Houkes, Inge; Nijhuis, Frans

2016-11-22

This is a process evaluation of an intervention to improve Cooperation regarding return-to-work (RTW) between sick-listed employees and their supervisors (COSS, which consists of a conversation roadmap, monitoring of cooperation using questionnaires and, if necessary, extra support by an occupational physician (OP). Objectives were to study (1) the adoption of COSS by a banking organization and (2) its implementation among individual employees, supervisors and OPs. We used quantitative data (online questionnaire, project administration, conversation minutes, emails) and qualitative data (semi-structured interviews). We analyzed quantitative data descriptively (by calculating sum scores, percentages, mean scores and standard deviations). The coding system to analyze the qualitative data was data-driven. The organization's representatives reported positively (e.g. fit with existing policy) and negatively (e.g. high intensity) about COSS. At least one OP (out of five) used the monitoring information. Project administration data show a modest reach of COSS among employees and supervisors. The roadmap was used by a minority (35% of the employees and 25% of the supervisors). Relatively many (40% of the employees and 100% of the supervisors who used COSS to evaluate conversations) were satisfied with COSS as a  tool to evaluate conversations with the employee/supervisor afterwards. Interview results indicate that the roadmap was considered useful in specific situations (e.g. psychological complaints). All employees and supervisors participated in the monitoring. The majority of the responding employees and supervisors received OP support and was satisfied about this support. Despite the good adoption of COSS by the organisation, it was only partially implemented by professionals, employees and supervisors. We hypothesize that our implementation approach did not fit completely with the culture at the bank. Also, the results illustrate the need for other intervention methods for improving cooperation between employees and supervisors and a more specific target population.

Impact of extended monitoring-guided intensive care on outcome after severe traumatic brain injury: A prospective multicentre cohort study (PariS-TBI study).

PubMed

Mateo, Joaquim; Payen, Didier; Ghout, Idir; Vallée, Fabrice; Lescot, Thomas; Welschbillig, Stephane; Tazarourte, Karim; Azouvi, Philippe; Weiss, Jean-Jacques; Aegerter, Philippe; Vigué, Bernard

2017-01-01

We evaluated whether an integrated monitoring with systemic and specific monitoring affect mortality and disability in adults with severe traumatic brain injury (sTBI). Adults with severeTBI (Glasgow Coma Scale [GCS] ≤ 8) admitted alive in intensive care units (ICUs) were prospectively included. Primary endpoints were in-hospital 30-day mortality and extended Glasgow outcome score (GOSE) at 3 years. Association with the intensity of monitoring and outcome was studied by comparing a high level of monitoring (HLM) (systemic and ≥3 specific monitoring) and low level of monitoring (LLM) (systemic and 0-2 specific monitoring) and using inverse probability weighting procedure. 476 patients were included and IPW was used to improve the balance between the two groups of treatments (HLM/LMM). Overall hospital mortality (at 30 days) was 43%, being significantly lower in HLM than LLM group (27% vs. 53%: RR, 1.63: 95% CI: 1.23-2.15). The 14-day hospital mortality was also lower in the HLM group than expected, based upon the CRASH prediction model (35%). At 3 years, disability was not significantly different between the monitoring groups. After adjustment, HLM group improved short-term mortality but did not show any improvement in the 3-year outcome compared with LLM.

Institutional profile: Karolinska Institutet.

PubMed

Eliasson, Erik; Sim, Sarah C; Rane, Anders; Ingelman-Sundberg, Magnus

2012-12-01

Research in pharmacogenomics has been intensive at Karolinska Institutet (KI) for approximately 25 years. Initial initiatives were focused on the identification and characterization of novel CYP2D6 alleles causing ultrarapid or defective drug metabolism. Such discoveries were possible owing to the early implementation of therapeutic drug monitoring and the access to individuals phenotyped with respect to drug metabolism. The translational work at KI has been of utmost importance for successful research, including functional characterization and clinical validation of allelic variants in drug metabolism, as well as discoveries of novel polymorphisms, recent examples being the CYP2C19 and UGT2B17 genes. The clinical pharmacology laboratory at KI campus Huddinge is one of the leading sites for therapeutic drug monitoring in northern Europe and obtains an increasing number of clinical requests, also important for pharmacogenetic research. Furthermore, the recently opened Center for Hematology and Regenerative Medicine, with a clear translational emphasis, offers an opportunity for studying drug metabolism and toxicity in vitro by use of human hepatocytes.

Continuous welding of unidirectional fiber reinforced thermoplastic tape material

NASA Astrophysics Data System (ADS)

Schledjewski, Ralf

2017-10-01

Continuous welding techniques like thermoplastic tape placement with in situ consolidation offer several advantages over traditional manufacturing processes like autoclave consolidation, thermoforming, etc. However, still there is a need to solve several important processing issues before it becomes a viable economic process. Intensive process analysis and optimization has been carried out in the past through experimental investigation, model definition and simulation development. Today process simulation is capable to predict resulting consolidation quality. Effects of material imperfections or process parameter variations are well known. But using this knowledge to control the process based on online process monitoring and according adaption of the process parameters is still challenging. Solving inverse problems and using methods for automated code generation allowing fast implementation of algorithms on targets are required. The paper explains the placement technique in general. Process-material-property-relationships and typical material imperfections are described. Furthermore, online monitoring techniques and how to use them for a model based process control system are presented.

Forecasting PM10 in metropolitan areas: Efficacy of neural networks.

PubMed

Fernando, H J S; Mammarella, M C; Grandoni, G; Fedele, P; Di Marco, R; Dimitrova, R; Hyde, P

2012-04-01

Deterministic photochemical air quality models are commonly used for regulatory management and planning of urban airsheds. These models are complex, computer intensive, and hence are prohibitively expensive for routine air quality predictions. Stochastic methods are becoming increasingly popular as an alternative, which relegate decision making to artificial intelligence based on Neural Networks that are made of artificial neurons or 'nodes' capable of 'learning through training' via historic data. A Neural Network was used to predict particulate matter concentration at a regulatory monitoring site in Phoenix, Arizona; its development, efficacy as a predictive tool and performance vis-à-vis a commonly used regulatory photochemical model are described in this paper. It is concluded that Neural Networks are much easier, quicker and economical to implement without compromising the accuracy of predictions. Neural Networks can be used to develop rapid air quality warning systems based on a network of automated monitoring stations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Preliminary Results on Design and Implementation of a Solar Radiation Monitoring System

PubMed Central

Balan, Mugur C.; Damian, Mihai; Jäntschi, Lorentz

2008-01-01

The paper presents a solar radiation monitoring system, using two scientific pyranometers and an on-line computer home-made data acquisition system. The first pyranometer measures the global solar radiation and the other one, which is shaded, measure the diffuse radiation. The values of total and diffuse solar radiation are continuously stored into a database on a server. Original software was created for data acquisition and interrogation of the created system. The server application acquires the data from pyranometers and stores it into a database with a baud rate of one record at 50 seconds. The client-server application queries the database and provides descriptive statistics. A web interface allow to any user to define the including criteria and to obtain the results. In terms of results, the system is able to provide direct, diffuse and total radiation intensities as time series. Our client-server application computes also derivate heats. The ability of the system to evaluate the local solar energy potential is highlighted. PMID:27879746

Operational tracking of lava lake surface motion at Kīlauea Volcano, Hawai‘i

USGS Publications Warehouse

Patrick, Matthew R.; Orr, Tim R.

2018-03-08

Surface motion is an important component of lava lake behavior, but previous studies of lake motion have been focused on short time intervals. In this study, we implement the first continuous, real-time operational routine for tracking lava lake surface motion, applying the technique to the persistent lava lake in Halema‘uma‘u Crater at the summit of Kīlauea Volcano, Hawai‘i. We measure lake motion by using images from a fixed thermal camera positioned on the crater rim, transmitting images to the Hawaiian Volcano Observatory (HVO) in real time. We use an existing optical flow toolbox in Matlab to calculate motion vectors, and we track the position of lava upwelling in the lake, as well as the intensity of spattering on the lake surface. Over the past 2 years, real-time tracking of lava lake surface motion at Halema‘uma‘u has been an important part of monitoring the lake’s activity, serving as another valuable tool in the volcano monitoring suite at HVO.

Inter-professional in-situ simulated team and resuscitation training for patient safety: Description and impact of a programmatic approach.

PubMed

Zimmermann, Katja; Holzinger, Iris Bachmann; Ganassi, Lorena; Esslinger, Peter; Pilgrim, Sina; Allen, Meredith; Burmester, Margarita; Stocker, Martin

2015-10-29

Inter-professional teamwork is key for patient safety and team training is an effective strategy to improve patient outcome. In-situ simulation is a relatively new strategy with emerging efficacy, but best practices for the design, delivery and implementation have yet to be evaluated. Our aim is to describe and evaluate the implementation of an inter-professional in-situ simulated team and resuscitation training in a teaching hospital with a programmatic approach. We designed and implemented a team and resuscitation training program according to Kern's six steps approach for curriculum development. General and specific needs assessments were conducted as independent cross-sectional surveys. Teamwork, technical skills and detection of latent safety threats were defined as specific objectives. Inter-professional in-situ simulation was used as educational strategy. The training was embedded within the workdays of participants and implemented in our highest acuity wards (emergency department, intensive care unit, intermediate care unit). Self-perceived impact and self-efficacy were sampled with an anonymous evaluation questionnaire after every simulated training session. Assessment of team performance was done with the team-based self-assessment tool TeamMonitor applying Van der Vleuten's conceptual framework of longitudinal evaluation after experienced real events. Latent safety threats were reported during training sessions and after experienced real events. The general and specific needs assessments clearly identified the problems, revealed specific training needs and assisted with stakeholder engagement. Ninety-five interdisciplinary staff members of the Children's Hospital participated in 20 in-situ simulated training sessions within 2 years. Participant feedback showed a high effect and acceptance of training with reference to self-perceived impact and self-efficacy. Thirty-five team members experiencing 8 real critical events assessed team performance with TeamMonitor. Team performance assessment with TeamMonitor was feasible and identified specific areas to target future team training sessions. Training sessions as well as experienced real events revealed important latent safety threats that directed system changes. The programmatic approach of Kern's six steps for curriculum development helped to overcome barriers of design, implementation and assessment of an in-situ team and resuscitation training program. This approach may help improve effectiveness and impact of an in-situ simulated training program.

Data processing system for the intensity monitoring spectrometer flown on the Orbiting Geophysical Observatory-F (OGO-F) satellite

NASA Technical Reports Server (NTRS)

Cronin, A. G.; Delaney, J. R.

1973-01-01

The system is discussed which was developed to process digitized telemetry data from the intensity monitoring spectrometer flown on the Orbiting Geophysical Observatory (OGO-F) Satellite. Functional descriptions and operating instructions are included for each program in the system.

Implementing AIM-based monitoring for natural resource management

USDA-ARS?s Scientific Manuscript database

Successful monitoring programs are built on clearly-defined objectives, thorough planning, and organized implementation. However, natural resource management decisions need to be made at many different organizational levels and scales – from local to national. Developing separate monitoring programs...

Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.

PubMed

Rosenthal, Victor D; Guzman, Sandra; Safdar, Nasia

2005-09-01

Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance. We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001). A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.

A new and highly selective turn-on fluorescent sensor with fast response time for the monitoring of cadmium ions in cosmetic, and health product samples.

PubMed

Khani, Rouhollah; Ghiamati, Ebrahim; Boroujerdi, Ramin; Rezaeifard, Abdolreza; Zaryabi, Mohadeseh Hosseinpour

2016-06-15

Cadmium (Cd) which is an extremely toxic could be found in many products like plastics, fossil fuel combustion, cosmetics, water resources, and wastewaters. It is capable of causing serious environmental and health problems such as lung, prostate, renal cancers and the other disorders. So, the development of a sensor to continually monitor cadmium is considerably demanding. Tetrakis(4-nitrophenyl)porphyrin, T(4-NO2-P)P, was synthesized and used as a new and highly selective fluorescent probe for monitoring cadmium ions in the "turn-on" mode. There was a linear relationship between fluorescence intensity and the concentration of Cd(II) in the range of 1.0×10(-6) to 1.0×10(-5)molL(-1) with a detection limit of 0.276μM. To examine the most important parameters involved and their interactions in the sensor optimization procedure, a four-factor central composite design (CCD) combined with response surface modeling (RSM) was implemented. The practical applicability of the developed sensor was investigated using real cosmetic, and personal care samples. Copyright © 2016 Elsevier B.V. All rights reserved.

Introducing a new monitoring manual for home fortification and strengthening capacity to monitor nutrition interventions.

PubMed

Jefferds, Maria Elena D; Flores-Ayala, Rafael

2015-12-01

Lack of monitoring capacity is a key barrier for nutrition interventions and limits programme management, decision making and programme effectiveness in many low-income and middle-income countries. A 2011 global assessment reported lack of monitoring capacity was the top barrier for home fortification interventions, such as micronutrient powders or lipid-based nutrient supplements. A Manual for Developing and Implementing Monitoring Systems for Home Fortification Interventions was recently disseminated. It is comprehensive and describes monitoring concepts and frameworks and includes monitoring tools and worksheets. The monitoring manual describes the steps of developing and implementing a monitoring system for home fortification interventions, including identifying and engaging stakeholders; developing a programme description including logic model and logical framework; refining the purpose of the monitoring system, identifying users and their monitoring needs; describing the design of the monitoring system; developing indicators; describing the core components of a comprehensive monitoring plan; and considering factors related to stage of programme development, sustainability and scale up. A fictional home fortification example is used throughout the monitoring manual to illustrate these steps. The monitoring manual is a useful tool to support the development and implementation of home fortification intervention monitoring systems. In the context of systematic capacity gaps to design, implement and monitor nutrition interventions in many low-income and middle-income countries, the dissemination of new tools, such as monitoring manuals may have limited impact without additional attention to strengthening other individual, organisational and systems levels capacities. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

75 FR 18782 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Alternate Monitoring...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-13

...EPA is proposing to approve a revision to Indiana's State Implementation Plan alternative monitoring requirements for Indianapolis Power and Light Company (IPL) at its Harding Street Generating Station. On December 31, 2008, Indiana requested approval of alternative monitoring requirements that allow the use of a particulate matter continuous emissions monitoring system in place of a continuous opacity monitor.

Challenges to natural resource monitoring in a small border park: terrestrial mammals at Coronado National Memorial, Cochise County, Arizona

USGS Publications Warehouse

Swann, Don E.; Bucci, Melanie; Kuenzi, Amy J.; Alberti, Barbara N.; Schwalbe, Cecil R.; Halvorson, William L.; van Riper, Charles; Schwalbe, Cecil R.

2010-01-01

Long-term monitoring in national parks is essential to meet National Park Service and other important public goals. Terrestrial mammals are often proposed for monitoring because large mammals are of interest to visitors and small mammals are important as prey. However, traditional monitoring strategies for mammals are often too expensive and complex to sustain for long periods, particularly in small parks. To evaluate potential strategies for long-term monitoring in small parks, we conducted an intensive one-year inventory of terrestrial mammals at Coronado National Memorial, located in Arizona on the U.S.-Mexico international border, then continued less-intensive monitoring at the site for 7 additional years. During 1996-2003 we confirmed 44 species of terrestrial mammals. Most species (40) were detected in the intensive first year of the study, but we continued to detect new species in later years. Mark-recapture data on small mammals indicated large inter-annual fluctuations in population size, but no significant trend over the 7-year period. Issues associated with the international border affected monitoring efforts and increased sampling costs. Our study confirms that sustained annual monitoring of mammals is probably not feasible in small park units like Coronado. However, comparisons of our data with past studies provide insight into important changes in the mammal community since the 1970s, including an increase in abundance and diversity of grassland rodents. Our results suggest that intensive inventories every 10-20 years may be a valuable and cost-effective approach for detecting long-term trends in terrestrial mammal communities in small natural areas.

Operation of the intensity monitors in beam transport lines at Fermilab during Run II¹

DOE PAGES

Crisp, J.; Fellenz, B.; Fitzgerald, J.; ...

2011-10-06

The intensity of charged particle beams at Fermilab must be kept within pre-determined safety and operational envelopes in part by assuring all beam within a few percent has been transported from any source to destination. Beam instensity monitors with toroidial pickups provide such beam intensity measurements in the transport lines between accelerators at FNAL. With Run II, much effort was made to continually improve the resolution and accuracy of the system.

Practical Approaches to Prescribing Physical Activity and Monitoring Exercise Intensity.

PubMed

Reed, Jennifer L; Pipe, Andrew L

2016-04-01

Regular physical activity helps to prevent heart disease, and reduces the risk of first or subsequent cardiovascular events. It is recommended that Canadian adults accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic exercise per week, in bouts of 10 minutes or more, and perform muscle- and bone-strengthening activities at least 2 days per week. Individual exercise prescriptions can be developed using the frequency, intensity, time, and type principles. Increasing evidence suggests that high-intensity interval training is efficacious for a broad spectrum of heart health outcomes. Several practical approaches to prescribing and monitoring exercise intensity exist including: heart rate monitoring, the Borg rating of perceived exertion scale, the Talk Test, and, motion sensors. The Borg rating of perceived exertion scale matches a numerical value to an individual's perception of effort, and can also be used to estimate heart rate. The Talk Test, the level at which simple conversation is possible, can be used to monitor desired levels of moderate- to vigorous-intensity exercise. Motion sensors can provide users with practical and useful exercise training information to aid in meeting current exercise recommendations. These approaches can be used by the public, exercise scientists, and clinicians to easily and effectively guide physical activity in a variety of settings. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Peculiarities of cosmic ray modulation in the solar minimum 23/24

NASA Astrophysics Data System (ADS)

Alania, M. V.; Modzelewska, R.; Wawrzynczak, A.

2014-06-01

We study changes of the galactic cosmic ray (GCR) intensity for the ending period of the solar cycle 23 and the beginning of the solar cycle 24 using neutron monitors experimental data. We show that an increase of the GCR intensity in 2009 is generally related with decrease of the solar wind velocity U, the strength B of the interplanetary magnetic field (IMF), and the drift in negative (A < 0) polarity epoch. We present that temporal changes of rigidity dependence of the GCR intensity variation, before reaching maximum level in 2009 and after it, do not noticeably differ from each other. The rigidity spectrum of the GCR intensity variations calculated based on neutron monitors data (for rigidities > 10 GV) is hard in the minimum and near-minimum epoch. We do not recognize any nonordinary changes in the physical mechanism of modulation of the GCR intensity in the rigidity range of GCR particles to which neutron monitors respond. We compose 2-D nonstationary model of transport equation to describe variations of the GCR intensity for 1996-2012 including the A > 0 (1996-2001) and the A < 0 (2002-2012) periods; diffusion coefficient of cosmic rays for rigidity 10-15 GV is increased by 30% in 2009 (A < 0) comparing with 1996 (A > 0). We believe that the proposed model is relatively realistic, and obtained results are satisfactorily compatible with neutron monitors data.

Method and apparatus for optical temperature measurements

DOEpatents

Angel, S.M.; Hirschfeld, T.B.

1986-04-22

A method and apparatus are provided for remotely monitoring temperature. Both method and apparatus employ a temperature probe material having an excitation-dependent emission line whose fluorescence intensity varies directly with temperature whenever excited by light having a first wavelength and whose fluorescence intensity varies inversely with temperature whenever excited by light having a second wavelength. Temperature is measured by alternatively illiminating the temperature probe material with light having the first wavelength and light having the second wavelength, monitoring the intensity of the successive emissions of the excitation-dependent emission line, and relating the intensity ratio of successive emissions to temperature. 3 figs.

Method and apparatus for optical temperature measurements

DOEpatents

Angel, S. Michael; Hirschfeld, Tomas B.

1988-01-01

A method and apparatus are provided for remotely monitoring temperature. Both method and apparatus employ a temperature probe material having an excitation-dependent emission line whose fluorescence intensity varies directly with temperature whenever excited by light having a first wavelength and whose fluorescence intensity varies inversely with temperature whenever excited by light having a second wavelength. Temperature is measured by alternatively illuminating the temperature probe material with light having the first wavelength and light having the second wavelength, monitoring the intensity of the successive emissions of the excitation-dependent emission line, and relating the intensity ratio of successive emissions to temperature.

Clinical Impact of Accurate Point-of-Care Glucose Monitoring for Tight Glycemic Control in Severely Burned Children.

PubMed

Tran, Nam K; Godwin, Zachary R; Steele, Amanda N; Wolf, Steven E; Palmieri, Tina L

2016-09-01

The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population. Retrospective analysis of an electronic health record system. Pediatric burn ICU at an academic medical center. Children (aged < 18 yr) with severe burns (≥ 20% total body surface area) receiving intensive insulin therapy guided by either a noncorrecting (blood glucose monitoring system-1) or an autocorrecting blood glucose monitoring system (blood glucose monitoring system-2). Patient demographics, insulin rates, and blood glucose monitoring system measurements were collected. The frequency of hypoglycemia and glycemic variability was compared between the two blood glucose monitoring system groups. A total of 122 patient charts from 2001 to 2014 were reviewed. Sixty-three patients received intensive insulin therapy using blood glucose monitoring system-1 and 59 via blood glucose monitoring system-2. Patient demographics were similar between the two groups. Mean insulin infusion rates (5.1 ± 3.8 U/hr; n = 535 paired measurements vs 2.4 ± 1.3 U/hr; n = 511 paired measurements; p < 0.001), glycemic variability, and frequency of hypoglycemic events (90 vs 12; p < 0.001) were significantly higher in blood glucose monitoring system-1-treated patients. Compared with laboratory measurements, blood glucose monitoring system-2 yielded the most accurate results (mean ± SD bias: -1.7 ± 6.9 mg/dL [-0.09 ± 0.4 mmol/L] vs 7.4 ± 13.5 mg/dL [0.4 ± 0.7 mmol/L]). Blood glucose monitoring system-2 patients achieve glycemic control more quickly (5.7 ± 4.3 vs 13.1 ± 6.9 hr; p< 0.001) and stayed within the target glycemic control range longer compared with blood glucose monitoring system-1 patients (85.2% ± 13.9% vs 57.9% ± 29.1%; p < 0.001). Accurate autocorrecting blood glucose monitoring system optimizes intensive insulin therapy, improves tight glycemic control, and reduces the risk of hypoglycemia and glycemic variability. The use of an autocorrecting blood glucose monitoring system for intensive insulin therapy may improve glycemic control in severely burned children.

Continuous EEG monitoring in the intensive care unit.

PubMed

Scheuer, Mark L

2002-01-01

Continuous EEG (CEEG) monitoring allows uninterrupted assessment of cerebral cortical activity with good spatial resolution and excellent temporal resolution. Thus, this procedure provides a means of constantly assessing brain function in critically ill obtunded and comatose patients. Recent advances in digital EEG acquisition, storage, quantitative analysis, and transmission have made CEEG monitoring in the intensive care unit (ICU) technically feasible and useful. This article summarizes the indications and methodology of CEEG monitoring in the ICU, and discusses the role of some quantitative EEG analysis techniques in near real-time remote observation of CEEG recordings. Clinical examples of CEEG use, including monitoring of status epilepticus, assessment of ongoing therapy for treatment of seizures in critically ill patients, and monitoring for cerebral ischemia, are presented. Areas requiring further development of CEEG monitoring techniques and indications are discussed.

Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians. A 5-year experience.

PubMed

Bochicchio, M; Latronico, N; Zappa, S; Beindorf, A; Candiani, A

1996-10-01

To assess the results of a 5-year experience with bedside burr hole for intracranial pressure (ICP) monitoring performed by intensive care physicians. Prospective, observational study in 120 patients. A general-neurologic Intensive Care Unit in a University Hospital. Patients admitted for acute neural lesion requiring ICP monitoring. A 2.71 mm burr hole was made with positioning of a subarachnoid screw, through which a miniaturized fiberoptic, tip transducer device (Camino) was advanced and inserted 2 mm in the frontal cortex. Over a 5-year period 120 patients, mainly with severe head trauma, underwent ICP monitoring. None of the planned patients was excluded because of technical difficulties. No life-threatening complications were reported, and the overall morbidity rate related to the ICP monitor was 3.3%. Complications were infectious in nature, with 2.5% wound infections and 0.8% meningitis. Although seven patients bled when opening the dura, no intracranial hematomas were recorded due to the ICP monitor. The fiberoptic device was left in place for 5 +/- 1.6 (SD) days (range 1-12 days). Five patients (4.1%) required catheter substitution due to breakage of the system components (fiberoptics). Bedside insertion of a ICP monitor performed by intensive care physicians is a safe procedure, with a complication rate comparable to other series published by neurosurgeons. The overall morbidity rate is comparable to, or even lower than, that caused by central vein catheterization.

Implementation of interval walking training in patients with type 2 diabetes in Denmark: rationale, design, and baseline characteristics

PubMed Central

Ried-Larsen, Mathias; Thomsen, Reimar W; Berencsi, Klara; Brinkløv, Cecilie F; Brøns, Charlotte; Valentiner, Laura S; Karstoft, Kristian; Langberg, Henning; Vaag, Allan A; Pedersen, Bente K; Nielsen, Jens S

2016-01-01

Promoting physical activity is a first-line choice of treatment for patients with type 2 diabetes (T2D). However, there is a need for more effective tools and technologies to facilitate structured lifestyle interventions and to ensure a better compliance, sustainability, and health benefits of exercise training in patients with T2D. The InterWalk initiative and its innovative application (app) for smartphones described in this study were developed by the Danish Centre for Strategic Research in T2D aiming at implementing, testing, and validating interval walking in patients with T2D in Denmark. The interval walking training approach consists of repetitive 3-minute cycles of slow and fast walking with simultaneous intensity guiding, based on the exercise capacity of the user. The individual intensity during slow and fast walking is determined by a short initial self-conducted and audio-guided fitness test, which combined with automated audio instructions strives to motivate the individual to adjust the intensity to the predetermined individualized walking intensities. The InterWalk app data are collected prospectively from all users and will be linked to the unique Danish nationwide databases and administrative registries, allowing extensive epidemiological studies of exercise in patients with T2D, such as the level of adherence to InterWalk training and long-term effectiveness surveys of important health outcomes, including cardiovascular morbidity and mortality. Currently, the InterWalk app has been downloaded by >30,000 persons, and the achieved epidemiological data quality is encouraging. Of the 9,466 persons providing personal information, 80% of the men and 62% women were overweight or obese (body mass index ≥25). The InterWalk project represents a contemporary technology-driven public health approach to monitor real-life exercise adherence and to propagate improved health through exercise intervention in T2D and in the general population. PMID:27354828

Space Environment Forecasting with Neutron Monitors: Establishing a novel service for the ESA SSA Program

NASA Astrophysics Data System (ADS)

Papaioannou, Athanasios; Mavromichalaki, Helen; Souvatzoglou, George; Paschalis, Pavlos; Sarlanis, Christos; Dimitroulakos, John; Gerontidou, Maria

2013-04-01

High-energy particles released at the Sun during a solar flare or a very energetic coronal mass ejection, result to a significant intensity increase at neutron monitor measurements known as Ground Level Enhancements (GLEs). Due to their space weather impact (i.e. risks and failures at communication and navigation systems, spacecraft electronics and operations, space power systems, manned space missions, and commercial aircraft operations) it is crucial to establish a real-time operational system that would be in place to issue reliable and timely GLE Alerts. Currently, the Cosmic Ray group of the National and Kapodistrian University of Athens is working towards the establishment of a Neutron Monitor Service that will be made available via the Space Weather Portal operated by the European Space Agency (ESA), under the Space Situational Awareness (SSA) Program. To this end, a web interface providing data from multiple Neutron Monitor stations as well as an upgraded GLE Alert will be provided. Both services are now under testing and validation and they will probably enter to an operational phase next year. The core of this Neutron Monitor Service is the GLE Alert software, and therefore, the main goal of this research effort is to upgrade the existing GLE Alert software, to minimize the probability of a false alarm and to enhance the usability of the corresponding results. The ESA Neutron Monitor Service is building upon the infrastructure made available with the implementation of the High-Resolution Neutron Monitor Database (NMDB). In this work the structure of the Neutron Monitor Service for ESA SSA Program and the impact of the novel GLE Alert Service that will be made available to future users via ESA SSA web portal will be presented and further discussed.

Absolute dose calculations for Monte Carlo simulations of radiotherapy beams

NASA Astrophysics Data System (ADS)

Popescu, I. A.; Shaw, C. P.; Zavgorodni, S. F.; Beckham, W. A.

2005-07-01

Monte Carlo (MC) simulations have traditionally been used for single field relative comparisons with experimental data or commercial treatment planning systems (TPS). However, clinical treatment plans commonly involve more than one field. Since the contribution of each field must be accurately quantified, multiple field MC simulations are only possible by employing absolute dosimetry. Therefore, we have developed a rigorous calibration method that allows the incorporation of monitor units (MU) in MC simulations. This absolute dosimetry formalism can be easily implemented by any BEAMnrc/DOSXYZnrc user, and applies to any configuration of open and blocked fields, including intensity-modulated radiation therapy (IMRT) plans. Our approach involves the relationship between the dose scored in the monitor ionization chamber of a radiotherapy linear accelerator (linac), the number of initial particles incident on the target, and the field size. We found that for a 10 × 10 cm2 field of a 6 MV photon beam, 1 MU corresponds, in our model, to 8.129 × 1013 ± 1.0% electrons incident on the target and a total dose of 20.87 cGy ± 1.0% in the monitor chambers of the virtual linac. We present an extensive experimental verification of our MC results for open and intensity-modulated fields, including a dynamic 7-field IMRT plan simulated on the CT data sets of a cylindrical phantom and of a Rando anthropomorphic phantom, which were validated by measurements using ionization chambers and thermoluminescent dosimeters (TLD). Our simulation results are in excellent agreement with experiment, with percentage differences of less than 2%, in general, demonstrating the accuracy of our Monte Carlo absolute dose calculations.

The ``Leakage Current Sentinel'': A novel plug-in socket device for online biomedical equipment electrical safety surveillance

NASA Astrophysics Data System (ADS)

Cappa, Paolo; Marinozzi, Franco; Sciuto, Salvatore Andrea

2000-07-01

The Leakage Current Sentinel (LCS) has been designed and implemented for the detection of hazardous situations caused by dangerous earth leakage current values in intensive care units and operating theaters. The device, designed and manufactured with full compliance of the high risk environment requirements, is able to monitor online the earth leakage current and detect ground wire faults. Operation utilizes a microammeter with an overall sensitivity of 2.5×104 V/A. In order to assure the reliability of the device in providing alarm signals, the simultaneous presence of absorbed power current is monitored by means of another ammeter with decreased sensitivity (3.0 V/A). The measured root mean square current values are compared with reference values in order to send signals to NAND and OR complementary metal-oxide-semiconductor gates to enable audible and visible alarms according to the possible hazardous cases examined in the article. The final LCS packaging was shaped as a wall socket adapter for common electromedical device power cord plugs, with particular attention to minimizing its dimensions and to provide analog voltage outputs for both measured leakage and power currents, in order to allow automatic data acquisition and computerized hazardous situation management. Finally, a personal computer based automatic measuring system has been configured to simultaneously monitor several LCSs installed in the same intensive care unit room and, as a consequence, to distinguish different hazardous scenarios and provide an adequate alert to the clinical personnel whose final decision is still required. The test results confirm the effectiveness and reliability of the LCS in giving an alert in case of leakage current anomalous values, either in case of a ground fault or in case of a dangerous leakage current.

High temporal resolution mapping of seismic noise sources using heterogeneous supercomputers

NASA Astrophysics Data System (ADS)

Gokhberg, Alexey; Ermert, Laura; Paitz, Patrick; Fichtner, Andreas

2017-04-01

Time- and space-dependent distribution of seismic noise sources is becoming a key ingredient of modern real-time monitoring of various geo-systems. Significant interest in seismic noise source maps with high temporal resolution (days) is expected to come from a number of domains, including natural resources exploration, analysis of active earthquake fault zones and volcanoes, as well as geothermal and hydrocarbon reservoir monitoring. Currently, knowledge of noise sources is insufficient for high-resolution subsurface monitoring applications. Near-real-time seismic data, as well as advanced imaging methods to constrain seismic noise sources have recently become available. These methods are based on the massive cross-correlation of seismic noise records from all available seismic stations in the region of interest and are therefore very computationally intensive. Heterogeneous massively parallel supercomputing systems introduced in the recent years combine conventional multi-core CPU with GPU accelerators and provide an opportunity for manifold increase and computing performance. Therefore, these systems represent an efficient platform for implementation of a noise source mapping solution. We present the first results of an ongoing research project conducted in collaboration with the Swiss National Supercomputing Centre (CSCS). The project aims at building a service that provides seismic noise source maps for Central Europe with high temporal resolution (days to few weeks depending on frequency and data availability). The service is hosted on the CSCS computing infrastructure; all computationally intensive processing is performed on the massively parallel heterogeneous supercomputer "Piz Daint". The solution architecture is based on the Application-as-a-Service concept in order to provide the interested external researchers the regular access to the noise source maps. The solution architecture includes the following sub-systems: (1) data acquisition responsible for collecting, on a periodic basis, raw seismic records from the European seismic networks, (2) high-performance noise source mapping application responsible for generation of source maps using cross-correlation of seismic records, (3) back-end infrastructure for the coordination of various tasks and computations, (4) front-end Web interface providing the service to the end-users and (5) data repository. The noise mapping application is composed of four principal modules: (1) pre-processing of raw data, (2) massive cross-correlation, (3) post-processing of correlation data based on computation of logarithmic energy ratio and (4) generation of source maps from post-processed data. Implementation of the solution posed various challenges, in particular, selection of data sources and transfer protocols, automation and monitoring of daily data downloads, ensuring the required data processing performance, design of a general service oriented architecture for coordination of various sub-systems, and engineering an appropriate data storage solution. The present pilot version of the service implements noise source maps for Switzerland. Extension of the solution to Central Europe is planned for the next project phase.

ST-segment monitoring: putting standards into practice.

PubMed

Flanders, Sonya A

2007-01-01

ST-segment monitoring is one key reason that continuous electrocardiographic monitoring is performed in hospitals, and can help with early detection of myocardial ischemia for at-risk patients. Although ST-segment monitoring research, guidelines, and expert consensus statements have been published, ST-segment monitoring has not been implemented in all appropriate clinical areas. The purpose of this article is to present relevant research, review the latest practice standards, and discuss issues important to nurses wishing to implement ST-segment monitoring.

Kilovoltage Intrafraction Monitoring for Prostate Intensity Modulated Arc Therapy: First Clinical Results

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

Ng, Jin Aun; Institute of Medical Physics, School of Physics, University of Sydney, New South Wales; Booth, Jeremy T.

2012-12-01

Purpose: Most linear accelerators purchased today are equipped with a gantry-mounted kilovoltage X-ray imager which is typically used for patient imaging prior to therapy. A novel application of the X-ray system is kilovoltage intrafraction monitoring (KIM), in which the 3-dimensional (3D) tumor position is determined during treatment. In this paper, we report on the first use of KIM in a prospective clinical study of prostate cancer patients undergoing intensity modulated arc therapy (IMAT). Methods and Materials: Ten prostate cancer patients with implanted fiducial markers undergoing conventionally fractionated IMAT (RapidArc) were enrolled in an ethics-approved study of KIM. KIM involves acquiringmore » kV images as the gantry rotates around the patient during treatment. Post-treatment, markers in these images were segmented to obtain 2D positions. From the 2D positions, a maximum likelihood estimation of a probability density function was used to obtain 3D prostate trajectories. The trajectories were analyzed to determine the motion type and the percentage of time the prostate was displaced {>=}3, 5, 7, and 10 mm. Independent verification of KIM positional accuracy was performed using kV/MV triangulation. Results: KIM was performed for 268 fractions. Various prostate trajectories were observed (ie, continuous target drift, transient excursion, stable target position, persistent excursion, high-frequency excursions, and erratic behavior). For all patients, 3D displacements of {>=}3, 5, 7, and 10 mm were observed 5.6%, 2.2%, 0.7% and 0.4% of the time, respectively. The average systematic accuracy of KIM was measured at 0.46 mm. Conclusions: KIM for prostate IMAT was successfully implemented clinically for the first time. Key advantages of this method are (1) submillimeter accuracy, (2) widespread applicability, and (3) a low barrier to clinical implementation. A disadvantage is that KIM delivers additional imaging dose to the patient.« less

Preliminary Prioritization of California Oil and Gas Fields for Regional Groundwater Monitoring Based on Intensity of Petroleum Resource Development and Proximity to Groundwater Resources

NASA Astrophysics Data System (ADS)

Davis, T. A.; Landon, M. K.; Bennett, G.

2016-12-01

The California State Water Resources Control Board is collaborating with the U.S. Geological Survey to implement a Regional Monitoring Program (RMP) to assess where and to what degree groundwater resources may be at risk of contamination from oil and gas development activities including stimulation, well integrity issues, produced water ponds, and underground injection. A key issue in the implementation of the RMP is that the state has 487 onshore oil fields covering 8,785 square kilometers but detailed characterization work can only be done in a few oil fields annually. The first step in the RMP is to prioritize fields using available data that indicate potential risk to groundwater from oil and gas development, including vertical proximity of groundwater and oil/gas resources, density of petroleum and water wells, and volume of water injected in oil fields. This study compiled data for these factors, computed summary metrics for each oil field, analyzed statewide distributions of summary metrics, used those distributions to define relative categories of potential risk for each factor, and combined these into an overall priority ranking. Aggregated results categorized 22% (107 fields) of the total number of onshore oil and gas fields in California as high priority, 23% as moderate priority, and 55% as low priority. On an area-weighted basis, 41% of the fields ranked high, 30% moderate, and 29% low, highlighting that larger fields tend to have higher potential risk because of greater intensity of development, sometimes coupled with closer proximity to groundwater. More than half of the fields ranked as high priority were located in the southern Central Valley or the Los Angeles Basin. The prioritization does not represent an assessment of groundwater risk from oil and gas development; rather, such assessments are planned to follow based on detailed analysis of data from the RMP near the oil fields selected for study in the future.

Putting Adaptive Management into Monitoring: Retrospective and Prospective Views of Northwest Forest Plan Monitoring

Treesearch

David E. Busch; Jon R. Martin

2006-01-01

Based on ten years of Northwest Forest Plan implementation, we focus on key scientifically-oriented questions relating to improving Plan monitoring. The questions, which fall into groups concerning issues of scale, integration, and efficiency, have applicability to monitoring programs being designed and implemented throughout the world. Progress toward answering such...

Activities of the National Water-Quality Assessment Program in the upper Snake River Basin, Idaho and western Wyoming, 1991-2001

USGS Publications Warehouse

Low, Walton H.

1997-01-01

In 1991, the U.S. Geological Survey (USGS) began a full-scale National Water-Quality Assessment (NAWQA) Program. The long-term goals of the NAWQA Program are to describe the status and trends in the water quality of a large part of the Nation's rivers and aquifers and to improve understanding of the primary natural and human factors that affect water-quality conditions. In meeting these goals, the program will produce water-quality, ecological, and geographic information that will be useful to policy makers and managers at the national, State, and local levels. A major component of the program is study-unit investigations, upon which national-level assessment activities are based. The program's 60 study-unit investigations are associated with principal river basins and aquifer systems throughout the Nation. Study units encompass areas from 1,200 to more than 65,000 mi2 (square miles) and incorporate about 60 to 70 percent of the Nation's water use and population served by public water supply. In 1991, the upper Snake River Basin was among the first 20 NAWQA study units selected for implementation. From 1991 to 1995, a high-intensity data-collection phase of the upper Snake River Basin study unit (fig. 1) was implemented and completed. Components of this phase are described in a report by Gilliom and others (1995). In 1997, a low-intensity phase of data collection began, and work continued on data analysis, report writing, and data documentation and archiving activities that began in 1996. Principal data-collection activities during the low-intensity phase will include monitoring of surface-water and ground-water quality, assessment of aquatic biological conditions, and continued compilation of environmental setting information.

Analysis of U. S. Forest Service bird point-count monitoring database - implications for designing and implementing avian monitoring

Treesearch

Eric T. Linder; David A. Buehler

2005-01-01

In 1996, Region 8 of the U. S. Forest Service implemented a program to monitor landbirds on southeastern U.S. national forests. The goal was to develop a monitoring system that could document population trends and bird-habitat relationships. Using power analysis, we examined the ability of the monitoring program to detect population trends (3 percent annual change) at...

PERSONAL RADIATION MONITOR

DOEpatents

Dilworth, R.H.; Borkowski, C.J.

1961-12-26

A transistorized, fountain pen type radiation monitor to be worn on the person is described. Radiation produces both light flashes in a small bulb and an audible warning tone, the frequency of both the tone and light flashes being proportional to radiation intensity. The device is powered by a battery and a blocking oscillator step-up power supply The oscillator frequency- is regulated to be proportional to the radiation intensity, to provide adequate power in high radiation fields, yet minimize battery drain at low operating intensities. (AEC)

Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

PubMed

Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

2013-09-05

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing. The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

Are Key Principles for improved health technology assessment supported and used by health technology assessment organizations?

PubMed

Neumann, Peter J; Drummond, Michael F; Jönsson, Bengt; Luce, Bryan R; Schwartz, J Sanford; Siebert, Uwe; Sullivan, Sean D

2010-01-01

Previously, our group-the International Working Group for HTA Advancement-proposed a set of fifteen Key Principles that could be applied to health technology assessment (HTA) programs in different jurisdictions and across a range of organizations and perspectives. In this commentary, we investigate the extent to which these principles are supported and used by fourteen selected HTA organizations worldwide. We find that some principles are broadly supported: examples include being explicit about HTA goals and scope; considering a wide range of evidence and outcomes; and being unbiased and transparent. Other principles receive less widespread support: examples are addressing issues of generalizability and transferability; being transparent on the link between HTA findings and decision-making processes; considering a full societal perspective; and monitoring the implementation of HTA findings. The analysis also suggests a lack of consensus in the field about some principles--for example, considering a societal perspective. Our study highlights differences in the uptake of key principles for HTA and indicates considerable room for improvement for HTA organizations to adopt principles identified to reflect good HTA practices. Most HTA organizations espouse certain general concepts of good practice--for example, assessments should be unbiased and transparent. However, principles that require more intensive follow-up--for example, monitoring the implementation of HTA findings--have received little support and execution.

Blending Qualitative and Computational Linguistics Methods for Fidelity Assessment: Experience with the Familias Unidas Preventive Intervention.

PubMed

Gallo, Carlos; Pantin, Hilda; Villamar, Juan; Prado, Guillermo; Tapia, Maria; Ogihara, Mitsunori; Cruden, Gracelyn; Brown, C Hendricks

2015-09-01

Careful fidelity monitoring and feedback are critical to implementing effective interventions. A wide range of procedures exist to assess fidelity; most are derived from observational assessments (Schoenwald and Garland, Psycholog Assess 25:146-156, 2013). However, these fidelity measures are resource intensive for research teams in efficacy/effectiveness trials, and are often unattainable or unmanageable for the host organization to rate when the program is implemented on a large scale. We present a first step towards automated processing of linguistic patterns in fidelity monitoring of a behavioral intervention using an innovative mixed methods approach to fidelity assessment that uses rule-based, computational linguistics to overcome major resource burdens. Data come from an effectiveness trial of the Familias Unidas intervention, an evidence-based, family-centered preventive intervention found to be efficacious in reducing conduct problems, substance use and HIV sexual risk behaviors among Hispanic youth. This computational approach focuses on "joining," which measures the quality of the working alliance of the facilitator with the family. Quantitative assessments of reliability are provided. Kappa scores between a human rater and a machine rater for the new method for measuring joining reached 0.83. Early findings suggest that this approach can reduce the high cost of fidelity measurement and the time delay between fidelity assessment and feedback to facilitators; it also has the potential for improving the quality of intervention fidelity ratings.

Compliance with Prevention Practices and their Association with Central Line-Associated Blood Stream Infections in Neonatal Intensive Care Units

PubMed Central

Zachariah, Philip; Furuya, E. Yoko; Edwards, Jeffrey; Dick, Andrew; Liu, Hangsheng; Herzig, Carolyn; Pogorzelska-Maziarz, Monika; Stone, Patricia W.; Saiman, Lisa

2014-01-01

Background Bundles and checklists have been shown to decrease CLABSIs, but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with prevention practices in a sample of US Neonatal ICUs and assess their association with CLABSI rates. Methods An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU specific CLABSI prevention practices and corresponding CLABSI rates. Results Overall, 190 Level II/III and Level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88% - 91%). Reporting ≥ 95% compliance for any of the practices ranged from 50%- 63%. Reporting ≥ 95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (p<0.05). Conclusions Most NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥ 95% was suboptimal. Reporting ≥ 95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Further studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates. PMID:25087136

Blending Qualitative and Computational Linguistics Methods for Fidelity Assessment: Experience with the Familias Unidas Preventive Intervention

PubMed Central

Gallo, Carlos; Pantin, Hilda; Villamar, Juan; Prado, Guillermo; Tapia, Maria; Ogihara, Mitsunori; Cruden, Gracelyn; Brown, C Hendricks

2014-01-01

Careful fidelity monitoring and feedback are critical to implementing effective interventions. A wide range of procedures exist to assess fidelity; most are derived from observational assessments (Schoenwald et al, 2013). However, these fidelity measures are resource intensive for research teams in efficacy/effectiveness trials, and are often unattainable or unmanageable for the host organization to rate when the program is implemented on a large scale. We present a first step towards automated processing of linguistic patterns in fidelity monitoring of a behavioral intervention using an innovative mixed methods approach to fidelity assessment that uses rule-based, computational linguistics to overcome major resource burdens. Data come from an effectiveness trial of the Familias Unidas intervention, an evidence-based, family-centered preventive intervention found to be efficacious in reducing conduct problems, substance use and HIV sexual risk behaviors among Hispanic youth. This computational approach focuses on “joining,” which measures the quality of the working alliance of the facilitator with the family. Quantitative assessments of reliability are provided. Kappa scores between a human rater and a machine rater for the new method for measuring joining reached .83. Early findings suggest that this approach can reduce the high cost of fidelity measurement and the time delay between fidelity assessment and feedback to facilitators; it also has the potential for improving the quality of intervention fidelity ratings. PMID:24500022

Monitoring Engine Vibrations And Spectrum Of Exhaust

NASA Technical Reports Server (NTRS)

Martinez, Carol L.; Randall, Michael R.; Reinert, John W.

1991-01-01

Real-time computation of intensities of peaks in visible-light emission spectrum of exhaust combined with real-time spectrum analysis of vibrations into developmental monitoring technique providing up-to-the-second information on conditions of critical bearings in engine. Conceived to monitor conditions of bearings in turbopump suppling oxygen to Space Shuttle main engine, based on observations that both vibrations in bearings and intensities of visible light emitted at specific wavelengths by exhaust plume of engine indicate wear and incipient failure of bearings. Applicable to monitoring "health" of other machinery via spectra of vibrations and electromagnetic emissions from exhausts. Concept related to one described in "Monitoring Bearing Vibrations For Signs Of Damage", (MFS-29734).

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

PubMed

Schultz, J A; Collie-Akers, V L; Fawcett, S B; Strauss, W J; Nagaraja, J; Landgraf, A J; McIver, K L; Weber, S A; Arteaga, S S; Nebeling, L C; Rauzon, S M

2018-06-19

Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability. © 2018 World Obesity Federation.

The difference of delay time in monitoring system of facial acupressure learning media using bluetooth, wireless and ethernet

NASA Astrophysics Data System (ADS)

Agustin, Eny Widhia; Hangga, Arimaz; Fahrian, Muhammad Iqbal; Azhari, Anis Fikri

2018-03-01

The implementation of monitoring system in the facial acupressure learning media could increase the students' proficiency. However the common learning media still has not implemented a monitoring system in their learning process. This research was conducted to implement monitoring system in the mannequin head prototype as a learning media of facial acupressure using Bluetooth, wireless and Ethernet. The results of the implementation of monitoring system in the prototype showed that there were differences in the delay time between Bluetooth and wireless or Ethernet. The results data showed no difference in the average delay time between the use of Bluetooth with wireless and the use of Bluetooth with Ethernet in monitoring system of facial acupressure learning media. From all the facial acupressure points, the forehead facial acupressure point has the longest delay time of 11.93 seconds. The average delay time in all 3 class rooms was 1.96 seconds therefore the use of Bluetooth, wireless and Ethernet is highly recommended in the monitoring system of facial acupressure.

Exercise Therapy for Management of Type 2 Diabetes Mellitus: Superior Efficacy of Activity Monitors over Pedometers.

PubMed

Miyauchi, Masaaki; Toyoda, Masao; Kaneyama, Noriko; Miyatake, Han; Tanaka, Eitaro; Kimura, Moritsugu; Umezono, Tomoya; Fukagawa, Masafumi

2016-01-01

We compared the efficacy of activity monitor (which displays exercise intensity and number of steps) versus that of pedometer in exercise therapy for patients with type 2 diabetes. The study subjects were divided into the activity monitor group ( n = 92) and pedometer group ( n = 95). The primary goal was improvement in hemoglobin A1c (HbA1c). The exercise target was set at 8,000 steps/day and 20 minutes of moderate-intensity exercise (≥3.5 metabolic equivalents). The activity monitor is equipped with a triple-axis accelerometer sensor capable of measuring medium-intensity walking duration, number of steps, walking distance, calorie consumption, and total calorie consumption. The pedometer counts the number of steps. Blood samples for laboratory tests were obtained during the visits. The first examination was conducted at the start of the study and repeated at 2 and 6 months. A significant difference in the decrease in HbA1c level was observed between the two groups at 2 months. The results suggest that the use of activity level monitor that displays information on exercise intensity, in addition to the number of steps, is useful in exercise therapy as it enhances the concept of exercise therapy and promotes lowering of HbA1c in diabetic patients.

Laser Atmospheric Transmitter Receiver-Network (LAnTeRN): A new approach for active measurement of atmospheric greenhouse gases

NASA Astrophysics Data System (ADS)

Dobler, J. T.; Braun, M.; Zaccheo, T.

2012-12-01

The Laser Atmospheric Transmitter Receiver-Network (LAnTeRN) is a new measurement concept that will enable local, regional and continental determination of key greenhouse gases, with unparalleled accuracy and precision. This new approach will offer the ability to make low bias, high precision, quasi-continuous, measurements to the accuracies required for separating anthropogenic and biogenic sources and sinks. In 2004 ITT Exelis developed an airborne demonstration unit, based on an intensity modulated continuous wave (IM-CW) lidar approach, for actively measuring atmospheric CO2 and O2. The multi-functional fiber laser lidar (MFLL) system relies on low peak power, high reliability, and efficient telecom laser components to implement this unique measurement approach. While evaluating methods for discriminating against thin clouds for the MFLL instrument, a new measurement concept was conceived. LAnTeRN has several fundamental characteristics in common with the MFLL instrument, but is a fundamentally different implementation and capability. The key difference is that LAnTeRN operates in transmission rather than in the traditional backscatter lidar configuration, which has several distinct advantages. Operating as a forward scatter, bistatic lidar system, LAnTeRN enables consideration of continuous monitoring from a geostationary orbit to multiple locations on the ground. Having the receivers on the ground significantly lowers cost and risk compared to an all space based mission, and allows the transmitter subsystem to be implemented, near term, as a hosted payload. Furthermore, the LAnTeRN measurement approach is also applicable for ground to ground measurements where high precision measurements over a long open path is required, such as facilities monitoring, or monitoring of passive volcanoes and fault lines. Using narrow linewidth laser sources allows flexibility to select the position on the absorption feature being probed. This feature allows for weighting the absorption toward lower altitudes for the space implementation or to handle large dynamic range measurements as would be required for volcano monitoring. This presentation will discuss results from a detailed instrument performance analyses, retrieval simulations, and from initial testing of a proof of concept demonstration unit being developed by Exelis. Initial analysis indicate that measurements from a transmitter in geostationary orbit to 25 ground receivers in the eastern U.S. can retrieve column integrated CO2 values to a precision of <0.2 ppm on monthly averages and <0.06 ppm on yearly averages, using conservative estimates of cloud cover and aerosol loading. The capability for continuous monitoring over a fixed geometry makes it possible to independently characterize the atmospheric column, using existing capabilities (e.g. aircore, aircraft and in-situ instrumentation), for quantification of bias. Furthermore, the ability to selectively locate the ground receivers can enable focused studies for specific applications.

Unmanned aerial vehicle acquisition of three-dimensional digital image correlation measurements for structural health monitoring of bridges

NASA Astrophysics Data System (ADS)

Reagan, Daniel; Sabato, Alessandro; Niezrecki, Christopher

2017-04-01

Civil engineering structures such as bridges, buildings, and tunnels continue to be used despite aging and deterioration well past their design life. In 2013, the American Society of Civil Engineers (ASCE) rated the state of the U.S. bridges as mediocre, despite the $12.8 billion USD annually invested. Traditional inspection and monitoring techniques may produce inconsistent results, are labor intensive and too time-consuming to be considered effective for large-scale monitoring. Therefore, new structural health monitoring systems must be developed that are automated, highly accurate, minimally invasive, and cost effective. Three-dimensional (3D) digital image correlation (DIC) systems possess the capability of extracting full-field strain, displacement, and geometry profiles. Furthermore, as this measurement technique is implemented within an Unmanned Aerial Vehicle (UAV) the capability to expedite the optical-based measurement process is increased as well as the infrastructure downtime being reduced. These resulting integrity maps of the structure of interest can be easily interpreted by trained personal. Within this paper, the feasibility of performing DIC measurements using a pair of cameras installed on a UAV is shown. Performance is validated with in-flight measurements. Also, full-field displacement monitoring, 3D measurement stitching, and 3D point-tracking techniques are employed in conjunction with 3D mapping and data management software. The results of these experiments show that the combination of autonomous flight with 3D DIC and other non-contact measurement systems provides a highly valuable and effective civil inspection platform.

A circumpolar monitoring framework for polar bears

USGS Publications Warehouse

Vongraven, Dag; Aars, Jon; Amstrup, Steven C.; Atkinson, Stephen N.; Belikov, Stanislav; Born, Erik W.; DeBruyn, T.D.; Derocher, Andrew E.; Durner, George M.; Gill, Michael J.; Lunn, Nicholas J.; Obbard, Martyn E.; Omelak, Jack; Ovsyanikov, Nikita; Peacock, Elizabeth; Richardson, E.E.; Sahanatien, Vicki; Stirling, Ian; Wiig, Øystein

2012-01-01

Polar bears (Ursus maritimus) occupy remote regions that are characterized by harsh weather and limited access. Polar bear populations can only persist where temporal and spatial availability of sea ice provides adequate access to their marine mammal prey. Observed declines in sea ice availability will continue as long as greenhouse gas concentrations rise. At the same time, human intrusion and pollution levels in the Arctic are expected to increase. A circumpolar understanding of the cumulative impacts of current and future stressors is lacking, long-term trends are known from only a few subpopulations, and there is no globally coordinated effort to monitor effects of stressors. Here, we describe a framework for an integrated circumpolar monitoring plan to detect ongoing patterns, predict future trends, and identify the most vulnerable polar bear subpopulations. We recommend strategies for monitoring subpopulation abundance and trends, reproduction, survival, ecosystem change, human-caused mortality, human–bear conflict, prey availability, health, stature, distribution, behavioral change, and the effects that monitoring itself may have on polar bears. We assign monitoring intensity for each subpopulation through adaptive assessment of the quality of existing baseline data and research accessibility. A global perspective is achieved by recommending high intensity monitoring for at least one subpopulation in each of four major polar bear ecoregions. Collection of data on harvest, where it occurs, and remote sensing of habitat, should occur with the same intensity for all subpopulations. We outline how local traditional knowledge may most effectively be combined with the best scientific methods to provide comparable and complementary lines of evidence. We also outline how previously collected intensive monitoring data may be sub-sampled to guide future sampling frequencies and develop indirect estimates or indices of subpopulation status. Adoption of this framework will inform management and policy responses to changing worldwide polar bear status and trends.

FPGA-based GEM detector signal acquisition for SXR spectroscopy system

NASA Astrophysics Data System (ADS)

Wojenski, A.; Pozniak, K. T.; Kasprowicz, G.; Kolasinski, P.; Krawczyk, R.; Zabolotny, W.; Chernyshova, M.; Czarski, T.; Malinowski, K.

2016-11-01

The presented work is related to the Gas Electron Multiplier (GEM) detector soft X-ray spectroscopy system for tokamak applications. The used GEM detector has one-dimensional, 128 channel readout structure. The channels are connected to the radiation-hard electronics with configurable analog stage and fast ADCs, supporting speeds of 125 MSPS for each channel. The digitalized data is sent directly to the FPGAs using fast serial links. The preprocessing algorithms are implemented in the FPGAs, with the data buffering made in the on-board 2Gb DDR3 memory chips. After the algorithmic stage, the data is sent to the Intel Xeon-based PC for further postprocessing using PCI-Express link Gen 2. For connection of multiple FPGAs, PCI-Express switch 8-to-1 was designed. The whole system can support up to 2048 analog channels. The scope of the work is an FPGA-based implementation of the recorder of the raw signal from GEM detector. Since the system will work in a very challenging environment (neutron radiation, intense electro-magnetic fields), the registered signals from the GEM detector can be corrupted. In the case of the very intense hot plasma radiation (e.g. laser generated plasma), the registered signals can overlap. Therefore, it is valuable to register the raw signals from the GEM detector with high number of events during soft X-ray radiation. The signal analysis will have the direct impact on the implementation of photon energy computation algorithms. As the result, the system will produce energy spectra and topological distribution of soft X-ray radiation. The advanced software was developed in order to perform complex system startup and monitoring of hardware units. Using the array of two one-dimensional GEM detectors it will be possible to perform tomographic reconstruction of plasma impurities radiation in the SXR region.

Analysis of the nutritional management practices in intensive care: Identification of needs for improvement.

PubMed

Lázaro-Martín, N I; Catalán-González, M; García-Fuentes, C; Terceros-Almanza, L; Montejo-González, J C

2015-12-01

To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions. Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation. ICU of a hospital of high complexity. Adult ICU forecast more than 48h of artificial nutrition. Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio. A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56). The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Design and implementation of a 3-lead ECG wireless remote monitoring system

NASA Astrophysics Data System (ADS)

Zhang, Shi; Jia, Xiaonan; Shang, Shuai

2006-11-01

Cardiovascular disease is one of the main diseases that menaces human health. It is necessary to monitor the patient's real-time electrocardiograph (ECG) for a long time to realize diagnosis and salvage. Remote ECG monitoring system is the solution. This paper introduces the design and implement of a 3-lead ECG wireless remote monitoring system. It collects, stores and transmits user's ECG which can be received by hospital and diagnosed by doctors. The development of the whole system contains three parts, the hardware and embedded software implementation of MONITOR, software of the MONITORING CENTER, and the routing software of NETWORK CENTER. According to the clinic experimentation, this system has high reliability and utility. There will be great social and economic benefit if this system is put into use.

Range Atmospheric and Oceanic Environmental Support Capabilities

DTIC Science & Technology

2011-12-01

Precipitation location/intensity, thunderstorm location/intensity, rainfall/flash flood warning, hydrometer characterization, wind warnings, and...intensity, lightning monitoring, rainfall and flash flood warning, hydrometer characterization, and wind warnings. b. Satellite: MTSAT, GOES-10

Tree species differentiation using intensity data derived from leaf-on and leaf-off airborne laser scanner data

Treesearch

Sooyoung Kim; Robert J. McGaughey; Hans-Erik Andersen; Gerard Schreuder

2009-01-01

Tree species identification is important for a variety of natural resource management and monitoring activities including riparian buffer characterization, wildfire risk assessment, biodiversity monitoring, and wildlife habitat assessment. Intensity data recorded for each laser point in a LIDAR system is related to the spectral reflectance of the target material and...

Accuracy of pulse oximetry in assessing heart rate of infants in the neonatal intensive care unit.

PubMed

Singh, Jasbir K S B; Kamlin, C Omar F; Morley, Colin J; O'Donnell, Colm P F; Donath, Susan M; Davis, Peter G

2008-05-01

To determine the accuracy of pulse oximetry measurement of heart rate in the neonatal intensive care unit. Stable preterm infants were monitored with a pulse oximeter and an ECG. The displays of both monitors were captured on video. Heart rate data from both monitors, including measures of signal quality, were extracted and analysed using Bland Altman plots. In 30 infants the mean (SD) difference between heart rate measured by pulse oximetry and electrocardiography was -0.4 (12) beats per minute. Accuracy was maintained when the signal quality or perfusion was low. Pulse oximetry may provide a useful measurement of heart rate in the neonatal intensive care unit. Studies of this technique in the delivery room are indicated.

VA Health Care: Processes to Evaluate, Implement, and Monitor Organizational Structure Changes Needed

DTIC Science & Technology

2016-09-01

VA HEALTH CARE Processes to Evaluate , Implement, and Monitor Organizational Structure Changes Needed Report to...Accountability Office Highlights of GAO-16-803, a report to congressional requesters September 2016 VA HEALTH CARE Processes to Evaluate , Implement, and...recommended organizational structure changes are evaluated to determine appropriate actions and implemented. This is inconsistent with federal standards

Operations automation using temporal dependency networks

NASA Technical Reports Server (NTRS)

Cooper, Lynne P.

1991-01-01

Precalibration activities for the Deep Space Network are time- and work force-intensive. Significant gains in availability and efficiency could be realized by intelligently incorporating automation techniques. An approach is presented to automation based on the use of Temporal Dependency Networks (TDNs). A TDN represents an activity by breaking it down into its component pieces and formalizing the precedence and other constraints associated with lower level activities. The representations are described which are used to implement a TDN and the underlying system architecture needed to support its use. The commercial applications of this technique are numerous. It has potential for application in any system which requires real-time, system-level control, and accurate monitoring of health, status, and configuration in an asynchronous environment.

Control of NO concentration in solutions of nitrosothiol compounds by light.

PubMed

Zhelyaskov, V R; Gee, K R; Godwin, D W

1998-03-01

We studied the thermal and photolytic decomposition of two S-nitrosothiols, S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylpenicillamine (SNAP), in water or propanol solutions. A "concentration clamp" (relatively constant concentration of NO as a function of time) could be implemented in a closed volume by varying the pH, concentration of nitrovasodilator and intensity of the light source. Depending on the conditions, the light either stimulated NO release or sharply decreased NO concentration in the test solutions. Changes in the absorption spectra of GSNO solutions were monitored as a function of light exposure. Generation of superoxide as a product of a photolytic decomposition reaction of S-nitrosothiols and further oxidation of NO is the most likely mechanism for light suppression of NO concentration.

Water-resources data index for Osceola National Forest, Florida

USGS Publications Warehouse

Seaber, Paul R.; Hull, Robert W.

1979-01-01

The U.S. Geological Survey conducted an intensive investigation from December 1975 to December 1977 of the geohydrology of Osceola National Forest, Fla. The primary purpose was to provide the geohydrological understanding needed to predict the impact of potential phosphate industry operations in the forest on the natural hydrologic system. The investigation involved test drilling, implementation of a hydrologic monitoring network, water-quality sampling, comprehensive aquifer tests, and literature study. This report is an index to the type, source, location, and availability of the data used in the interpretive investigation. The indexes include: geological, geophysical, ground water, surface water, quality of water, meteorological, climatological, aquifer tests, maps, photographs, elevations, and reference publications. The manner of storage and retrieval of the data is decribed also. (Woodard-USGS).

77 FR 48173 - Comment Request for Information Collection for Monitoring Implementation of Changes to State...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-13

... Collection for Monitoring Implementation of Changes to State Unemployment Insurance (UI) Programs, Extension... to Scott Gibbons, Office of Unemployment Insurance, Employment and Training Administration, U.S... responsibility for ensuring that states implement the extension and modifications to the Emergency Unemployment...

Ionosphere Scintillation at Low and High Latitudes (Modelling vs Measurement)

NASA Astrophysics Data System (ADS)

Béniguel, Yannick

2016-04-01

This paper will address the problem of scintillations characteristics, focusing on the parameters of interest for a navigation system. Those parameters are the probabilities of occurrence of simultaneous fading, the bubbles surface at IPP level, the cycle slips and the fades duration statistics. The scintillation characteristics obtained at low and high latitudes will be compared. These results correspond to the data analysis performed after the ESA Monitor ionosphere measurement campaign [1], [2]. A second aspect of the presentation will be the modelling aspect. It has been observed that the phase scintillation dominates at high latitudes while the intensity scintillation dominates at low latitudes. The way it can be reproduced and implemented in a propagation model (e.g. GISM model [3]) will be presented. Comparisons of measurements with results obtained by modelling will be presented on some typical scenarios. References [1] R. Prieto Cerdeira, Y. Beniguel, "The MONITOR project: architecture, data and products", Ionospheric Effects Symposium, Alexandria (Va), May 2011 [2] Y. Béniguel, R Orus-Perez , R. Prieto-Cerdeira , S. Schlueter , S. Scortan, A. Grosu "MONITOR 2: ionospheric monitoring network in support to SBAS and other GNSS and scientific purposes", IES Conference, Alexandria (Va), May 2015-05-22 [3] Y. Béniguel, P. Hamel, "A Global Ionosphere Scintillation Propagation Model for Equatorial Regions", Journal of Space Weather Space Climate, 1, (2011), doi: 10.1051/swsc/2011004

Tools for monitoring system suitability in LC MS/MS centric proteomic experiments.

PubMed

Bereman, Michael S

2015-03-01

With advances in liquid chromatography coupled to tandem mass spectrometry technologies combined with the continued goals of biomarker discovery, clinical applications of established biomarkers, and integrating large multiomic datasets (i.e. "big data"), there remains an urgent need for robust tools to assess instrument performance (i.e. system suitability) in proteomic workflows. To this end, several freely available tools have been introduced that monitor a number of peptide identification (ID) and/or peptide ID free metrics. Peptide ID metrics include numbers of proteins, peptides, or peptide spectral matches identified from a complex mixture. Peptide ID free metrics include retention time reproducibility, full width half maximum, ion injection times, and integrated peptide intensities. The main driving force in the development of these tools is to monitor both intra- and interexperiment performance variability and to identify sources of variation. The purpose of this review is to summarize and evaluate these tools based on versatility, automation, vendor neutrality, metrics monitored, and visualization capabilities. In addition, the implementation of a robust system suitability workflow is discussed in terms of metrics, type of standard, and frequency of evaluation along with the obstacles to overcome prior to incorporating a more proactive approach to overall quality control in liquid chromatography coupled to tandem mass spectrometry based proteomic workflows. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Phenobarbital in intensive care unit pediatric population: predictive performances of population pharmacokinetic model.

PubMed

Marsot, Amélie; Michel, Fabrice; Chasseloup, Estelle; Paut, Olivier; Guilhaumou, Romain; Blin, Olivier

2017-10-01

An external evaluation of phenobarbital population pharmacokinetic model described by Marsot et al. was performed in pediatric intensive care unit. Model evaluation is an important issue for dose adjustment. This external evaluation should allow confirming the proposed dosage adaptation and extending these recommendations to the entire intensive care pediatric population. External evaluation of phenobarbital published population pharmacokinetic model of Marsot et al. was realized in a new retrospective dataset of 35 patients hospitalized in a pediatric intensive care unit. The published population pharmacokinetic model was implemented in nonmem 7.3. Predictive performance was assessed by quantifying bias and inaccuracy of model prediction. Normalized prediction distribution errors (NPDE) and visual predictive check (VPC) were also evaluated. A total of 35 infants were studied with a mean age of 33.5 weeks (range: 12 days-16 years) and a mean weight of 12.6 kg (range: 2.7-70.0 kg). The model predicted the observed phenobarbital concentrations with a reasonable bias and inaccuracy. The median prediction error was 3.03% (95% CI: -8.52 to 58.12%), and the median absolute prediction error was 26.20% (95% CI: 13.07-75.59%). No trends in NPDE and VPC were observed. The model previously proposed by Marsot et al. in neonates hospitalized in intensive care unit was externally validated for IV infusion administration. The model-based dosing regimen was extended in all pediatric intensive care unit to optimize treatment. Due to inter- and intravariability in pharmacokinetic model, this dosing regimen should be combined with therapeutic drug monitoring. © 2017 Société Française de Pharmacologie et de Thérapeutique.

Some computer graphical user interfaces in radiation therapy.

PubMed

Chow, James C L

2016-03-28

In this review, five graphical user interfaces (GUIs) used in radiation therapy practices and researches are introduced. They are: (1) the treatment time calculator, superficial X-ray treatment time calculator (SUPCALC) used in the superficial X-ray radiation therapy; (2) the monitor unit calculator, electron monitor unit calculator (EMUC) used in the electron radiation therapy; (3) the multileaf collimator machine file creator, sliding window intensity modulated radiotherapy (SWIMRT) used in generating fluence map for research and quality assurance in intensity modulated radiation therapy; (4) the treatment planning system, DOSCTP used in the calculation of 3D dose distribution using Monte Carlo simulation; and (5) the monitor unit calculator, photon beam monitor unit calculator (PMUC) used in photon beam radiation therapy. One common issue of these GUIs is that all user-friendly interfaces are linked to complex formulas and algorithms based on various theories, which do not have to be understood and noted by the user. In that case, user only needs to input the required information with help from graphical elements in order to produce desired results. SUPCALC is a superficial radiation treatment time calculator using the GUI technique to provide a convenient way for radiation therapist to calculate the treatment time, and keep a record for the skin cancer patient. EMUC is an electron monitor unit calculator for electron radiation therapy. Instead of doing hand calculation according to pre-determined dosimetric tables, clinical user needs only to input the required drawing of electron field in computer graphical file format, prescription dose, and beam parameters to EMUC to calculate the required monitor unit for the electron beam treatment. EMUC is based on a semi-experimental theory of sector-integration algorithm. SWIMRT is a multileaf collimator machine file creator to generate a fluence map produced by a medical linear accelerator. This machine file controls the multileaf collimator to deliver intensity modulated beams for a specific fluence map used in quality assurance or research. DOSCTP is a treatment planning system using the computed tomography images. Radiation beams (photon or electron) with different energies and field sizes produced by a linear accelerator can be placed in different positions to irradiate the tumour in the patient. DOSCTP is linked to a Monte Carlo simulation engine using the EGSnrc-based code, so that 3D dose distribution can be determined accurately for radiation therapy. Moreover, DOSCTP can be used for treatment planning of patient or small animal. PMUC is a GUI for calculation of the monitor unit based on the prescription dose of patient in photon beam radiation therapy. The calculation is based on dose corrections in changes of photon beam energy, treatment depth, field size, jaw position, beam axis, treatment distance and beam modifiers. All GUIs mentioned in this review were written either by the Microsoft Visual Basic.net or a MATLAB GUI development tool called GUIDE. In addition, all GUIs were verified and tested using measurements to ensure their accuracies were up to clinical acceptable levels for implementations.

40 CFR 258.58 - Implementation of the corrective action program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Ground-Water Monitoring and Corrective...) Establish and implement a corrective action ground-water monitoring program that: (i) At a minimum, meet the requirements of an assessment monitoring program under § 258.55; (ii) Indicate the effectiveness of the...

40 CFR 258.58 - Implementation of the corrective action program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Ground-Water Monitoring and Corrective Action § 258... implement a corrective action ground-water monitoring program that: (i) At a minimum, meet the requirements of an assessment monitoring program under § 258.55; (ii) Indicate the effectiveness of the corrective...

40 CFR 258.58 - Implementation of the corrective action program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Ground-Water Monitoring and Corrective...) Establish and implement a corrective action ground-water monitoring program that: (i) At a minimum, meet the requirements of an assessment monitoring program under § 258.55; (ii) Indicate the effectiveness of the...

40 CFR 258.58 - Implementation of the corrective action program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Ground-Water Monitoring and Corrective...) Establish and implement a corrective action ground-water monitoring program that: (i) At a minimum, meet the requirements of an assessment monitoring program under § 258.55; (ii) Indicate the effectiveness of the...

40 CFR 257.28 - Implementation of the corrective action program.

Code of Federal Regulations, 2012 CFR

2012-07-01

...-Hazardous Waste Disposal Units Ground-Water Monitoring and Corrective Action § 257.28 Implementation of the... ground-water monitoring program that: (i) At a minimum, meets the requirements of an assessment monitoring program under § 257.25; (ii) Indicates the effectiveness of the corrective action remedy; and (iii...

A low cost mid-infrared sensor for on line contamination monitoring of lubricating oils in marine engines

NASA Astrophysics Data System (ADS)

Ben Mohammadi, L.; Kullmann, F.; Holzki, M.; Sigloch, S.; Klotzbuecher, T.; Spiesen, J.; Tommingas, T.; Weismann, P.; Kimber, G.

2010-04-01

The chemical and physical condition of oils in marine engines must be monitored to ensure optimum performance of the engine and to avoid damage by degraded oil not adequately lubricating the engine. Routine monitoring requires expensive laboratory testing and highly skilled analysts. This work describes the adaptation and implementation of a mid infrared (MIR) sensor module for continued oil condition monitoring in two-stroke and four-stroke diesel engines. The developed sensor module will help to reduce costs in oil analysis by eliminating the need to collect and send samples to a laboratory for analysis. The online MIR-Sensor module measures the contamination of oil with water, soot, as well as the degradation indicated by the TBN (Total Base Number) value. For the analysis of water, TBN, and soot in marine engine oils, four spectral regions of interest have been identified. The optical absorption in these bands correlating with the contaminations is measured simultaneously by using a four-field thermopile detector, combined with appropriate bandpass filters. Recording of the MIR-absorption was performed in a transmission mode using a flow-through cell with appropriate path length. Since in this case no spectrometer is required, the sensor including the light source, the flowthrough- cell, and the detector can be realised at low cost and in a very compact manner. The optical configuration of the sensor with minimal component number and signal intensity optimisation at the four-field detector was implemented by using non-sequential ray tracing simulation. The used calibration model was robust enough to predict accurately the value for soot, water, and TBN concentration for two-stroke and four-stroke engine oils. The sensor device is designed for direct installation on the host engine or machine and, therefore, becoming an integral part of the lubrication system. It can also be used as a portable stand-alone system for machine fluid analysis in the field.

Interdisciplinary approach to the ecological status assessment of Rio Quequén Grande watershed in Argentina

NASA Astrophysics Data System (ADS)

Teruggi, L. B.; Caporali, E.; Sala, S.; Kristensen, M. J.

2010-12-01

The Río Quequén Grande (RQG) watershed is located in the southeast section of Buenos Aires province, in Argentina, and it has an area of about 9.940 km2. The RQG outflows into the Atlantic Ocean, near the city of Necochea and it is a representative example of Argentinean River that drains the flat pampas of the region. The region is very important from a social and economical point of view, it is in fact characterized by intense agricultural activity and it is part of one of the most productive plain in the world. In spite of all that, the related environmental impacts, in this part of the world, are habitually faced studying specific aspects and using local measures, which often lead to the collapse of the living riverine systems. In this frame, the integration of all the available data, coupled with specific data from appropriate monitoring campaigns is proposed. Particularly geological, hydrological and geomorphological data are integrated with biological monitoring data for surface water quality assessment. Concepts like biotic integrity or ecological status are introduced to effectively protect and enhance water resources. The aim of the research is to recognize natural and anthropogenic spatial heterogeneity and to test methodologies for ecological status assessment of RQG watershed, integrating abiotic and biotic data together with all the available information. A dedicated Geographic Information System (GIS) is developed and an interdisciplinary approach is implemented. The watershed is characterized, using an integrated informative system of geological, geomorphological, sedimentological, hydrological, geochemical, land uses and biological information. Textural and geochemical river bed sediments data and water chemical parameters of the main tributaries and the main course were also monitored. Bankfull channel and caliche outcrops crossing the RQG channel were mapped and the fluvial cross sections were surveyed. The hydrological and hydraulic analyses have been carried out. All the data and analysis results are recorded in the dedicated GIS. As a preliminary approach, a biological monitoring campaign was defined and samples of principal nutrients analyses were collected. General habitat quality was also evaluated and benthic algal communities, aquatic and riparian vegetation were sampled. The results indicate that the monitored rivers have an insufficient water quality possibly related to the diffused pollution due to intensive agricultural activities. Even if the bio-monitoring activities need to be continued, and the number of monitoring sites need to be increased, the preliminary obtained results by the monitoring campaign and the modelling, integrating with the GIS, are giving encouraging response.

SME2EM: Smart mobile end-to-end monitoring architecture for life-long diseases.

PubMed

Serhani, Mohamed Adel; Menshawy, Mohamed El; Benharref, Abdelghani

2016-01-01

Monitoring life-long diseases requires continuous measurements and recording of physical vital signs. Most of these diseases are manifested through unexpected and non-uniform occurrences and behaviors. It is impractical to keep patients in hospitals, health-care institutions, or even at home for long periods of time. Monitoring solutions based on smartphones combined with mobile sensors and wireless communication technologies are a potential candidate to support complete mobility-freedom, not only for patients, but also for physicians. However, existing monitoring architectures based on smartphones and modern communication technologies are not suitable to address some challenging issues, such as intensive and big data, resource constraints, data integration, and context awareness in an integrated framework. This manuscript provides a novel mobile-based end-to-end architecture for live monitoring and visualization of life-long diseases. The proposed architecture provides smartness features to cope with continuous monitoring, data explosion, dynamic adaptation, unlimited mobility, and constrained devices resources. The integration of the architecture׳s components provides information about diseases׳ recurrences as soon as they occur to expedite taking necessary actions, and thus prevent severe consequences. Our architecture system is formally model-checked to automatically verify its correctness against designers׳ desirable properties at design time. Its components are fully implemented as Web services with respect to the SOA architecture to be easy to deploy and integrate, and supported by Cloud infrastructure and services to allow high scalability, availability of processes and data being stored and exchanged. The architecture׳s applicability is evaluated through concrete experimental scenarios on monitoring and visualizing states of epileptic diseases. The obtained theoretical and experimental results are very promising and efficiently satisfy the proposed architecture׳s objectives, including resource awareness, smart data integration and visualization, cost reduction, and performance guarantee. Copyright © 2015 Elsevier Ltd. All rights reserved.

Intensive Care Nurses' Attitude on Palliative and End of Life Care.

PubMed

Tripathy, Swagata; Routray, Pragyan K; Mishra, Jagdish C

2017-10-01

Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation. This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL. A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs. Of 178 questionnaires distributed, 138 completed, with a response rate of 75.5*. About half (48.5*) had more than 1 year ICU experience. A majority (81.9*) agreed that nurses should be involved in and initiate (62.3*) EOL discussions. Terms "EOL care or palliative care in ICU" were new for 19.6*; 21* and 55.8* disagreed with allowing peaceful death in terminal patients and unrestricted family visits, respectively. Work experience was associated with wanting unrestricted family visitation, discontinuing monitoring and investigations at EOL, equating withholding and withdrawal of treatment, and being a part of EOL team discussions ( P = 0.005, 0.01, 0.01, and 0.001), respectively. Religiousness was associated with a greater desire to initiate EOL discussions ( P = 0.001). Greater emphasis on palliative care in critical care curriculum may improve awareness among critical care nurses.

Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

PubMed

Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

2016-01-01

The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility

PubMed Central

Bassett, Rick; Adams, Kelly McCutcheon; Danesh, Valerie; Groat, Patricia M.; Haugen, Angie; Kiewel, Angi; Small, Cora; Van-Leuven, Mark; Venus, Sam; Ely, E. Wesley

2016-01-01

Background/Methods Sedation management, delirium monitoring, and mobility programs are key features of recent evidence-based critical care guidelines and care bundles, yet implementation in the intensive care unit (ICU) remains highly variable. The Institute for Healthcare Improvement’s Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. It involved one live case study and five iterations of an in-person seminar over 33 months (March 2011 to November 2013) that emphasized interdisciplinary teamwork and culture change. IHI-RCC has involved over 650 participants from 215 organizations. This report describes a convenience sample of five participating organizations chosen in advance of knowing their clinical outcomes. Results Qualitative descriptions of the changes tested at each of the five case study sites are provided, demonstrating the necessary teamwork, improved processes, and increased reliability of daily work. These sites all worked to implement the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) within the context of a bundled interventional care plan; they then tracked length of stay in the ICU and duration of mechanical ventilation, which are reported. Discussion Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The IHI-RCC program is based on testing changes on a small scale, building highly effective interdisciplinary rounds, frequent data feedback to the frontline, and use of in-person demonstrations. Key lessons are emerging about effectively caring for critically ill patients in light of data about the harm of over-sedation, unrecognized and unaddressed delirium, and immobility. PMID:25976892

Nurse adoption of continuous patient monitoring on acute post-surgical units: managing technology implementation.

PubMed

Jeskey, Mary; Card, Elizabeth; Nelson, Donna; Mercaldo, Nathaniel D; Sanders, Neal; Higgins, Michael S; Shi, Yaping; Michaels, Damon; Miller, Anne

2011-10-01

To report an exploratory action-research process used during the implementation of continuous patient monitoring in acute post-surgical nursing units. Substantial US Federal funding has been committed to implementing new health care technology, but failure to manage implementation processes may limit successful adoption and the realisation of proposed benefits. Effective approaches for managing barriers to new technology implementation are needed. Continuous patient monitoring was implemented in three of 13 medical/surgical units. An exploratory action-feedback approach, using time-series nurse surveys, was used to identify barriers and develop and evaluate responses. Post-hoc interviews and document analysis were used to describe the change implementation process. Significant differences were identified in night- and dayshift nurses' perceptions of technology benefits. Research nurses' facilitated the change process by evolving 'clinical nurse implementation specialist' expertise. Health information technology (HIT)-related patient outcomes are mediated through nurses' acting on new information but HIT designed for critical care may not transfer to acute care settings. Exploratory action-feedback approaches can assist nurse managers in assessing and mitigating the real-world effects of HIT implementations. It is strongly recommended that nurse managers identify stakeholders and develop comprehensive plans for monitoring the effects of HIT in their units. © 2011 Blackwell Publishing Ltd.

FutureGen 2.0 Monitoring Program: An Overview of the Monitoring Approach and Technologies Selected for Implementation

DOE PAGES

Vermeul, Vince R.; Strickland, Chris E.; Thorne, Paul D.; ...

2014-12-31

The FutureGen 2.0 Project will design and build a first-of-its-kind, near-zero emissions coal-fueled power plant with carbon capture and storage (CCS). To assess storage site performance and meet the regulatory requirements of the Class VI Underground Injection Control (UIC) Program for CO2 Geologic Sequestration, the FutureGen 2.0 project will implement a suite of monitoring technologies designed to 1) evaluate CO2 mass balance and 2) detect any unforeseen loss in CO2 containment. The monitoring program will include direct monitoring of the injection stream and reservoir, and early-leak-detection monitoring directly above the primary confining zone. It will also implement an adaptive monitoringmore » strategy whereby monitoring results are continually evaluated and the monitoring network is modified as required, including the option to drill additional wells in out-years. Wells will be monitored for changes in CO2 concentration and formation pressure, and other geochemical/isotopic signatures that provide indication of CO2 or brine leakage. Indirect geophysical monitoring technologies that were selected for implementation include passive seismic, integrated surface deformation, time-lapse gravity, and pulsed neutron capture logging. Near-surface monitoring approaches that have been initiated include surficial aquifer and surface- water monitoring, soil-gas monitoring, atmospheric monitoring, and hyperspectral data acquisition for assessment of vegetation conditions. Initially, only the collection of baseline data sets is planned; the need for additional near- surface monitoring will be continually evaluated throughout the design and operational phases of the project, and selected approaches may be reinstituted if conditions warrant. Given the current conceptual understanding of the subsurface environment, early and appreciable impacts to near-surface environments are not expected.« less

Environmental performance, profitability, asset utilization, debt monitoring and firm value

NASA Astrophysics Data System (ADS)

Bukit, R. Br; Haryanto, B.; Ginting, P.

2018-02-01

The growing issue on firm value shows that firm value is not only determined by the firm ability to increase financial profit, but also by the company's concern in maintaining the environmental condition. The industrial development produces waste that pollutes the environment that has potential to serious impact on the next life. In addition to provide financial benefits, companies are increasingly facing pressure to be socially responsible for the survival of the company. However, past findings demonstrate that the effect of environmental performance, profitability, and asset utilization to the firm’s value are still unclear. This study aims to test whether environmental performance, firm profitability and asset utilization can effectively enhance firm value in two different conditions: intensive debt monitoring and less intensive debt monitoring. Sample of companies is taken from the list of Indonesia Stock Exchange during the period of 2013 to 2015. Using multiple regression analysis, discloses that: in intensive monitoring, managers tend to have high firm value when company has high environmental performance and or high profitability and high asset utilization. Monitoring system needs to be intensified especially for companies with the above characteristics.

An 'Early Warning System' for the prevention of dredging potential impacts on sensitive areas

NASA Astrophysics Data System (ADS)

Piermattei, Viviana; Martellucci, Riccardo; Pierattini, Alberto; Bonamano, Simone; Paladini de Mendoza, Francesco; Albani, Marta; Stefanì, Chiara; Madonia, Alice; Fersini, Giorgio; Marcelli, Marco

2016-04-01

Coastal marine ecosystems are increasingly subject to multiple pressures and stressors produced by the effects of human activities. Intense and frequent disturbances which affect marine environment can derive from dredging activity, which is a fundamental management for most ports and harbours. The potential environmental effects of dredging procedures are generally due to the excavation of material from the sea bottom and the relocation elsewhere for disposal, overflow from the dredger and loss of material from pipelines during transport. Depending on the location and the intensity of these activities the marine environment, particularly sensitive areas, may be affected by dredging. The main environmental effects can be associated with suspended sediments and increases in turbidity into the water column, which can have adverse effects on marine animals and plants by reducing light penetration and by physical disturbance. For this reason it is fundamental to implement a real time monitoring system to control and prevent negative effects, enabling a rapid response to adverse water quality conditions and a fast activation of mitigation procedures, in agreement with all the reference authorities. In this work we present the development of an innovative 'Early Warning System' based on fixed stations, ad hoc in situ surveys and forecasting models, which was applied to a dredging activity carried out in the Gulf of Gaeta (Latium, Italy). It represents an extension of the C-CEMS (Civitavecchia Coastal Environmental Monitoring System) network, which is operative in the Tyrrhenian sea since 2005.

Development of wireless sensor network for landslide monitoring system

NASA Astrophysics Data System (ADS)

Suryadi; Puranto, Prabowo; Adinanta, Hendra; Tohari, Adrin; Priambodo, Purnomo S.

2017-05-01

A wireless sensor network has been developed to monitor soil movement of some observed areas periodically. The system consists of four nodes and one gateway which installed on a scope area of 0.2 Km2. Each of nodehastwo types of sensor,an inclinometer and an extensometer. An inclinometer sensor is used to measure the tilt of a structure while anextensometer sensor is used to measure the displacement of soil movement. Each of nodeisalso supported by awireless communication device, a solar power supply unit, and a microcontroller unit called sensor module. In this system, there is also gateway module as a main communication system consistinga wireless communication device, power supply unit, and rain gauge to measure the rainfall intensity of the observed area. Each sensor of inclinometer and extensometer isconnected to the sensor module in wiring system but sensor module iscommunicating with gateway in a wireless system. Those four nodes are alsoconnectedeach other in a wireless system collecting the data from inclinometer and extensometer sensors. Module Gateway istransmitting the instruction code to each sensor module one by one and collecting the data from them. Gateway module is an important part to communicate with not only sensor modules but also to the server. This wireless system wasdesigned toreducethe electric consumption powered by 80 WP solar panel and 55Ah battery. This system has been implemented in Pangalengan, Bandung, which has high intensity of rainfall and it can be seen on the website.

Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach.

PubMed

Ward, Marie; McAuliffe, Eilish; Wakai, Abel; Geary, Una; Browne, John; Deasy, Conor; Schull, Michael; Boland, Fiona; McDaid, Fiona; Coughlan, Eoin; O'Sullivan, Ronan

2017-01-23

Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED). A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of 'Plan Do Study Act' (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed. Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration.

Application of GPS Technology to Monitor Traffic Intensity and Soil Impacts in a Forest Harvest Operation

Treesearch

Emily A. Carter; Timothy P. McDonald; John L. Torbert

1999-01-01

A study was initiated in the Winter of 1998 to examine the utility of employing Global Positioning Systems (GPS) to monitor harvest traffic throughout a loblolly pine plantation and utilize traffic intensity information to assess impacts of select soil physical properties. Traffic maps prepared from GPS positional data indicated the highest concentration of traffic...

Visual monitoring of autonomous life sciences experimentation

NASA Technical Reports Server (NTRS)

Blank, G. E.; Martin, W. N.

1987-01-01

The design and implementation of a computerized visual monitoring system to aid in the monitoring and control of life sciences experiments on board a space station was investigated. A likely multiprocessor design was chosen, a plausible life science experiment with which to work was defined, the theoretical issues involved in the programming of a visual monitoring system for the experiment was considered on the multiprocessor, a system for monitoring the experiment was designed, and simulations of such a system was implemented on a network of Apollo workstations.

Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service.

PubMed

Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R

2014-06-01

The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

Neutron beam flux monitors in coaxial and planar geometry for neutron scattering instruments at Dhruva reactor

NASA Astrophysics Data System (ADS)

Desai, Shraddha S.; Devan, Shylaja; Das, Amrita; Patkar, S. M.; Rao, Mala N.

2018-04-01

Neutron scattering instruments at Dhruva reactor are equipped with in house developed neutron beam flux monitors. Measurements of variations in intensity are essential to normalize the scattered neutron spectra against the reactor power fluctuations, energy of monochromatic beam, and various other factors. Two different beam monitor geometries are considered as per the beam size and optics. These detectors are fabricated with tailor-made designs to suit individual beam size and neutron flux. Pencil size beam monitors for integral intensity measurement are fabricated with coaxial geometry and BF3 fill gas for high n-gamma discrimination and count rate capability. Brass cathode design is modified to SS based rugged design, considering beam transmission. Coaxial beam monitor partially intercepts the collimated beam and gives relative magnitude of the flux with time. For certain experiments, size of beam varies due to use of focusing monochromator. Thus a beam monitor with square sensitive region covering entire beam is essential. Multiwire based planar detector for use in transmission mode is designed. Negligible absorption of neutron beam intensity within the detector hardware is ensured. Design of detectors is tailor made for beam geometry. Both these types of beam monitors are fabricated and characterized at G2 beam line and Triple Axis Spectrometer at Dhruva reactor. Performance of detector is suitable for the beam monitoring up to neutron flux ˜ 106 n/cm2/sec. Design aspects and performance details of these beam monitors are mentioned in the paper.

Idaho Habitat Evaluation for Off-Site Mitigation Record : Annual Report 1988.

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

Idaho. Dept. of Fish and Game.

1990-03-01

The Idaho Department of Fish and Game (IDFG) has been monitoring and evaluating existing and proposed habitat improvement projects for steelhead and chinook in the Clearwater and Salmon subbasins since 1984. Projects included in the monitoring are funded by, or proposed for funding by, the Bonneville Power Administration (BPA) under the Northwest Power Planning Act as off-site mitigation for downstream hydropower development on the Snake and Columbia Rivers. This monitoring project is also funded under the same authority. A mitigation record is being developed to use actual and potential increases in smolt production as the best measures of benefit frommore » a habitat improvement project. This project is divided into two subprojects: general and intensive monitoring. Primary objectives of the general monitoring subproject are to determine natural production increases due to habitat improvement projects in terms of parr production and to determine natural production status and trends in Idaho. The second objective is accomplished by combining parr density from monitoring and evaluation of BPA habitat projects and from other IDFG management and research activities. The primary objective of the intensive monitoring subproject is to determine the relationships between spawning escapement, parr production, and smolt production in two Idaho streams; the upper Salmon River and Crooked River. Results of the intensive monitoring will be used to estimate mitigation benefits in terms of smolt production and to interpret natural production monitoring in Idaho. 30 refs., 19 figs., 34 tabs.« less

Proposal for Monitoring Within the Centrifuge Cascades of Uranium Enrichment Facilities

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

Farrar, David R.

2017-04-01

Safeguards are technical measures implemented by the International Atomic Energy Agency (IAEA) to independently verify that nuclear material is not diverted from peaceful purposes to weapons (IAEA, 2017a). Safeguards implemented at uranium enrichment facilities (facilities hereafter) include enrichment monitors (IAEA, 2011). Figure 1 shows a diagram of how a facility could be monitored. The use of a system for monitoring within centrifuge cascades is proposed.

Medical decision-making inspired from aerospace multisensor data fusion concepts.

PubMed

Pombo, Nuno; Bousson, Kouamana; Araújo, Pedro; Viana, Joaquim

2015-01-01

In recent years, Internet-delivered treatments have been largely used for pain monitoring, offering healthcare professionals and patients the ability to interact anywhere and at any time. Electronic diaries have been increasingly adopted as the preferred methodology to collect data related to pain intensity and symptoms, replacing traditional pen-and-paper diaries. This article presents a multisensor data fusion methodology based on the capabilities provided by aerospace systems to evaluate the effects of electronic and pen-and-paper diaries on pain. We examined English-language studies of randomized controlled trials that use computerized systems and the Internet to collect data about chronic pain complaints. These studies were obtained from three data sources: BioMed Central, PubMed Central and ScienceDirect from the year 2000 until 30 June 2012. Based on comparisons of the reported pain intensity collected during pre- and post-treatment in both the control and intervention groups, the proposed multisensor data fusion model revealed that the benefits of technology and pen-and-paper are qualitatively equivalent [Formula: see text]. We conclude that the proposed model is suitable, intelligible, easy to implement, time efficient and resource efficient.

Measurements of Laser Plasma Instability (LPI) and Electron Density/Temperature Profiles in Plasmas Produced by the Nike KrF Laser

NASA Astrophysics Data System (ADS)

Oh, Jaechul; Weaver, J. L.; Serlin, V.; Obenschain, S. P.

2016-10-01

We will present results of simultaneous measurements of LPI-driven light scattering and density/temperature profiles in CH plasmas produced by the Nike krypton fluoride laser (λ = 248 nm). The primary diagnostics for the LPI measurement are time-resolved spectrometers with absolute intensity calibration in spectral ranges relevant to the optical detection of stimulated Raman scattering or two plasmon decay. The spectrometers are capable of monitoring signal intensity relative to thermal background radiation from plasma providing a useful way to analyze LPI initiation. For further understanding of LPI processes, the recently implemented grid image refractometer (Nike-GIR)a is used to measure the coronal plasma profiles. In this experiment, Nike-GIR is equipped with a 5th harmonic probe laser (λ = 213 nm) in attempt to probe into a high density region over the previous peak density with λ = 263 nm probe light ( 4 ×1021 cm-3). The LPI behaviors will be discussed with the measured data sets. Work supported by DoE/NNSA.

Implementation of a post-cardiac arrest care bundle including therapeutic hypothermia and hemodynamic optimization in comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a feasibility study.

PubMed

Walters, Elizabeth Lea; Morawski, Kyle; Dorotta, Ihab; Ramsingh, Davinder; Lumen, Kelly; Bland, David; Clem, Kathleen; Nguyen, H Bryant

2011-04-01

Patients who present to the emergency department (ED) with return of spontaneous circulation after cardiac arrest generally have poor outcomes. Guidelines for treatment can be complicated and difficult to implement. This study examined the feasibility of implementing a care bundle including therapeutic hypothermia (TH) and early hemodynamic optimization for comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest. The study included patients over a 2-year period in the ED and intensive care unit of an academic tertiary-care medical center. The first year (prebundle) provided a historical control, followed by a prospective observational period of bundle implementation during the second year. The bundle elements included (a) TH initiated; (b) central venous pressure/central venous oxygen saturation monitoring in 2 h; (c) target temperature in 4 h; (d) central venous pressure greater than 12 mmHg in 6 h; (e) MAP greater than 65 mmHg in 6 h; (f) central venous oxygen saturation greater than 70% in 6 h; (g) TH maintained for 24 h; and (h) decreasing lactate in 24 h. Fifty-five patients were enrolled, 26 patients in the prebundle phase and 29 patients in the bundle phase. Seventy-seven percent of bundle elements were completed during the bundle phase. In-hospital mortality in bundle compared with prebundle patients was 55.2% vs. 69.2% (P = 0.29). In the bundle patients, those patients who received all elements of the care bundle had mortality 33.3% compared with 60.9% in those receiving some of the bundle elements (P = 0.22). Bundle patients tended to achieve good neurologic outcome compared with prebundle patients, Cerebral Performance Category 1 or 2 in 31 vs. 12% patients, respectively (P = 0.08). Our study demonstrated that a post-cardiac arrest care bundle that incorporates TH and early hemodynamic optimization can be implemented in the ED and intensive care unit collaboratively and can achieve similar clinical benefits compared with those observed in previous clinical trials.

Intensive care window: real-time monitoring and analysis in the intensive care environment.

PubMed

Stylianides, Nikolas; Dikaiakos, Marios D; Gjermundrød, Harald; Panayi, George; Kyprianou, Theodoros

2011-01-01

This paper introduces a novel, open-source middleware framework for communication with medical devices and an application using the middleware named intensive care window (ICW). The middleware enables communication with intensive care unit bedside-installed medical devices over standard and proprietary communication protocol stacks. The ICW application facilitates the acquisition of vital signs and physiological parameters exported from patient-attached medical devices and sensors. Moreover, ICW provides runtime and post-analysis procedures for data annotation, data visualization, data query, and analysis. The ICW application can be deployed as a stand-alone solution or in conjunction with existing clinical information systems providing a holistic solution to inpatient medical condition monitoring, early diagnosis, and prognosis.

Biological Effects–Based Tools for Monitoring Impacted Surface Waters in the Great Lakes: A Multiagency Program in Support of the Great Lakes Restoration Initiative

EPA Science Inventory

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particul...

VizieR Online Data Catalog: X-ray/UV Swift monitoring of NGC 4151 (Edelson+, 2017)

NASA Astrophysics Data System (ADS)

Edelson, R.; Gelbord, J.; Cackett, E.; Connolly, S.; Done, C.; Fausnaugh, M.; Gardner, E.; Gehrels, N.; Goad, M.; Horne, K.; McHardy, I.; Peterson, B. M.; Vaughan, S.; Vestergaard, M.; Breeveld, A.; Barth, A. J.; Bentz, M.; Bottorff, M.; Brandt, W. N.; Crawford, S. M.; Bonta, E. D.; Emmanoulopoulos, D.; Evans, P.; Jaimes, R. F.; Filippenko, A. V.; Ferland, G.; Grupe, D.; Joner, M.; Kennea, J.; Korista, K. T.; Krimm, H. A.; Kriss, G.; Leonard, D. C.; Mathur, S.; Netzer, H.; Nousek, J.; Page, K.; Romero-Colmenero, E.; Siegel, M.; Starkey, D. A.; Treu, T.; Vogler, H. A.; Winkler, H.; Zheng, W.

2017-11-01

During 2016 February 20 through April 29, Swift executed an intensive monitoring campaign on NGC 4151, consisting of 319 separate visits of at least 120s, an average of nearly five visits per day. These Swift observations were coordinated with intensive monitoring with numerous ground-based telescopes including the Las Cumbres Observatory Global Telescope network and the Liverpool Telescope at La Palma. Those data will be presented in subsequent papers (K. Horne et al. 2017, in preparation; M. Goad et al. 2017, in preparation). (3 data files).

Modular mechatronic system for stationary bicycles interfaced with virtual environment for rehabilitation

PubMed Central

2014-01-01

Background Cycling has been used in the rehabilitation of individuals with both chronic and post-surgical conditions. Among the challenges with implementing bicycling for rehabilitation is the recruitment of both extremities, in particular when one is weaker or less coordinated. Feedback embedded in virtual reality (VR) augmented cycling may serve to address the requirement for efficacious cycling; specifically recruitment of both extremities and exercising at a high intensity. Methods In this paper a mechatronic rehabilitation bicycling system with an interactive virtual environment, called Virtual Reality Augmented Cycling Kit (VRACK), is presented. Novel hardware components embedded with sensors were implemented on a stationary exercise bicycle to monitor physiological and biomechanical parameters of participants while immersing them in an augmented reality simulation providing the user with visual, auditory and haptic feedback. This modular and adaptable system attaches to commercially-available stationary bicycle systems and interfaces with a personal computer for simulation and data acquisition processes. The complete bicycle system includes: a) handle bars based on hydraulic pressure sensors; b) pedals that monitor pedal kinematics with an inertial measurement unit (IMU) and forces on the pedals while providing vibratory feedback; c) off the shelf electronics to monitor heart rate and d) customized software for rehabilitation. Bench testing for the handle and pedal systems is presented for calibration of the sensors detecting force and angle. Results The modular mechatronic kit for exercise bicycles was tested in bench testing and human tests. Bench tests performed on the sensorized handle bars and the instrumented pedals validated the measurement accuracy of these components. Rider tests with the VRACK system focused on the pedal system and successfully monitored kinetic and kinematic parameters of the rider’s lower extremities. Conclusions The VRACK system, a virtual reality mechatronic bicycle rehabilitation modular system was designed to convert most bicycles in virtual reality (VR) cycles. Preliminary testing of the augmented reality bicycle system was successful in demonstrating that a modular mechatronic kit can monitor and record kinetic and kinematic parameters of several riders. PMID:24902780

Validity of Wearable Activity Monitors during Cycling and Resistance Exercise.

PubMed

Boudreaux, Benjamin D; Hebert, Edward P; Hollander, Daniel B; Williams, Brian M; Cormier, Corinne L; Naquin, Mildred R; Gillan, Wynn W; Gusew, Emily E; Kraemer, Robert R

2018-03-01

The use of wearable activity monitors has seen rapid growth; however, the mode and intensity of exercise could affect the validity of heart rate (HR) and caloric (energy) expenditure (EE) readings. There is a lack of data regarding the validity of wearable activity monitors during graded cycling regimen and a standard resistance exercise. The present study determined the validity of eight monitors for HR compared with an ECG and seven monitors for EE compared with a metabolic analyzer during graded cycling and resistance exercise. Fifty subjects (28 women, 22 men) completed separate trials of graded cycling and three sets of four resistance exercises at a 10-repetition-maximum load. Monitors included the following: Apple Watch Series 2, Fitbit Blaze, Fitbit Charge 2, Polar H7, Polar A360, Garmin Vivosmart HR, TomTom Touch, and Bose SoundSport Pulse (BSP) headphones. HR was recorded after each cycling intensity and after each resistance exercise set. EE was recorded after both protocols. Validity was established as having a mean absolute percent error (MAPE) value of ≤10%. The Polar H7 and BSP were valid during both exercise modes (cycling: MAPE = 6.87%, R = 0.79; resistance exercise: MAPE = 6.31%, R = 0.83). During cycling, the Apple Watch Series 2 revealed the greatest HR validity (MAPE = 4.14%, R = 0.80). The BSP revealed the greatest HR accuracy during resistance exercise (MAPE = 6.24%, R = 0.86). Across all devices, as exercise intensity increased, there was greater underestimation of HR. No device was valid for EE during cycling or resistance exercise. HR from wearable devices differed at different exercise intensities; EE estimates from wearable devices were inaccurate. Wearable devices are not medical devices, and users should be cautious when using these devices for monitoring physiological responses to exercise.

Implementation of effective practices in health facilities: a systematic review of cluster randomised trials.

PubMed

Allanson, Emma R; Tunçalp, Özge; Vogel, Joshua P; Khan, Dina N; Oladapo, Olufemi T; Long, Qian; Gülmezoglu, Ahmet Metin

2017-01-01

The capacity for health systems to support the translation of research in to clinical practice may be limited. The cluster randomised controlled trial (cluster RCT) design is often employed in evaluating the effectiveness of implementation of evidence-based practices. We aimed to systematically review available evidence to identify and evaluate the components in the implementation process at the facility level using cluster RCT designs. All cluster RCTs where the healthcare facility was the unit of randomisation, published or written from 1990 to 2014, were assessed. Included studies were analysed for the components of implementation interventions employed in each. Through iterative mapping and analysis, we synthesised a master list of components used and summarised the effects of different combinations of interventions on practices. Forty-six studies met the inclusion criteria and covered the specialty groups of obstetrics and gynaecology (n=9), paediatrics and neonatology (n=4), intensive care (n=4), internal medicine (n=20), and anaesthetics and surgery (n=3). Six studies included interventions that were delivered across specialties. Nine components of multifaceted implementation interventions were identified: leadership, barrier identification, tailoring to the context, patient involvement, communication, education, supportive supervision, provision of resources, and audit and feedback. The four main components that were most commonly used were education (n=42, 91%), audit and feedback (n=26, 57%), provision of resources (n=23, 50%) and leadership (n=21, 46%). Future implementation research should focus on better reporting of multifaceted approaches, incorporating sets of components that facilitate the translation of research into practice, and should employ rigorous monitoring and evaluation.

33 CFR 157.12b - Implementation requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12b Implementation requirements. Oil discharge monitoring and control systems must be fitted to oil tankers to which this subpart applies. A monitoring and...

33 CFR 157.12b - Implementation requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12b Implementation requirements. Oil discharge monitoring and control systems must be fitted to oil tankers to which this subpart applies. A monitoring and...

33 CFR 157.12b - Implementation requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12b Implementation requirements. Oil discharge monitoring and control systems must be fitted to oil tankers to which this subpart applies. A monitoring and...

33 CFR 157.12b - Implementation requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12b Implementation requirements. Oil discharge monitoring and control systems must be fitted to oil tankers to which this subpart applies. A monitoring and...

33 CFR 157.12b - Implementation requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12b Implementation requirements. Oil discharge monitoring and control systems must be fitted to oil tankers to which this subpart applies. A monitoring and...

Monitoring HIV and AIDS Related Policy Reforms: A Road Map to Strengthen Policy Monitoring and Implementation in PEPFAR Partner Countries

PubMed Central

2016-01-01

Achieving an AIDS-free generation will require the adoption and implementation of critical health policy reforms. However, countries with high HIV burden often have low policy development, advocacy, and monitoring capacity. This lack of capacity may be a significant barrier to achieving the AIDS-free generation goals. This manuscript describes the increased focus on policy development and implementation by the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It evaluates the curriculum and learning modalities used for two regional policy capacity building workshops organized around the PEPFAR Partnership Framework agreements and the Road Map for Monitoring and Implementing Policy Reforms. A total of 64 participants representing the U.S. Government, partner country governments, and civil society organizations attended the workshops. On average, participants responded that their policy monitoring skills improved and that they felt they were better prepared to monitor policy reforms three months after the workshop. When followed-up regarding utilization of the Road Map action plan, responses were mixed. Reasons cited for not making progress included an inability to meet or a lack of time, personnel, or governmental support. This lack of progress may point to a need for building policy monitoring systems in high HIV burden countries. Because the success of policy reforms cannot be measured by the mere adoption of written policy documents, monitoring the implementation of policy reforms and evaluating their public health impact is essential. In many high HIV burden countries, policy development and monitoring capacity remains weak. This lack of capacity could hinder efforts to achieve the ambitious AIDS-free generation treatment, care and prevention goals. The Road Map appears to be a useful tool for strengthening these critical capacities. PMID:26914708

Hands-On Experiences in Deploying Cost-Effective Ambient-Assisted Living Systems

PubMed Central

Dasios, Athanasios; Gavalas, Damianos; Pantziou, Grammati; Konstantopoulos, Charalampos

2015-01-01

Older adults’ preferences to remain independent in their own homes along with the high costs of nursing home care have motivated the development of Ambient Assisted Living (AAL) technologies which aim at improving the safety, health conditions and wellness of the elderly. This paper reports hands-on experiences in designing, implementing and operating UbiCare, an AAL based prototype system for elderly home care monitoring. The monitoring is based on the recording of environmental parameters like temperature and light intensity as well as micro-level incidents which allows one to infer daily activities like moving, sitting, sleeping, usage of electrical appliances and plumbing components. The prototype is built upon inexpensive, off-the-shelf hardware (e.g., various sensors, Arduino microcontrollers, ZigBee-compatible wireless communication modules) and license-free software, thereby ensuring low system deployment costs. The network comprises nodes placed in a house’s main rooms or mounted on furniture, one wearable node, one actuator node and a centralized processing element (coordinator). Upon detecting significant deviations from the ordinary activity patterns of individuals and/or sudden falls, the system issues automated alarms which may be forwarded to authorized caregivers via a variety of communication channels. Furthermore, measured environmental parameters and activity incidents may be monitored through standard web interfaces. PMID:26094631

Hands-On Experiences in Deploying Cost-Effective Ambient-Assisted Living Systems.

PubMed

Dasios, Athanasios; Gavalas, Damianos; Pantziou, Grammati; Konstantopoulos, Charalampos

2015-06-18

Older adults' preferences to remain independent in their own homes along with the high costs of nursing home care have motivated the development of Ambient Assisted Living (AAL) technologies which aim at improving the safety, health conditions and wellness of the elderly. This paper reports hands-on experiences in designing, implementing and operating UbiCare, an AAL based prototype system for elderly home care monitoring. The monitoring is based on the recording of environmental parameters like temperature and light intensity as well as micro-level incidents which allows one to infer daily activities like moving, sitting, sleeping, usage of electrical appliances and plumbing components. The prototype is built upon inexpensive, off-the-shelf hardware (e.g., various sensors, Arduino microcontrollers, ZigBee-compatible wireless communication modules) and license-free software, thereby ensuring low system deployment costs. The network comprises nodes placed in a house's main rooms or mounted on furniture, one wearable node, one actuator node and a centralized processing element (coordinator). Upon detecting significant deviations from the ordinary activity patterns of individuals and/or sudden falls, the system issues automated alarms which may be forwarded to authorized caregivers via a variety of communication channels. Furthermore, measured environmental parameters and activity incidents may be monitored through standard web interfaces.

Image Corruption Detection in Diffusion Tensor Imaging for Post-Processing and Real-Time Monitoring

PubMed Central

Li, Yue; Shea, Steven M.; Lorenz, Christine H.; Jiang, Hangyi; Chou, Ming-Chung; Mori, Susumu

2013-01-01

Due to the high sensitivity of diffusion tensor imaging (DTI) to physiological motion, clinical DTI scans often suffer a significant amount of artifacts. Tensor-fitting-based, post-processing outlier rejection is often used to reduce the influence of motion artifacts. Although it is an effective approach, when there are multiple corrupted data, this method may no longer correctly identify and reject the corrupted data. In this paper, we introduce a new criterion called “corrected Inter-Slice Intensity Discontinuity” (cISID) to detect motion-induced artifacts. We compared the performance of algorithms using cISID and other existing methods with regard to artifact detection. The experimental results show that the integration of cISID into fitting-based methods significantly improves the retrospective detection performance at post-processing analysis. The performance of the cISID criterion, if used alone, was inferior to the fitting-based methods, but cISID could effectively identify severely corrupted images with a rapid calculation time. In the second part of this paper, an outlier rejection scheme was implemented on a scanner for real-time monitoring of image quality and reacquisition of the corrupted data. The real-time monitoring, based on cISID and followed by post-processing, fitting-based outlier rejection, could provide a robust environment for routine DTI studies. PMID:24204551

An Interoperable System toward Cardiac Risk Stratification from ECG Monitoring

PubMed Central

Mora-Jiménez, Inmaculada; Ramos-López, Javier; Quintanilla Fernández, Teresa; García-García, Antonio; Díez-Mazuela, Daniel; García-Alberola, Arcadi

2018-01-01

Many indices have been proposed for cardiovascular risk stratification from electrocardiogram signal processing, still with limited use in clinical practice. We created a system integrating the clinical definition of cardiac risk subdomains from ECGs and the use of diverse signal processing techniques. Three subdomains were defined from the joint analysis of the technical and clinical viewpoints. One subdomain was devoted to demographic and clinical data. The other two subdomains were intended to obtain widely defined risk indices from ECG monitoring: a simple-domain (heart rate turbulence (HRT)), and a complex-domain (heart rate variability (HRV)). Data provided by the three subdomains allowed for the generation of alerts with different intensity and nature, as well as for the grouping and scrutinization of patients according to the established processing and risk-thresholding criteria. The implemented system was tested by connecting data from real-world in-hospital electronic health records and ECG monitoring by considering standards for syntactic (HL7 messages) and semantic interoperability (archetypes based on CEN/ISO EN13606 and SNOMED-CT). The system was able to provide risk indices and to generate alerts in the health records to support decision-making. Overall, the system allows for the agile interaction of research and clinical practice in the Holter-ECG-based cardiac risk domain. PMID:29494497

Distributed Large Data-Object Environments: End-to-End Performance Analysis of High Speed Distributed Storage Systems in Wide Area ATM Networks

NASA Technical Reports Server (NTRS)

Johnston, William; Tierney, Brian; Lee, Jason; Hoo, Gary; Thompson, Mary

1996-01-01

We have developed and deployed a distributed-parallel storage system (DPSS) in several high speed asynchronous transfer mode (ATM) wide area networks (WAN) testbeds to support several different types of data-intensive applications. Architecturally, the DPSS is a network striped disk array, but is fairly unique in that its implementation allows applications complete freedom to determine optimal data layout, replication and/or coding redundancy strategy, security policy, and dynamic reconfiguration. In conjunction with the DPSS, we have developed a 'top-to-bottom, end-to-end' performance monitoring and analysis methodology that has allowed us to characterize all aspects of the DPSS operating in high speed ATM networks. In particular, we have run a variety of performance monitoring experiments involving the DPSS in the MAGIC testbed, which is a large scale, high speed, ATM network and we describe our experience using the monitoring methodology to identify and correct problems that limit the performance of high speed distributed applications. Finally, the DPSS is part of an overall architecture for using high speed, WAN's for enabling the routine, location independent use of large data-objects. Since this is part of the motivation for a distributed storage system, we describe this architecture.

Fast segmentation of industrial quality pavement images using Laws texture energy measures and k -means clustering

NASA Astrophysics Data System (ADS)

Mathavan, Senthan; Kumar, Akash; Kamal, Khurram; Nieminen, Michael; Shah, Hitesh; Rahman, Mujib

2016-09-01

Thousands of pavement images are collected by road authorities daily for condition monitoring surveys. These images typically have intensity variations and texture nonuniformities that make their segmentation challenging. The automated segmentation of such pavement images is crucial for accurate, thorough, and expedited health monitoring of roads. In the pavement monitoring area, well-known texture descriptors, such as gray-level co-occurrence matrices and local binary patterns, are often used for surface segmentation and identification. These, despite being the established methods for texture discrimination, are inherently slow. This work evaluates Laws texture energy measures as a viable alternative for pavement images for the first time. k-means clustering is used to partition the feature space, limiting the human subjectivity in the process. Data classification, hence image segmentation, is performed by the k-nearest neighbor method. Laws texture energy masks are shown to perform well with resulting accuracy and precision values of more than 80%. The implementations of the algorithm, in both MATLAB® and OpenCV/C++, are extensively compared against the state of the art for execution speed, clearly showing the advantages of the proposed method. Furthermore, the OpenCV-based segmentation shows a 100% increase in processing speed when compared to the fastest algorithm available in literature.

Review of atmospheric ammonia data in the context of developing technologies, changing climate, and future policy evidence needs

NASA Astrophysics Data System (ADS)

Braban, Christine; Tang, Sim; Bealey, Bill; Roberts, Elin; Stephens, Amy; Galloway, Megan; Greenwood, Sarah; Sutton, Mark; Nemitz, Eiko; Leaver, David

2017-04-01

Ambient ammonia measurements have been undertaken both in the atmosphere to understand sources, concentrations at background and vulnerable ecosystems and for long term monitoring of concentrations. As a pollutant which is projected to increase concentration in the coming decades with significant policy challenges to implementing mitigation strategies it is useful to assess what has been measured, where and why. In this study a review of the literature, has shown that ammonia measurements are frequently not publically reported and in general not reposited in the open data centres, available for research. The specific sectors where measurements have been undertaken are: agricultural point source assessments, agricultural surface exchange measurements, sensitive ecosystem monitoring, landscape/regional studies and governmental long term monitoring. Less frequently ammonia is measured as part of an intensive atmospheric chemistry field campaign. Technology is developing which means a shift from chemical denuder methods to spectroscopic techniques may be possible, however chemical denuding techniques with off-line laboratory analysis will likely be an economical approach for some time to come. This paper reviews existing datasets from the different sectors of research and integrates them for a global picture to allow both a long term understanding and facilitate comparison with future measurements.

A Decade of Change in NO2 and SO2 over the Canadian Oil Sands As Seen from Space

NASA Technical Reports Server (NTRS)

Mclinden, Chris A.; Fioletov, Vitali; Krotkov, Nickolay A.; Li, Can; Boersma, K. Folkert; Adams, Cristen

2015-01-01

A decade (20052014) of observations from the Ozone Monitoring Instrument (OMI) were used to examine trends in nitrogen dioxide(NO2) and sulfur dioxide (SO2) over a large region of western Canada and the northern United States, with a focus on the Canadian oil sands. In the oil sands, primarily over an area of intensive surface mining, NO2 tropospheric vertical column densities (VCDs) are seen to be increasing by as much as 10year, with the location of the largest trends in a newly developing NO2 lobe well removed from surface monitoring stations. SO2 VCDs in the oil sands have remained approximately constant. The only other significant increase in the region was seen in NO2 over Bakken gas fields in North Dakota which showed increases of up to5yr. By contrast, other locations in the region show substantial declines in both pollutants, providing strong evidence to the efficacy of environmental pollution control measures implemented by both nations. The OMI-derived trends were found to be consistent with those from the Canadian surface monitoring network, although in the case of SO2, it was necessary to apply a correction in order to remove the residual signal from volcanic eruptions present in the OMI data.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Creating and Implementing a Regularized Monitoring and EnforcementSystem for China's Mandatory Standards and Energy Information Label forAppliances

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

Lin, Jiang

2007-03-01

China has developed a comprehensive program of energy efficiency standards and labels for household appliances. In 1989, China first launched its minimum energy performance standards (MEPS), which are now applied to an extensive list of products. In 1998, China launched a voluntary energy endorsement label, which has grown to cover both energy-saving and water-saving products. And, in 2005, China launched a mandatory energy information label that initially covered two products. CLASP has assisted China in developing 11 minimum energy performance standards (MEPS) for 9 products and endorsement labels for 11 products including: refrigerators; air conditioners; televisions; printers; computers; monitors; faxmore » machines; copiers; DVD/VCD players; external power supplies; and set-top boxes. CLASP has also assisted China in the development of the mandatory energy information label. Increasingly, attention is being placed on maximum energy savings from China's standards and labeling (S&L) efforts in order to meet the recently announced goal of reducing China's energy intensity by 20 percent by 2010 with an interim objective of 4 percent in 2006. China's mandatory standards system is heavily focused on the technical requirements for efficiency performance, but historically, it has lacked administrative and personnel capacity to undertake monitoring and enforcement of these legally binding standards. Similarly, resources for monitoring and enforcement have been quite limited. As a consequence, compliance to both the mandatory standards and the mandatory energy information label is uneven with the potential and likely result of lost energy savings. Thus, a major area for improvement, which could significantly increase overall energy savings, is the creation and implementation of a regularized monitoring system for tracking the compliance to, and enforcement of, mandatory standards and the energy information label in China. CLASP has been working with the China National Institute of Standardization (CNIS), the China Administration for Quality, Supervision, Inspection and Quarantine (AQSIQ) and relevant stakeholders in the industry to develop a stronger system of monitoring and enforcement. In November 2005, CNIS and LBNL (a CLASP implementing partner) with funding from the Energy Foundation jointly organized an international workshop to present the international best practices in S&L monitoring and enforcement. Currently, CNIS is developing a guideline for monitoring and enforcement for appliance standards. With support from METI, CLASP has been able to expand the on-going collaboration with CNIS to include enforcement needs for the mandatory energy information label and to accelerate the progress of the project to develop a more robust monitoring and enforcement for S&L programs in China. This expanded effort has included: (1) Holding an enforcement and monitoring roadmap planning workshop with key S&L stakeholders; (2) Interviews with S&L stakeholders on the need and scope of national compliance tests; (3) Research on past enforcement activities; (4) An analysis of compliance data from the mandatory energy information labeling program; (5) Interviews with stakeholders on the need and scope of testing infrastructure; and (6) Development of a roadmap for future activities. This report summarizes the findings of these activities and identifies the progress that China is making, and can make, toward developing a stronger system of monitoring and enforcement (M&E). In sum, it outlines a vision of moving forward with more vigorous M&E in China.« less

A Randomized Controlled Trial to Evaluate Outcomes of a Workplace Self-Management Intervention and an Intensive Monitoring Intervention

ERIC Educational Resources Information Center

Schopp, Laura H.; Clark, Mary J.; Lamberson, William R.; Uhr, David J.; Minor, Marian A.

2017-01-01

The purpose of this study was to determine and compare outcomes of two voluntary workplace health management methods: an adapted worksite self-management (WSM) approach and an intensive health monitoring (IM) approach. Research participants were randomly assigned to either the WSM group or the IM group by a computer-generated list (n = 180; 92 WSM…

Students, Teachers, and Schools as Sources of Variability, Integrity, and Sustainability in Implementing Progress Monitoring

ERIC Educational Resources Information Center

Bolt, Daniel M.; Ysseldyke, Jim; Patterson, Michael J.

2010-01-01

A three-level variance decomposition analysis was used to examine the sources of variability in implementation of a technology-enhanced progress monitoring system within each year of a 2-year study using a randomized-controlled design. We show that results of technology-enhanced progress monitoring are not necessarily a measure of student…

Cost calculation for a flash glucose monitoring system for UK adults with type 1 diabetes mellitus receiving intensive insulin treatment.

PubMed

Hellmund, Richard; Weitgasser, Raimund; Blissett, Deirdre

2018-04-01

To estimate the costs associated with a flash glucose monitoring system as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 1 diabetes mellitus (T1DM) using intensive insulin, from a UK National Health Service (NHS) perspective. The base-case cost calculation was created using the maximum frequency of glucose monitoring recommended by the 2015 National Institute for Health and Care Excellence guidelines (4-10 tests per day). Scenario analyses considered SMBG at the frequency observed in the IMPACT clinical trial (5.6 tests per day) and at the frequency of flash monitoring observed in a real-world analysis (16 tests per day). A further scenario included potential costs associated with severe hypoglycaemia. In the base case, the annual cost per patient using flash monitoring was £234 (19%) lower compared with routine SMBG (10 tests per day). In scenario analyses, the annual cost per patient of flash monitoring compared with 5.6 and 16 SMBG tests per day was £296 higher and £957 lower, respectively. The annual cost of severe hypoglycaemia for flash monitoring users was estimated to be £221 per patient, compared with £428 for routine SMBG users (based on 5.6 tests/day), corresponding to a reduction in costs of £207. The flash monitoring system has a modest impact on glucose monitoring costs for the UK NHS for patients with T1DM using intensive insulin. For people requiring frequent tests, flash monitoring may be cost saving, especially when taking into account potential reductions in the rate of severe hypoglycaemia. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Fiber optic choline biosensor

NASA Astrophysics Data System (ADS)

Wang, Hong; Cao, Xiaojian; Jia, Ke; Chai, Xueting; Lu, Hua; Lu, Zuhong

2001-10-01

A fiber optic fluorescence biosensor for choline is introduced in this paper. Choline is an important neurotransmitter in mammals. Due to the growing needs for on-site clinical monitoring of the choline, much effect has been devoted to develop choline biosensors. Fiber-optic fluorescence biosensors have many advantages, including miniaturization, flexibility, and lack of electrical contact and interference. The choline fiber-optic biosensor we designed implemented a bifurcated fiber to perform fluorescence measurements. The light of the blue LED is coupled into one end of the fiber as excitation and the emission spectrum from sensing film is monitored by fiber-spectrometer (S2000, Ocean Optics) through the other end of the fiber. The sensing end of the fiber is coated with Nafion film dispersed with choline oxidase and oxygen sensitive luminescent Ru(II) complex (Tris(2,2'-bipyridyl)dichlororuthenium(II), hexahydrate). Choline oxidase catalyzes the oxidation of choline to betaine and hydrogen peroxide while consuming oxygen. The fluorescence intensity of oxygen- sensitive Ru(II) are related to the choline concentration. The response of the fiber-optic sensor in choline solution is represented and discussed. The result indicates a low-cost, high-performance, portable choline biosensor.

Study on laser-assisted drug delivery with optical coherence tomography

NASA Astrophysics Data System (ADS)

Tsai, Wen-Guei; Tsai, Ting-Yen; Yang, Chih-Hsun; Tsai, Meng-Tsan

2017-04-01

The nail provides a functional protection to the fingertips and surrounding tissue from external injuries. Nail plate divided into three layers including dorsal, intermediate, and ventral layers. The dorsal layer consists of compact, hard keratins, limiting topical drug delivery through the nail. In this study, we investigate the application of fractional CO2 laser that produces arrays of microthermal ablation zones (MAZs) to facilitate drug delivery in the nails. Moreover, optical coherence tomography (OCT) is implemented for real-time monitoring of the laser-skin tissue interaction, sparing the patient from invasive surgical sampling procedure. Observations of drug diffusion through the induced MAZ array are achieved by evaluating the time-dependent OCT intensity variance. Subsequently, nails are treated with cream and liquid topical drugs to investigate the feasibility and diffusion efficacy of laser-assisted drug delivery. Our results show that fractional CO2 laser improves the efficacy of topical drug delivery in the nail plate, and that OCT could potentially be used for in vivo monitoring of the depth of laser penetration as well as real-time observations of drug delivery.

Surgical treatment of secondary peritonitis : A continuing problem.

PubMed

van Ruler, O; Boermeester, M A

2017-01-01

Secondary peritonitis remains associated with high mortality and morbidity rates. Treatment of secondary peritonitis is challenging even in modern medicine. Surgical intervention for source control remains the cornerstone of treatment, beside adequate antimicrobial therapy and resuscitation. A randomized clinical trial showed that relaparotomy on demand (ROD) after initial emergency surgery is the preferred treatment strategy, irrespective of the severity and extent of peritonitis. The effective and safe use of ROD requires intensive monitoring of the patient in a setting where diagnostic tests and decision making about relaparotomy are guaranteed round the clock. The lack of knowledge on timely and adequate patient selection, together with the lack of use of easy but reliable monitoring tools, seems to hamper full implementation of ROD. The accuracy of the relap decision tool is reasonable for prediction of ongoing peritonitis and selection for computer tomography (CT). The value of CT in an early postoperative phase is unclear. Future research and innovative technologies should focus on the additive value of CT in cases of operated secondary peritonitis and on the further optimization of bedside prediction tools to enhance adequate patient selection for intervention in a multidisciplinary setting.

Sampling Approaches for Multi-Domain Internet Performance Measurement Infrastructures

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

Calyam, Prasad

2014-09-15

The next-generation of high-performance networks being developed in DOE communities are critical for supporting current and emerging data-intensive science applications. The goal of this project is to investigate multi-domain network status sampling techniques and tools to measure/analyze performance, and thereby provide “network awareness” to end-users and network operators in DOE communities. We leverage the infrastructure and datasets available through perfSONAR, which is a multi-domain measurement framework that has been widely deployed in high-performance computing and networking communities; the DOE community is a core developer and the largest adopter of perfSONAR. Our investigations include development of semantic scheduling algorithms, measurement federationmore » policies, and tools to sample multi-domain and multi-layer network status within perfSONAR deployments. We validate our algorithms and policies with end-to-end measurement analysis tools for various monitoring objectives such as network weather forecasting, anomaly detection, and fault-diagnosis. In addition, we develop a multi-domain architecture for an enterprise-specific perfSONAR deployment that can implement monitoring-objective based sampling and that adheres to any domain-specific measurement policies.« less

Ichthyoplankton abundance and variance in a large river system concerns for long-term monitoring

USGS Publications Warehouse

Holland-Bartels, Leslie E.; Dewey, Michael R.; Zigler, Steven J.

1995-01-01

System-wide spatial patterns of ichthyoplankton abundance and variability were assessed in the upper Mississippi and lower Illinois rivers to address the experimental design and statistical confidence in density estimates. Ichthyoplankton was sampled from June to August 1989 in primary milieus (vegetated and non-vegated backwaters and impounded areas, main channels and main channel borders) in three navigation pools (8, 13 and 26) of the upper Mississippi River and in a downstream reach of the Illinois River. Ichthyoplankton densities varied among stations of similar aquatic landscapes (milieus) more than among subsamples within a station. An analysis of sampling effort indicated that the collection of single samples at many stations in a given milieu type is statistically and economically preferable to the collection of multiple subsamples at fewer stations. Cluster analyses also revealed that stations only generally grouped by their preassigned milieu types. Pilot studies such as this can define station groupings and sources of variation beyond an a priori habitat classification. Thus the minimum intensity of sampling required to achieve a desired statistical confidence can be identified before implementing monitoring efforts.

Interstage Home Monitoring After Newborn First-Stage Palliation for Hypoplastic Left Heart Syndrome: Family Education Strategies.

PubMed

Nieves, Jo Ann; Uzark, Karen; Rudd, Nancy A; Strawn, Jennifer; Schmelzer, Anne; Dobrolet, Nancy

2017-04-01

Children born with hypoplastic left heart syndrome are at high risk for serious morbidity, growth failure, and mortality during the interstage period, which is the time from discharge home after first-stage hypoplastic left heart syndrome palliation until the second-stage surgical intervention. The single-ventricle circulatory physiology is complex, fragile, and potentially unstable. Multicenter initiatives have been successfully implemented to improve outcomes and optimize growth and survival during the interstage period. A crucial focus of care is the comprehensive family training in the use of home surveillance monitoring of oxygen saturation, enteral intake, weight, and the early recognition of "red flag" symptoms indicating potential cardiopulmonary or nutritional decompensation. Beginning with admission to the intensive care unit of the newborn with hypoplastic left heart syndrome, nurses provide critical care and education to prepare the family for interstage home care. This article presents detailed nursing guidelines for educating families on the home care of their medically fragile infant with single-ventricle circulation. ©2017 American Association of Critical-Care Nurses.

Design and Implementation of a Coastal-Mounted Sensor for Oil Film Detection on Seawater

PubMed Central

Hou, Yongchao; Li, Ying; Liu, Yu; Wang, Tong

2017-01-01

The routine surveillance of oil spills in major ports is important. However, existing techniques and sensors are unable to trace oil and micron-thin oil films on the surface of seawater. Therefore, we designed and studied a coastal-mounted sensor, using ultraviolet-induced fluorescence and fluorescence-filter systems (FFSs), to monitor oil spills and overcome the disadvantages of traditional surveillance systems. Using seawater from the port of Lingshui (Yellow Sea, China) and six oil samples of different types, we found that diesel oil’s relative fluorescence intensity (RFI) was significantly higher than those of heavy fuel and crude oils in the 180–300 nm range—in the 300–400 nm range, the RFI value of diesel is far lower. The heavy fuel and crude oils exhibited an opposite trend in their fluorescence spectra. A photomultiplier tube, employed as the fluorescence detection unit, efficiently monitored different oils on seawater in field experiments. On-site tests indicated that this sensor system could be used as a coastal-mounted early-warning detection system for oil spills. PMID:29283412

Identifying professionals' needs in integrating electronic pain monitoring in community palliative care services: An interview study.

PubMed

Taylor, Sally; Allsop, Matthew J; Bekker, Hilary L; Bennett, Michael I; Bewick, Bridgette M

2017-07-01

Poor pain assessment is a barrier to effective pain control. There is growing interest internationally in the development and implementation of remote monitoring technologies to enhance assessment in cancer and chronic disease contexts. Findings describe the development and testing of pain monitoring systems, but research identifying the needs of health professionals to implement routine monitoring systems within clinical practice is limited. To inform the development and implementation strategy of an electronic pain monitoring system, PainCheck, by understanding palliative care professionals' needs when integrating PainCheck into routine clinical practice. Qualitative study using face-to-face interviews. Data were analysed using framework analysis Setting/participants: Purposive sample of health professionals managing the palliative care of patients living in the community Results: A total of 15 interviews with health professionals took place. Three meta-themes emerged from the data: (1) uncertainties about integration of PainCheck and changes to current practice, (2) appraisal of current practice and (3) pain management is everybody's responsibility Conclusion: Even the most sceptical of health professionals could see the potential benefits of implementing an electronic patient-reported pain monitoring system. Health professionals have reservations about how PainCheck would work in practice. For optimal use, PainCheck needs embedding within existing electronic health records. Electronic pain monitoring systems have the potential to enable professionals to support patients' pain management more effectively but only when barriers to implementation are appropriately identified and addressed.

Efficient color correction method for smartphone camera-based health monitoring application.

PubMed

Duc Dang; Chae Ho Cho; Daeik Kim; Oh Seok Kwon; Jo Woon Chong

2017-07-01

Smartphone health monitoring applications are recently highlighted due to the rapid development of hardware and software performance of smartphones. However, color characteristics of images captured by different smartphone models are dissimilar each other and this difference may give non-identical health monitoring results when the smartphone health monitoring applications monitor physiological information using their embedded smartphone cameras. In this paper, we investigate the differences in color properties of the captured images from different smartphone models and apply a color correction method to adjust dissimilar color values obtained from different smartphone cameras. Experimental results show that the color corrected images using the correction method provide much smaller color intensity errors compared to the images without correction. These results can be applied to enhance the consistency of smartphone camera-based health monitoring applications by reducing color intensity errors among the images obtained from different smartphones.

Introducing a modular activity monitoring system.

PubMed

Reiss, Attila; Stricker, Didier

2011-01-01

In this paper, the idea of a modular activity monitoring system is introduced. By using different combinations of the system's three modules, different functionality becomes available: 1) a coarse intensity estimation of physical activities 2) different features based on HR-data and 3) the recognition of basic activities and postures. 3D-accelerometers--placed on lower arm, chest and foot--and a heart rate monitor were used as sensors. A dataset with 8 subjects and 14 different activities was recorded to evaluate the performance of the system. The overall performance on the intensity estimation task, relying on the chest-worn accelerometer and the HR-monitor, was 94.37%. The overall performance on the activity recognition task, using all three accelerometer placements and the HR-monitor, was 90.65%. This paper also gives an analysis of the importance of different accelerometer placements and the importance of a HR-monitor for both tasks.

Pervasive technology in Neonatal Intensive Care Unit: a prototype for newborns unobtrusive monitoring.

PubMed

Ciani, Oriana; Piccini, Luca; Parini, Sergio; Rullo, Alessia; Bagnoli, Franco; Marti, Patrizia; Andreoni, Giuseppe

2008-01-01

Pervasive computing research is introducing new perspectives in a wide range of applications, including healthcare domain. In this study we explore the possibility to realize a prototype of a system for unobtrusive recording and monitoring of multiple biological parameters on premature newborns hospitalized in the Neonatal Intensive Care Unit (NICU). It consists of three different units: a sensitized belt for Electrocardiogram (ECG) and chest dilatation monitoring, augmented with extrinsic transducers for temperature and respiratory activity measure, a device for signals pre-processing, sampling and transmission through Bluetooth(R) (BT) technology to a remote PC station and a software for data capture and post-processing. Preliminary results obtained by monitoring babies just discharged from the ward demonstrated the feasibility of the unobtrusive monitoring on this kind of subjects and open a new scenario for premature newborns monitoring and developmental cares practice in NICU.

The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial.

PubMed

Cheng, D C; Newman, M F; Duke, P; Wong, D T; Finegan, B; Howie, M; Fitch, J; Bowdle, T A; Hogue, C; Hillel, Z; Pierce, E; Bukenya, D

2001-05-01

We compared (a) the perioperative complications; (b) times to eligibility for, and actual time of the following: extubation, less intense monitoring, intensive care unit (ICU), and hospital discharge; and (c) resource utilization of nursing ratio for patients receiving either a typical fentanyl/isoflurane/propofol regimen or a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in 304 adults by using a prospective randomized, double-blinded, double-dummy trial. There were no differences in demographic data, or perioperative mortality and morbidity between the two study groups. The mini-mental status examination at postoperative Days 1 to 3 were similar between the two groups. The eligible and actual times for extubation, less intense monitoring, ICU discharge, and hospital discharge were not significantly different. Further analyses revealed no differences in times for extubation and resource utilization after stratification by preoperative risk scores, age, and country. The nurse/patient ratio was similar between the remifentanil/isoflurane/propofol and fentanyl/isoflu-rane/propofol groups during the initial ICU phase and less intense monitoring phase. Increasing preoperative risk scores and older age (>70 yr) were associated with longer times until extubation (eligible), ICU discharge (eligible and actual), and hospital discharge (eligible and actual). Times until extubation (eligible and actual) and less intense monitoring (eligible) were significantly shorter in Canadian patients than United States' patients. However, there was no difference in hospital length of stay in Canadian and United States' patients. We conclude that both anesthesia techniques permit early and similar times until tracheal extubation, less intense monitoring, ICU and hospital discharge, and reduced resource utilization after coronary artery bypass graft surgery. An ultra-short opioid technique was compared with a standard fast-track small-dose opioid technique in coronary artery bypass graft patients in a prospective randomized, double-blinded controlled study. The postoperative recovery and resource utilization, including stratification of preoperative risk score, age, and country, were analyzed.

Low-intensity, stocker-based channel catfish culture

USDA-ARS?s Scientific Manuscript database

Low-intensity Channel Catfish production is characterized by low stocking rates, low installed aeration capacity, and no automated dissolved oxygen monitoring. Two studies conducted in nine 0.25-acre ponds quantified production characteristics of stocker Channel Catfish stocked for low-intensity foo...

Using iKidTools™ Software Support Systems to Develop and Implement Self-Monitoring Interventions

ERIC Educational Resources Information Center

Patti, Angela L.; Miller, Kevin J.

2011-01-01

Educational teams often are faced with the task of developing and implementing Behavioral Intervention Plans (BIPs) for students who present challenging and/or disruptive behaviors. This article describes the steps used to develop and implement a self-monitoring BIP that incorporated an innovative software system, iKidTools™. An authentic case…

The Reliability and User-Feasibility of Materials and Procedures for Monitoring the Implementation Integrity of a Reading Intervention

ERIC Educational Resources Information Center

Begeny, John C.; Easton, Julia E.; Upright, James J.; Tunstall, Kali R.; Ehrenbock, Cassia A.

2014-01-01

Within the realm of school-based interventions, implementation integrity is important for practical, legal, and ethical purposes. Unfortunately, evidence suggests that proper monitoring of implementation integrity is often absent from both research and practice. School psychology practitioners and researchers have reported that a major barrier to…

Implementation of a research prototype onboard fault monitoring and diagnosis system

NASA Technical Reports Server (NTRS)

Palmer, Michael T.; Abbott, Kathy H.; Schutte, Paul C.; Ricks, Wendell R.

1987-01-01

Due to the dynamic and complex nature of in-flight fault monitoring and diagnosis, a research effort was undertaken at NASA Langley Research Center to investigate the application of artificial intelligence techniques for improved situational awareness. Under this research effort, concepts were developed and a software architecture was designed to address the complexities of onboard monitoring and diagnosis. This paper describes the implementation of these concepts in a computer program called FaultFinder. The implementation of the monitoring, diagnosis, and interface functions as separate modules is discussed, as well as the blackboard designed for the communication of these modules. Some related issues concerning the future installation of FaultFinder in an aircraft are also discussed.

NCCN Mountain Lakes Monitoring Strategy: Guidelines to Resolution

USGS Publications Warehouse

Hoffman, Robert L.; Huff, Mark H.

2008-01-01

The North Coast and Cascades Network (NCCN) Inventory and Monitoring Program provides funds to its Network Parks to plan and implement the goals and objectives of the National Park Services? (NPS) Inventory and Monitoring (I&M) Program. The primary purpose of the I&M program is to develop and implement a long-term monitoring program in each network. The purpose of this document is to describe the outcome of a meeting held to find solutions to obstacles inhibiting development of a unified core design and methodology for mountain lake monitoring.

[Research and implementation of a real-time monitoring system for running status of medical monitors based on the internet of things].

PubMed

Li, Yiming; Qian, Mingli; Li, Long; Li, Bin

2014-07-01

This paper proposed a real-time monitoring system for running status of medical monitors based on the internet of things. In the aspect of hardware, a solution of ZigBee networks plus 470 MHz networks is proposed. In the aspect of software, graphical display of monitoring interface and real-time equipment failure alarm is implemented. The system has the function of remote equipment failure detection and wireless localization, which provides a practical and effective method for medical equipment management.

High Intensity Tests of the NuMI Beam Monitoring Ionization Chambers

NASA Astrophysics Data System (ADS)

Zwaska, Robert

2002-04-01

The NuMI facility at Fermilab will generate an intense beam of neutrinos directed toward Soudan, MN, 735 km away. Components of the planned beam monitoring system will be exposed to fluences of up to 8 x 10^9 charge particles / cm^2 and 6 x 10^10 neutrons / cm^2 in an 8.6 us beam spill. These fluences will be measured by an array of Helium ionization chambers. We tested a pair of chambers with 8 GeV protons at the Fermilab Booster accelerator, and with high intensity neutron sources at the Texas Experimental Nuclear Facility.

Diverse Approaches to Implement and Monitor River Restoration: A Comparative Perspective in France and Germany

NASA Astrophysics Data System (ADS)

Morandi, Bertrand; Kail, Jochem; Toedter, Anne; Wolter, Christian; Piégay, Hervé

2017-11-01

River restoration is a main emphasis of river management in European countries. Cross-national comparisons of its implementation are still rare in scientific literature. Based on French and German national censuses, this study compares river restoration practices and monitoring by analysing 102 French and 270 German projects. This comparison aims to draw a spatial and temporal framework of restoration practices in both countries to identify potential drivers of cross-national similarities and differences. The results underline four major trends: (1) a lag of almost 15 years in river restoration implementation between France and Germany, with a consequently higher share of projects in Germany than in France, (2) substantial similarities in restored reach characteristics, short reach length, small rivers, and in "agricultural" areas, (3) good correspondences between stressors identified and restoration measures implemented. Morphological alterations were the most important highlighted stressors. River morphology enhancement, especially instream enhancements, were the most frequently implemented restoration measures. Some differences exist in specific restoration practices, as river continuity restoration were most frequently implemented in French projects, while large wood introduction or channel re-braiding were most frequently implemented in German projects, and (4) some quantitative and qualitative differences in monitoring practices and a significant lack of project monitoring, especially in Germany compared to France. These similarities and differences between Germany and France in restoration application and monitoring possibly result from a complex set of drivers that might be difficult to untangle (e.g., environmental, technical, political, cultural).

Diverse Approaches to Implement and Monitor River Restoration: A Comparative Perspective in France and Germany.

PubMed

Morandi, Bertrand; Kail, Jochem; Toedter, Anne; Wolter, Christian; Piégay, Hervé

2017-11-01

River restoration is a main emphasis of river management in European countries. Cross-national comparisons of its implementation are still rare in scientific literature. Based on French and German national censuses, this study compares river restoration practices and monitoring by analysing 102 French and 270 German projects. This comparison aims to draw a spatial and temporal framework of restoration practices in both countries to identify potential drivers of cross-national similarities and differences. The results underline four major trends: (1) a lag of almost 15 years in river restoration implementation between France and Germany, with a consequently higher share of projects in Germany than in France, (2) substantial similarities in restored reach characteristics, short reach length, small rivers, and in "agricultural" areas, (3) good correspondences between stressors identified and restoration measures implemented. Morphological alterations were the most important highlighted stressors. River morphology enhancement, especially instream enhancements, were the most frequently implemented restoration measures. Some differences exist in specific restoration practices, as river continuity restoration were most frequently implemented in French projects, while large wood introduction or channel re-braiding were most frequently implemented in German projects, and (4) some quantitative and qualitative differences in monitoring practices and a significant lack of project monitoring, especially in Germany compared to France. These similarities and differences between Germany and France in restoration application and monitoring possibly result from a complex set of drivers that might be difficult to untangle (e.g., environmental, technical, political, cultural).

Variation in anticonvulsant selection and EEG monitoring following severe traumatic brain injury in children – Understanding resource availability in sites participating in a comparative effectiveness study

PubMed Central

Kurz, Jonathan E.; Poloyac, Samuel M.; Abend, Nicholas S.; Fabio, Anthony; Bell, Michael J.; Wainwright, Mark S.

2016-01-01

Objective Early post-traumatic seizures (PTS) may contribute to worsened outcomes after traumatic brain injury (TBI). Evidence to guide the evaluation and management of early PTS in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring (cEEG), seizure prophylaxis and the management of early PTS to provide essential information for trial design and the development of PTS management pathways. Design Surveys were sent to site principal investigators at all 43 sites participating in the ADAPT (Approaches and Decisions in Acute Pediatric TBI) trial at the time of the survey. Surveys consisted of 12 questions addressing strategies to (i) implement cEEG monitoring, (ii) PTS prophylaxis, (iii) treat acute PTS, (iv) treat status epilepticus (SE) and refractory status epilepticus (RSE) and (v) monitor anti-seizure drug levels. Setting Institutions comprised a mixture of free-standing children’s hospitals and university medical centers across the United States and Europe. Measurements and Main Results cEEG monitoring was available in the pediatric intensive care unit in the overwhelming majority of clinical sites (98%); however, the plans to operationalize such monitoring for children varied considerably. A similar majority of sites report that administration of prophylactic anti-seizure medications is anticipated in children (93%), yet a minority reports that a specified protocol for treatment of PTS is in place (43%). Reported medication choices varied substantially between sites, but the majority of sites reported pentobarbital for RSE (81%). Presence of an treatment protocols for seizure prophylaxis, early PTS, post-traumatic SE and RSE was associated with decreased reported medications (all p < 0.05). Conclusions This study reports the current management practices for early PTS in select academic centers after pediatric severe TBI. The substantial variation in cEEG implementation, choice of seizure prophylaxis medications, and management of early PTS across institutions was reported, signifying areas of clinical uncertainty that will help provide for focused design of clinical trials. While sites with treatment protocols reported decreased number of medications for the scenarios described, completion of the ADAPT Trial will be able to determine if these protocols lead to decreased variability in medication administration in children at the clinical sites. PMID:27243415

Development and Feasibility Testing of a Critical Care EEG Monitoring Database for Standardized Clinical Reporting and Multicenter Collaborative Research.

PubMed

Lee, Jong Woo; LaRoche, Suzette; Choi, Hyunmi; Rodriguez Ruiz, Andres A; Fertig, Evan; Politsky, Jeffrey M; Herman, Susan T; Loddenkemper, Tobias; Sansevere, Arnold J; Korb, Pearce J; Abend, Nicholas S; Goldstein, Joshua L; Sinha, Saurabh R; Dombrowski, Keith E; Ritzl, Eva K; Westover, Michael B; Gavvala, Jay R; Gerard, Elizabeth E; Schmitt, Sarah E; Szaflarski, Jerzy P; Ding, Kan; Haas, Kevin F; Buchsbaum, Richard; Hirsch, Lawrence J; Wusthoff, Courtney J; Hopp, Jennifer L; Hahn, Cecil D

2016-04-01

The rapid expansion of the use of continuous critical care electroencephalogram (cEEG) monitoring and resulting multicenter research studies through the Critical Care EEG Monitoring Research Consortium has created the need for a collaborative data sharing mechanism and repository. The authors describe the development of a research database incorporating the American Clinical Neurophysiology Society standardized terminology for critical care EEG monitoring. The database includes flexible report generation tools that allow for daily clinical use. Key clinical and research variables were incorporated into a Microsoft Access database. To assess its utility for multicenter research data collection, the authors performed a 21-center feasibility study in which each center entered data from 12 consecutive intensive care unit monitoring patients. To assess its utility as a clinical report generating tool, three large volume centers used it to generate daily clinical critical care EEG reports. A total of 280 subjects were enrolled in the multicenter feasibility study. The duration of recording (median, 25.5 hours) varied significantly between the centers. The incidence of seizure (17.6%), periodic/rhythmic discharges (35.7%), and interictal epileptiform discharges (11.8%) was similar to previous studies. The database was used as a clinical reporting tool by 3 centers that entered a total of 3,144 unique patients covering 6,665 recording days. The Critical Care EEG Monitoring Research Consortium database has been successfully developed and implemented with a dual role as a collaborative research platform and a clinical reporting tool. It is now available for public download to be used as a clinical data repository and report generating tool.

The EVNATURB project: toward an operational platform to assess Blue Green Solutions eco-systemic services in urban environment

NASA Astrophysics Data System (ADS)

Schertzer, D. J. M.; Versini, P. A.; Tchiguirinskaia, I.

2017-12-01

Urban areas are facing an expected increase in intensity and frequency of extreme weather events due to climate change. Combined with unsustainable urbanization, this should exacerbate the environmental consequences related to the water cycle as stormwater management issues, urban heat island increase and biodiversity degradation. Blue Green Solutions (BGS), such as green roofs, vegetated swales or urban ponds, appear to be particularly efficient to reduce the potential impact of new and existing urban developments with respect to these issues. Based on this statement, the French ANR EVNATURB project aims to develop a platform to assess the eco-systemic services provided by BGS and related with the previously mentioned issues. By proposing a multi-disciplinary consortium coupling monitoring, modelling and prospecting, it attempts to tackle several scientific issues currently limiting BGS wide implementation. Based on high resolution monitored sites and modelling tools, space-time variability of the related physical processes will be studied over a wide range of scales (from the material to the district scale), as well as local social-environmental stakes and constraints, to better consider the complexity of the urban environment. The EVNATURB platform developed during the project is intended for every stakeholder involved in urban development projects (planners, architects, engineering and environmental certification companies…) and will help them to implement BGS and evaluate which ones are the most appropriate for a particular project depending on its environmental objectives and constraints, and particularly for obtaining environmental certification.

Developing a multi-Kinect-system for monitoring in dairy cows: object recognition and surface analysis using wavelets.

PubMed

Salau, J; Haas, J H; Thaller, G; Leisen, M; Junge, W

2016-09-01

Camera-based systems in dairy cattle were intensively studied over the last years. Different from this study, single camera systems with a limited range of applications were presented, mostly using 2D cameras. This study presents current steps in the development of a camera system comprising multiple 3D cameras (six Microsoft Kinect cameras) for monitoring purposes in dairy cows. An early prototype was constructed, and alpha versions of software for recording, synchronizing, sorting and segmenting images and transforming the 3D data in a joint coordinate system have already been implemented. This study introduced the application of two-dimensional wavelet transforms as method for object recognition and surface analyses. The method was explained in detail, and four differently shaped wavelets were tested with respect to their reconstruction error concerning Kinect recorded depth maps from different camera positions. The images' high frequency parts reconstructed from wavelet decompositions using the haar and the biorthogonal 1.5 wavelet were statistically analyzed with regard to the effects of image fore- or background and of cows' or persons' surface. Furthermore, binary classifiers based on the local high frequencies have been implemented to decide whether a pixel belongs to the image foreground and if it was located on a cow or a person. Classifiers distinguishing between image regions showed high (⩾0.8) values of Area Under reciever operation characteristic Curve (AUC). The classifications due to species showed maximal AUC values of 0.69.

Implementation of medical monitor system based on networks

NASA Astrophysics Data System (ADS)

Yu, Hui; Cao, Yuzhen; Zhang, Lixin; Ding, Mingshi

2006-11-01

In this paper, the development trend of medical monitor system is analyzed and portable trend and network function become more and more popular among all kinds of medical monitor devices. The architecture of medical network monitor system solution is provided and design and implementation details of medical monitor terminal, monitor center software, distributed medical database and two kind of medical information terminal are especially discussed. Rabbit3000 system is used in medical monitor terminal to implement security administration of data transfer on network, human-machine interface, power management and DSP interface while DSP chip TMS5402 is used in signal analysis and data compression. Distributed medical database is designed for hospital center according to DICOM information model and HL7 standard. Pocket medical information terminal based on ARM9 embedded platform is also developed to interactive with center database on networks. Two kernels based on WINCE are customized and corresponding terminal software are developed for nurse's routine care and doctor's auxiliary diagnosis. Now invention patent of the monitor terminal is approved and manufacture and clinic test plans are scheduled. Applications for invention patent are also arranged for two medical information terminals.

Increasing Psychotherapists’ Adoption and Implementation of the Evidence-based Practice of Progress Monitoring

PubMed Central

Persons, Jacqueline B.; Koerner, Kelly; Eidelman, Polina; Thomas, Cannon; Liu, Howard

2015-01-01

Evidence-based practices (EBPs) reach consumers slowly because practitioners are slow to adopt and implement them. We hypothesized that giving psychotherapists a tool + training intervention that was designed to help the therapist integrate the EBP of progress monitoring into his or her usual way of working would be associated with adoption and sustained implementation of the particular progress monitoring tool we trained them to use (the Depression Anxiety Stress Scales on our Online Progress Tracking tool) and would generalize to all types of progress monitoring measures. To test these hypotheses, we developed an online progress monitoring tool and a course that trained psychotherapists to use it, and we assessed progress monitoring behavior in 26 psychotherapists before, during, immediately after, and 12 months after they received the tool and training. Immediately after receiving the tool + training intervention, participants showed statistically significant increases in use of the online tool and of all types of progress monitoring measures. Twelve months later, participants showed sustained use of any type of progress monitoring measure but not the online tool. PMID:26618237

Increasing psychotherapists' adoption and implementation of the evidence-based practice of progress monitoring.

PubMed

Persons, Jacqueline B; Koerner, Kelly; Eidelman, Polina; Thomas, Cannon; Liu, Howard

2016-01-01

Evidence-based practices (EBPs) reach consumers slowly because practitioners are slow to adopt and implement them. We hypothesized that giving psychotherapists a tool + training intervention that was designed to help the therapist integrate the EBP of progress monitoring into his or her usual way of working would be associated with adoption and sustained implementation of the particular progress monitoring tool we trained them to use (the Depression Anxiety Stress Scales on our Online Progress Tracking tool) and would generalize to all types of progress monitoring measures. To test these hypotheses, we developed an online progress monitoring tool and a course that trained psychotherapists to use it, and we assessed progress monitoring behavior in 26 psychotherapists before, during, immediately after, and 12 months after they received the tool and training. Immediately after receiving the tool + training intervention, participants showed statistically significant increases in use of the online tool and of all types of progress monitoring measures. Twelve months later, participants showed sustained use of any type of progress monitoring measure but not the online tool. Copyright © 2015 Elsevier Ltd. All rights reserved.

Extending the life of mature basins in the North Sea and imaging sub-basalt and sub-intrusive structures using seismic intensity monitoring.

NASA Astrophysics Data System (ADS)

De Siena, Luca; Rawlinson, Nicholas

2016-04-01

Non-standard seismic imaging (velocity, attenuation, and scattering tomography) of the North Sea basins by using unexploited seismic intensities from previous passive and active surveys are key for better imaging and monitoring fluid under the subsurface. These intensities provide unique solutions to the problem of locating/tracking gas/fluid movements in the crust and depicting sub-basalt and sub-intrusives in volcanic reservoirs. The proposed techniques have been tested in volcanic Islands (Deception Island) and have been proved effective at monitoring fracture opening, imaging buried fluid-filled bodies, and tracking water/gas interfaces. These novel seismic attributes are modelled in space and time and connected with the lithology of the sampled medium, specifically density and permeability with as key output a novel computational code with strong commercial potential.

A "Neurological Emergency Trolley" reduces turnaround time for high-risk medications in a general intensive care unit.

PubMed

Ajzenberg, Henry; Newman, Paula; Harris, Gail-Anne; Cranston, Marnie; Boyd, J Gordon

2018-02-01

To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses. 33-bed general medical-surgical intensive care unit in an academic teaching hospital. Time to medication administration. In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts. The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times. Copyright © 2017 Elsevier Ltd. All rights reserved.

TU-G-BRA-05: Predicting Volume Change of the Tumor and Critical Structures Throughout Radiation Therapy by CT-CBCT Registration with Local Intensity Correction

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

Park, S; Robinson, A; Kiess, A

2015-06-15

Purpose: The purpose of this study is to develop an accurate and effective technique to predict and monitor volume changes of the tumor and organs at risk (OARs) from daily cone-beam CTs (CBCTs). Methods: While CBCT is typically used to minimize the patient setup error, its poor image quality impedes accurate monitoring of daily anatomical changes in radiotherapy. Reconstruction artifacts in CBCT often cause undesirable errors in registration-based contour propagation from the planning CT, a conventional way to estimate anatomical changes. To improve the registration and segmentation accuracy, we developed a new deformable image registration (DIR) that iteratively corrects CBCTmore » intensities using slice-based histogram matching during the registration process. Three popular DIR algorithms (hierarchical B-spline, demons, optical flow) augmented by the intensity correction were implemented on a graphics processing unit for efficient computation, and their performances were evaluated on six head and neck (HN) cancer cases. Four trained scientists manually contoured nodal gross tumor volume (GTV) on the planning CT and every other fraction CBCTs for each case, to which the propagated GTV contours by DIR were compared. The performance was also compared with commercial software, VelocityAI (Varian Medical Systems Inc.). Results: Manual contouring showed significant variations, [-76, +141]% from the mean of all four sets of contours. The volume differences (mean±std in cc) between the average manual segmentation and four automatic segmentations are 3.70±2.30(B-spline), 1.25±1.78(demons), 0.93±1.14(optical flow), and 4.39±3.86 (VelocityAI). In comparison to the average volume of the manual segmentations, the proposed approach significantly reduced the estimation error by 9%(B-spline), 38%(demons), and 51%(optical flow) over the conventional mutual information based method (VelocityAI). Conclusion: The proposed CT-CBCT registration with local CBCT intensity correction can accurately predict the tumor volume change with reduced errors. Although demonstrated only on HN nodal GTVs, the results imply improved accuracy for other critical structures. This work was supported by NIH/NCI under grant R42CA137886.« less

Impact of court monitoring on DWI adjudication

DOT National Transportation Integrated Search

1990-12-01

Author's abstract: Court monitoring of Driving While Intoxicated (DWI) cases is a labor intensive effort conducted by over 300 concerned citizen groups across the U.S. The present project assessed the impact of court monitoring by analyzing the diffe...

Treating Panic Disorder Hypnotically.

PubMed

Reid, David B

2017-10-01

A hypnosis protocol for treating panic disorder is provided. The implementation of this protocol is demonstrated through a case example involving the successful treatment of a 28-year-old firefighter presenting with a 4-month history of near-daily panic attacks. Core principles associated with this protocol include: (1) Elementary education about the physiology of panic; (2) A review of primary factors contributing to the evolution and manifestation of panic; (3) Encouragement of physical activity; (4) Utilization of hypnosis applications; and (5) Monitoring and measuring progress evidenced by a reduction in the frequency and intensity of panic attacks. Six years after his last hypnosis session, "Jason," the once panicked firefighter returned to my office for concerns unrelated to panic, and reported that he remained panic-free, retained his job, and was twice promoted.

Transcript and protein environmental biomarkers in fish--a review.

PubMed

Tom, Moshe; Auslander, Meirav

2005-04-01

The levels of contaminant-affected gene products (transcripts and proteins) are increasingly utilized as environmental biomarkers, and their appropriate implementation as diagnostic tools is discussed. The required characteristics of a gene product biomarker are accurate evaluation using properly normalized absolute units, aiming at long-term comparability of biomarker levels over a wide geographical range and among many laboratories. Quantitative RT-PCR and competitive ELISA are suggested as preferred evaluation methods for transcript and protein, respectively. Constitutively expressed RNAs or proteins which are part of the examined homogenate are suggested as normalizing agents, compensating for variable processing efficiency. Essential characterization of expression patterns is suggested, providing reference values to be compared to the monitored levels. This comparison would enable estimation of the intensity of biological effects of contaminants. Contaminant-independent reference expression patterns should include natural fluctuations of the biomarker level. Contaminant-dependent patterns should include dose response to model contaminants chronically administered in two environmentally-realistic routes, reaching extreme sub-lethal affected levels. Recent studies using fish as environmental sentinel species, applying gene products as environmental biomarkers, and implementing at least part of the depicted methodologies are reviewed.

Nurses' perceptions, acceptance, and use of a novel in-room pediatric ICU technology: testing an expanded technology acceptance model.

PubMed

Holden, Richard J; Asan, Onur; Wozniak, Erica M; Flynn, Kathryn E; Scanlon, Matthew C

2016-11-15

The value of health information technology (IT) ultimately depends on end users accepting and appropriately using it for patient care. This study examined pediatric intensive care unit nurses' perceptions, acceptance, and use of a novel health IT, the Large Customizable Interactive Monitor. An expanded technology acceptance model was tested by applying stepwise linear regression to data from a standardized survey of 167 nurses. Nurses reported low-moderate ratings of the novel IT's ease of use and low to very low ratings of usefulness, social influence, and training. Perceived ease of use, usefulness for patient/family involvement, and usefulness for care delivery were associated with system satisfaction (R 2  = 70%). Perceived usefulness for care delivery and patient/family social influence were associated with intention to use the system (R 2  = 65%). Satisfaction and intention were associated with actual system use (R 2  = 51%). The findings have implications for research, design, implementation, and policies for nursing informatics, particularly novel nursing IT. Several changes are recommended to improve the design and implementation of the studied IT.

Long-Term Solar and Cosmic Radiation Data Bases

DTIC Science & Technology

1991-01-01

determine the magnitude of the variations in the cosmic ray intensity caused by solar activity. Neutron monitors, with their much lower energy threshold...expression that neutron monitors are sensors on spacecraft EARTH. Here we will consider cosmic ray detectors to measure two components of cosmic ...A comparison with the solar cycle as illustrated by the sunspot number in Fig. 1. shows that the maximum cosmic ray intensity occurs near sunspot

Operational Procedures for Collecting Water-Quality Samples at Monitoring Sites on Maple Creek Near Nickerson and the Platte River at Louisville, Eastern Nebraska

USGS Publications Warehouse

Johnson, Steven M.; Swanson, Robert B.

1994-01-01

Prototype stream-monitoring sites were operated during part of 1992 in the Central Nebraska Basins (CNBR) and three other study areas of the National Water-Quality Assessment (NAWQ) Program of the U.S. Geological Survey. Results from the prototype project provide information needed to operate a net- work of intensive fixed station stream-monitoring sites. This report evaluates operating procedures for two NAWQA prototype sites at Maple Creek near Nickerson and the Platte River at Louisville, eastern Nebraska. Each site was sampled intensively in the spring and late summer 1992, with less intensive sampling in midsummer. In addition, multiple samples were collected during two high- flow periods at the Maple Creek site--one early and the other late in the growing season. Water-samples analyses included determination of pesticides, nutrients, major ions, suspended sediment, and measurements of physical properties. Equipment and protocols for the water-quality sampling procedures were evaluated. Operation of the prototype stream- monitoring sites included development and comparison of onsite and laboratory sample-processing proce- dures. Onsite processing was labor intensive but allowed for immediate preservation of all sampled constituents. Laboratory processing required less field labor and decreased the risk of contamination, but allowed for no immediate preservation of the samples.

Monitoring post-fire vegetation rehabilitation projects: A common approach for non-forested ecosystems

USGS Publications Warehouse

Wirth, Troy A.; Pyke, David A.

2007-01-01

Emergency Stabilization and Rehabilitation (ES&R) and Burned Area Emergency Response (BAER) treatments are short-term, high-intensity treatments designed to mitigate the adverse effects of wildfire on public lands. The federal government expends significant resources implementing ES&R and BAER treatments after wildfires; however, recent reviews have found that existing data from monitoring and research are insufficient to evaluate the effects of these activities. The purpose of this report is to: (1) document what monitoring methods are generally used by personnel in the field; (2) describe approaches and methods for post-fire vegetation and soil monitoring documented in agency manuals; (3) determine the common elements of monitoring programs recommended in these manuals; and (4) describe a common monitoring approach to determine the effectiveness of future ES&R and BAER treatments in non-forested regions. Both qualitative and quantitative methods to measure effectiveness of ES&R treatments are used by federal land management agencies. Quantitative methods are used in the field depending on factors such as funding, personnel, and time constraints. There are seven vegetation monitoring manuals produced by the federal government that address monitoring methods for (primarily) vegetation and soil attributes. These methods vary in their objectivity and repeatability. The most repeatable methods are point-intercept, quadrat-based density measurements, gap intercepts, and direct measurement of soil erosion. Additionally, these manuals recommend approaches for designing monitoring programs for the state of ecosystems or the effect of management actions. The elements of a defensible monitoring program applicable to ES&R and BAER projects that most of these manuals have in common are objectives, stratification, control areas, random sampling, data quality, and statistical analysis. The effectiveness of treatments can be determined more accurately if data are gathered using an approach that incorporates these six monitoring program design elements and objectives, as well as repeatable procedures to measure cover, density, gap intercept, and soil erosion within each ecoregion and plant community. Additionally, using a common monitoring program design with comparable methods, consistently documenting results, and creating and maintaining a central database for query and reporting, will ultimately allow a determination of the effectiveness of post-fire rehabilitation activities region-wide.

Randomized Controlled Trial of Nuevo Amanecer: A Peer-delivered Stress Management Intervention for Spanish-speaking Latinas with Breast Cancer

PubMed Central

Nápoles, Anna María; Santoyo-Olsson, Jasmine; Ortiz, Carmen; Gregorich, Steven; Lee, Howard E.; Duron, Ysabel; Graves, Kristi; Luce, Judith A.; McGuire, Peggy; Díaz-Méndez, Marynieves; Stewart, Anita L.

2014-01-01

Background Latinas with breast cancer suffer symptom and psychosocial health disparities. Effective interventions have not been developed for or tested in this population. Purpose We describe community-based participatory research methods used to develop and implement the Nuevo Amanecer program, a culturally tailored, peer-delivered cognitive-behavioral stress management intervention for low-income Spanish-speaking Latinas with breast cancer, and unique considerations in implementing a randomized controlled trial to test the program in community settings. Methods We applied an implementation science framework to delineate the methodological phases used to develop and implement the Nuevo Amanecer program and trial, emphasizing community engagement processes. Results In phase 1, we established project infrastructure: academic and community Co-Principal Investigators, community partners, community advisory board, steering committee, and funding. In phase 2, we identified three program inputs: formative research, a community best practices model, and an evidence-based intervention tested in non-Latinas. In phase 3, we created the new program by integrating and adapting intervention components from the three sources, making adaptations to accommodate low-literacy, Spanish language, cultural factors, community context, and population needs. In phase 4, we built community capacity for the program and trial by training field staff (recruiters and interventionists embedded in community sites), compensating field staff, and creating a system for identifying potential participants. In phase 5, we implemented and monitored the program and trial. Engaging community partners in all phases has resulted in a new, culturally tailored program that is suitable for newly diagnosed Latinas with breast cancer and a trial that is acceptable and supported by community and clinical partners. Lessons Learned Engagement of community-based organizations and cancer survivors as research partners and hiring recruiters and interventionists from the community were critical to successful implementation in community settings. Having culturally and linguistically competent research staff with excellent interpersonal skills facilitated implementation. Facilitating and maintaining excellent communication among community partners was imperative to troubleshoot implementation issues. Randomization was challenging due to community concerns about assigning women to a control group. Patient privacy regulations and the need for extensive outreach to establish relationships between community partners and clinical sites hampered initial recruitment. Limitations These were resource-intensive processes to develop and implement the program that need to be compared to less intensive alternatives. Conclusions Engaging community members in design and implementation of community-based programs and trials enhances cultural appropriateness and congruence with the community context. If the randomized trial demonstrates that the intervention is effective, it will fill a gap in evidence-based programs to address ethnic disparities in quality of life among Spanish-speaking Latinas with breast cancer. PMID:24577971

Matrix-Inversion-Free Compressed Sensing With Variable Orthogonal Multi-Matching Pursuit Based on Prior Information for ECG Signals.

PubMed

Cheng, Yih-Chun; Tsai, Pei-Yun; Huang, Ming-Hao

2016-05-19

Low-complexity compressed sensing (CS) techniques for monitoring electrocardiogram (ECG) signals in wireless body sensor network (WBSN) are presented. The prior probability of ECG sparsity in the wavelet domain is first exploited. Then, variable orthogonal multi-matching pursuit (vOMMP) algorithm that consists of two phases is proposed. In the first phase, orthogonal matching pursuit (OMP) algorithm is adopted to effectively augment the support set with reliable indices and in the second phase, the orthogonal multi-matching pursuit (OMMP) is employed to rescue the missing indices. The reconstruction performance is thus enhanced with the prior information and the vOMMP algorithm. Furthermore, the computation-intensive pseudo-inverse operation is simplified by the matrix-inversion-free (MIF) technique based on QR decomposition. The vOMMP-MIF CS decoder is then implemented in 90 nm CMOS technology. The QR decomposition is accomplished by two systolic arrays working in parallel. The implementation supports three settings for obtaining 40, 44, and 48 coefficients in the sparse vector. From the measurement result, the power consumption is 11.7 mW at 0.9 V and 12 MHz. Compared to prior chip implementations, our design shows good hardware efficiency and is suitable for low-energy applications.

Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules.

PubMed

Van Stan, Jarrad H; Mehta, Daryush D; Petit, Robert J; Sternad, Dagmar; Muise, Jason; Burns, James A; Hillman, Robert E

2017-02-01

Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented. The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities. With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed. Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules.

Design and Implementation of PACS at Georgetown University Hospital

NASA Astrophysics Data System (ADS)

Mun, S. K.; Benson, H.. R.; Choyke, P.; Fahey, F. H.; Wang, P. C.; Zeman, R. K...; Elliott, L. P.

1985-09-01

During the preparation and planning phase of the PACS project at Georgetown University Hospital it was realized that PACS requires truly the state of the art technology in data communication, image processing and man machine interfacing. It was also realized that un-like many other technology intensive devices used in radiology, PACS cannot be seen as an independent system that will provide well defined services. PACS will be the backbone of the department operation in clinical, educational and managerial functions. It will indeed be the nerve center of the radiologic services affecting every aspect of the department. PACS will have to be designed to perform in a cost-effective manner to widely varying needs within the radiology departments. The integration of ever changing complex technology that will impact every aspect of a radiology service is not a trivial matter. This transition period going from current manual film based PACS to Digital PACS can be long, expansive and disruptive unless careful planning preceeds the implementation. PACS is still an emerging technology at its infancy. Performance monitoring and evaluation of diversified functions have to be also established so that improvement to the system can be efficiently implemented. Thus the evaluation criteria should be also established as early as possible.

Integration of Motor Learning Principles Into Real-Time Ambulatory Voice Biofeedback and Example Implementation Via a Clinical Case Study With Vocal Fold Nodules

PubMed Central

Mehta, Daryush D.; Petit, Robert J.; Sternad, Dagmar; Muise, Jason; Burns, James A.; Hillman, Robert E.

2017-01-01

Purpose Ambulatory voice biofeedback (AVB) has the potential to significantly improve voice therapy effectiveness by targeting one of the most challenging aspects of rehabilitation: carryover of desired behaviors outside of the therapy session. Although initial evidence indicates that AVB can alter vocal behavior in daily life, retention of the new behavior after biofeedback has not been demonstrated. Motor learning studies repeatedly have shown retention-related benefits when reducing feedback frequency or providing summary statistics. Therefore, novel AVB settings that are based on these concepts are developed and implemented. Method The underlying theoretical framework and resultant implementation of innovative AVB settings on a smartphone-based voice monitor are described. A clinical case study demonstrates the functionality of the new relative frequency feedback capabilities. Results With new technical capabilities, 2 aspects of feedback are directly modifiable for AVB: relative frequency and summary feedback. Although reduced-frequency AVB was associated with improved carryover of a therapeutic vocal behavior (i.e., reduced vocal intensity) in a patient post-excision of vocal fold nodules, causation cannot be assumed. Conclusions Timing and frequency of AVB schedules can be manipulated to empirically assess generalization of motor learning principles to vocal behavior modification and test the clinical effectiveness of AVB with various feedback schedules. PMID:28124070

Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice: Overlaying a Care Bundle Approach With a Model for Research Implementation.

PubMed

Tayyib, Nahla; Coyer, Fiona

This article reports on the development and implementation process used to integrate a care bundle approach (a pressure ulcer [PU] prevention bundle to improve patients' skin integrity in intensive care) and the Ottawa Model of Research Use (OMRU). The PU prevention care bundle demonstrated significant reduction in PU incidence, with the OMRU model providing a consolidated framework for the implementation of bundled evidence in an effective and consistent manner into daily clinical nursing practice.

Estimating Intensities and/or Strong Motion Parameters Using Civilian Monitoring Videos: The May 12, 2008, Wenchuan Earthquake

NASA Astrophysics Data System (ADS)

Yang, Xiaolin; Wu, Zhongliang; Jiang, Changsheng; Xia, Min

2011-05-01

One of the important issues in macroseismology and engineering seismology is how to get as much intensity and/or strong motion data as possible. We collected and studied several cases in the May 12, 2008, Wenchuan earthquake, exploring the possibility of estimating intensities and/or strong ground motion parameters using civilian monitoring videos which were deployed originally for security purposes. We used 53 video recordings in different places to determine the intensity distribution of the earthquake, which is shown to be consistent with the intensity distribution mapped by field investigation, and even better than that given by the Community Internet Intensity Map. In some of the videos, the seismic wave propagation is clearly visible, and can be measured with the reference of some artificial objects such as cars and/or trucks. By measuring the propagating wave, strong motion parameters can be roughly but quantitatively estimated. As a demonstration of this `propagating-wave method', we used a series of civilian videos recorded in different parts of Sichuan and Shaanxi and estimated the local PGAs. The estimate is compared with the measurement reported by strong motion instruments. The result shows that civilian monitoring video provide a practical way of collecting and estimating intensity and/or strong motion parameters, having the advantage of being dynamic, and being able to be played back for further analysis, reflecting a new trend for macroseismology in our digital era.

Theoretical considerations to optimize transabdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

NASA Astrophysics Data System (ADS)

Zourabian, Anna; Boas, David A.

2001-06-01

Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are: the first in the range of 670-720nm and the second in the range of 825-925nm. Further we discuss the possible systematic errors during our measurements, and their contribution to the obtained saturation results.

The Impact of Evidence-Based Practice Implementation and Fidelity Monitoring on Staff Turnover: Evidence for a Protective Effect

ERIC Educational Resources Information Center

Aarons, Gregory A.; Sommerfeld, David H.; Hecht, Debra B.; Silovsky, Jane F.; Chaffin, Mark J.

2009-01-01

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff…

Accountability for the human right to health through treaty monitoring: Human rights treaty bodies and the influence of concluding observations.

PubMed

Meier, Benjamin Mason; De Milliano, Marlous; Chakrabarti, Averi; Kim, Yuna

2017-11-04

Employing novel coding methods to evaluate human rights monitoring, this article examines the influence of United Nations (UN) treaty bodies on national implementation of the human right to health. The advancement of the right to health in the UN human rights system has shifted over the past 20 years from the development of norms under international law to the implementation of those norms through national policy. Facilitating accountability for this rights-based policy implementation under the right to health, the UN Committee on Economic, Social and Cultural Rights (CESCR) monitors state implementation by reviewing periodic reports from state parties, engaging in formal sessions of 'constructive dialogue' with state representatives, and issuing concluding observations for state response. These concluding observations recognise the positive steps taken by states and highlight the principal areas of CESCR concern, providing recommendations for implementing human rights and detailing issues to be addressed in the next state report. Through analytic coding of the normative indicators of the right to health in both state reports and concluding observations, this article provides an empirical basis to understand the policy effects of the CESCR monitoring process on state implementation of the right to health.

Update on the Mapping of Prevalence and Intensity of Infection for Soil-Transmitted Helminth Infections in Latin America and the Caribbean: A Call for Action

PubMed Central

Saboyá, Martha Idalí; Catalá, Laura; Nicholls, Rubén Santiago; Ault, Steven Kenyon

2013-01-01

It is estimated that in Latin America and the Caribbean (LAC) at least 13.9 million preschool age and 35.4 million school age children are at risk of infections by soil-transmitted helminths (STH): Ascaris lumbricoides, Trichuris trichiura and hookworms (Necator americanus and Ancylostoma duodenale). Although infections caused by this group of parasites are associated with chronic deleterious effects on nutrition and growth, iron and vitamin A status and cognitive development in children, few countries in the LAC Region have implemented nationwide surveys on prevalence and intensity of infection. The aim of this study was to identify gaps on the mapping of prevalence and intensity of STH infections based on data published between 2000 and 2010 in LAC, and to call for including mapping as part of action plans against these infections. A total of 335 published data points for STH prevalence were found for 18 countries (11.9% data points for preschool age children, 56.7% for school age children and 31.3% for children from 1 to 14 years of age). We found that 62.7% of data points showed prevalence levels above 20%. Data on the intensity of infection were found for seven countries. The analysis also highlights that there is still an important lack of data on prevalence and intensity of infection to determine the burden of disease based on epidemiological surveys, particularly among preschool age children. This situation is a challenge for LAC given that adequate planning of interventions such as deworming requires information on prevalence to determine the frequency of needed anthelmintic drug administration and to conduct monitoring and evaluation of progress in drug coverage. PMID:24069476

Update on the mapping of prevalence and intensity of infection for soil-transmitted helminth infections in Latin America and the Caribbean: a call for action.

PubMed

Saboyá, Martha Idalí; Catalá, Laura; Nicholls, Rubén Santiago; Ault, Steven Kenyon

2013-01-01

It is estimated that in Latin America and the Caribbean (LAC) at least 13.9 million preschool age and 35.4 million school age children are at risk of infections by soil-transmitted helminths (STH): Ascaris lumbricoides, Trichuris trichiura and hookworms (Necator americanus and Ancylostoma duodenale). Although infections caused by this group of parasites are associated with chronic deleterious effects on nutrition and growth, iron and vitamin A status and cognitive development in children, few countries in the LAC Region have implemented nationwide surveys on prevalence and intensity of infection. The aim of this study was to identify gaps on the mapping of prevalence and intensity of STH infections based on data published between 2000 and 2010 in LAC, and to call for including mapping as part of action plans against these infections. A total of 335 published data points for STH prevalence were found for 18 countries (11.9% data points for preschool age children, 56.7% for school age children and 31.3% for children from 1 to 14 years of age). We found that 62.7% of data points showed prevalence levels above 20%. Data on the intensity of infection were found for seven countries. The analysis also highlights that there is still an important lack of data on prevalence and intensity of infection to determine the burden of disease based on epidemiological surveys, particularly among preschool age children. This situation is a challenge for LAC given that adequate planning of interventions such as deworming requires information on prevalence to determine the frequency of needed anthelmintic drug administration and to conduct monitoring and evaluation of progress in drug coverage.

Gas Filled RF Resonator Hadron Beam Monitor for Intense Neutrino Beam Experiments

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

Yonehara, Katsuya; Abrams, Robert; Dinkel, Holly

MW-class beam facilities are being considered all over the world to produce an intense neutrino beam for fundamental particle physics experiments. A radiation-robust beam monitor system is required to diagnose the primary and secondary beam qualities in high-radiation environments. We have proposed a novel gas-filled RF-resonator hadron beam monitor in which charged particles passing through the resonator produce ionized plasma that changes the permittivity of the gas. The sensitivity of the monitor has been evaluated in numerical simulation. A signal manipulation algorithm has been designed. A prototype system will be constructed and tested by using a proton beam at themore » MuCool Test Area at Fermilab.« less

Laser intensity modulated real time monitoring cell growth sensor for bioprocess applications

NASA Astrophysics Data System (ADS)

Kishore, P.; Babu, P. Ravindra; Devi, V. Rama; Maunika, T.; Soujanya, P.; Kishore, P. V. N.; Dinakar, D.

2016-04-01

This article proposes an optical method for monitoring the growth of Escherichia coli in Luria Bertani medium and Saccharomyces cereviciae in YPD. Suitable light is selected which on interaction with the analyte under consideration, gets adsorption / scattered. Required electronic circuitry is designed to drive the laser source and to detect the intensity of light using Photo-detector. All these components are embedded and arranged in a proper way and monitored the growth of the microbs in real time. The sensors results are compared with standard techniques such as colorimeter, Nephelometer and hemocytometer. The experimental results are in good agreement with the existed techniques and well suitable for real time monitoring applications of the growth of the microbs.

Intensive Evaluation of Head Start Implementation in the Tucson Early Education Model.

ERIC Educational Resources Information Center

Rentfrow, Robert K.

As part of the national Head Start Planned Variation Study, this study used a relatively small sample in an intensive evaluation of program implementation in one field community using the Tucson Early Education Model (TEEM). A modified Solomon four-group research design formed the organization framework. Evaluation of six TEEM classrooms and two…

Using the ATL HDI 1000 to collect demodulated RF data for monitoring HIFU lesion formation

NASA Astrophysics Data System (ADS)

Anand, Ajay; Kaczkowski, Peter J.; Daigle, Ron E.; Huang, Lingyun; Paun, Marla; Beach, Kirk W.; Crum, Lawrence A.

2003-05-01

The ability to accurately track and monitor the progress of lesion formation during HIFU (High Intensity Focused Ultrasound) therapy is important for the success of HIFU-based treatment protocols. To aid in the development of algorithms for accurately targeting and monitoring formation of HIFU induced lesions, we have developed a software system to perform RF data acquisition during HIFU therapy using a commercially available clinical ultrasound scanner (ATL HDI 1000, Philips Medical Systems, Bothell, WA). The HDI 1000 scanner functions on a software dominant architecture, permitting straightforward external control of its operation and relatively easy access to quadrature demodulated RF data. A PC running a custom developed program sends control signals to the HIFU module via GPIB and to the HDI 1000 via Telnet, alternately interleaving HIFU exposures and RF frame acquisitions. The system was tested during experiments in which HIFU lesions were created in excised animal tissue. No crosstalk between the HIFU beam and the ultrasound imager was detected, thus demonstrating synchronization. Newly developed acquisition modes allow greater user control in setting the image geometry and scanline density, and enables high frame rate acquisition. This system facilitates rapid development of signal-processing based HIFU therapy monitoring algorithms and their implementation in image-guided thermal therapy systems. In addition, the HDI 1000 system can be easily customized for use with other emerging imaging modalities that require access to the RF data such as elastographic methods and new Doppler-based imaging and tissue characterization techniques.

Wireless pilot monitoring system for extreme race conditions.

PubMed

Pino, Esteban J; Arias, Diego E; Aqueveque, Pablo; Melin, Pedro; Curtis, Dorothy W

2012-01-01

This paper presents the design and implementation of an assistive device to monitor car drivers under extreme conditions. In particular, this system is designed in preparation for the 2012 Atacama Solar Challenge to be held in the Chilean desert. Actual preliminary results show the feasibility of such a project including physiological and ambient sensors, real-time processing algorithms, wireless data transmission and a remote monitoring station. Implementation details and field results are shown along with a discussion of the main problems found in real-life telemetry monitoring.

Catfish production using intensive aeration

USDA-ARS?s Scientific Manuscript database

For the last 3 years, researchers at UAPB and NWAC have been monitoring and verifying production yields in intensively aerated catfish ponds with aeration rates greater than 6 hp/acre. We now have three years of data on commercial catfish production in intensively aerated ponds. With stocking densi...

Investigation of Service Quality of Measurement Reference Points for the Internet Services on Mobile Networks

NASA Astrophysics Data System (ADS)

Lipenbergs, E.; Bobrovs, Vj.; Ivanovs, G.

2016-10-01

To ensure that end-users and consumers have access to comprehensive, comparable and user-friendly information regarding the Internet access service quality, it is necessary to implement and regularly renew a set of legislative regulatory acts and to provide monitoring of the quality of Internet access services regarding the current European Regulatory Framework. The actual situation regarding the quality of service monitoring solutions in different European countries depends on national regulatory initiatives and public awareness. The service monitoring solutions are implemented using different measurement methodologies and tools. The paper investigates the practical implementations for developing a harmonising approach to quality monitoring in order to obtain objective information on the quality of Internet access services on mobile networks.

Some computer graphical user interfaces in radiation therapy

PubMed Central

Chow, James C L

2016-01-01

In this review, five graphical user interfaces (GUIs) used in radiation therapy practices and researches are introduced. They are: (1) the treatment time calculator, superficial X-ray treatment time calculator (SUPCALC) used in the superficial X-ray radiation therapy; (2) the monitor unit calculator, electron monitor unit calculator (EMUC) used in the electron radiation therapy; (3) the multileaf collimator machine file creator, sliding window intensity modulated radiotherapy (SWIMRT) used in generating fluence map for research and quality assurance in intensity modulated radiation therapy; (4) the treatment planning system, DOSCTP used in the calculation of 3D dose distribution using Monte Carlo simulation; and (5) the monitor unit calculator, photon beam monitor unit calculator (PMUC) used in photon beam radiation therapy. One common issue of these GUIs is that all user-friendly interfaces are linked to complex formulas and algorithms based on various theories, which do not have to be understood and noted by the user. In that case, user only needs to input the required information with help from graphical elements in order to produce desired results. SUPCALC is a superficial radiation treatment time calculator using the GUI technique to provide a convenient way for radiation therapist to calculate the treatment time, and keep a record for the skin cancer patient. EMUC is an electron monitor unit calculator for electron radiation therapy. Instead of doing hand calculation according to pre-determined dosimetric tables, clinical user needs only to input the required drawing of electron field in computer graphical file format, prescription dose, and beam parameters to EMUC to calculate the required monitor unit for the electron beam treatment. EMUC is based on a semi-experimental theory of sector-integration algorithm. SWIMRT is a multileaf collimator machine file creator to generate a fluence map produced by a medical linear accelerator. This machine file controls the multileaf collimator to deliver intensity modulated beams for a specific fluence map used in quality assurance or research. DOSCTP is a treatment planning system using the computed tomography images. Radiation beams (photon or electron) with different energies and field sizes produced by a linear accelerator can be placed in different positions to irradiate the tumour in the patient. DOSCTP is linked to a Monte Carlo simulation engine using the EGSnrc-based code, so that 3D dose distribution can be determined accurately for radiation therapy. Moreover, DOSCTP can be used for treatment planning of patient or small animal. PMUC is a GUI for calculation of the monitor unit based on the prescription dose of patient in photon beam radiation therapy. The calculation is based on dose corrections in changes of photon beam energy, treatment depth, field size, jaw position, beam axis, treatment distance and beam modifiers. All GUIs mentioned in this review were written either by the Microsoft Visual Basic.net or a MATLAB GUI development tool called GUIDE. In addition, all GUIs were verified and tested using measurements to ensure their accuracies were up to clinical acceptable levels for implementations. PMID:27027225

Design and Analysis of Architectures for Structural Health Monitoring Systems

NASA Technical Reports Server (NTRS)

Mukkamala, Ravi; Sixto, S. L. (Technical Monitor)

2002-01-01

During the two-year project period, we have worked on several aspects of Health Usage and Monitoring Systems for structural health monitoring. In particular, we have made contributions in the following areas. 1. Reference HUMS architecture: We developed a high-level architecture for health monitoring and usage systems (HUMS). The proposed reference architecture is shown. It is compatible with the Generic Open Architecture (GOA) proposed as a standard for avionics systems. 2. HUMS kernel: One of the critical layers of HUMS reference architecture is the HUMS kernel. We developed a detailed design of a kernel to implement the high level architecture.3. Prototype implementation of HUMS kernel: We have implemented a preliminary version of the HUMS kernel on a Unix platform.We have implemented both a centralized system version and a distributed version. 4. SCRAMNet and HUMS: SCRAMNet (Shared Common Random Access Memory Network) is a system that is found to be suitable to implement HUMS. For this reason, we have conducted a simulation study to determine its stability in handling the input data rates in HUMS. 5. Architectural specification.

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect.

PubMed

Aarons, Gregory A; Sommerfeld, David H; Hecht, Debra B; Silovsky, Jane F; Chaffin, Mark J

2009-04-01

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values-innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families.

The Impact of Evidence-Based Practice Implementation and Fidelity Monitoring on Staff Turnover: Evidence for a Protective Effect

PubMed Central

Aarons, Gregory A.; Sommerfeld, David H.; Hecht, Debra B.; Silovsky, Jane F.; Chaffin, Mark J.

2009-01-01

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children’s services system. The study took place in the context of a statewide regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. Twenty-one teams consisting of 153 home-based service providers were followed over a 29 month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values-innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families. PMID:19309186

WIH-based IEEE 802.11 ECG monitoring implementation.

PubMed

Moein, A; Pouladian, M

2007-01-01

New wireless technologies make possible the implementation of high level integration wireless devices which allow the replacement of traditional large wired monitoring devices. It offers new functionalities to physicians and will reduce the costs. Among these functionalities, biomedical signals can be sent to other devices (PDA, PC . . . ) or processing centers, without restricting the patients' mobility. This article discusses the WIH (Ward-In-Hand) structure and the software required for its implementation before an operational example is presented with its results. The aim of this project is the development and implementation of a reduced size electrocardiograph based on IEEE 802.11 with high speed and more accuracy, which allows wireless monitoring of patients, and the insertion of the information into the Wi-Fi hospital networks.

Smart real-time cardiac diagnostic sensor systems for football players and soldiers under intense physical training

NASA Astrophysics Data System (ADS)

Kumar, Prashanth S.; Oh, Sechang; Kwon, Hyeokjun; Rai, Pratyush; Varadan, Vijay K.

2013-04-01

Sudden cardiac death (SCD) and acute myocardial infarctions (AMIs) have been reported to be up to 7.6 times higher in rate of occurrence during intense exercise as compared to sedentary activities. The risk is high in individuals with both diagnosed as well as occult heart diseases. Recently, SCDs have been reported with a high rate of occurrence among young athletes and soldiers who routinely undergo vigorous training. Prescreening Electrocardiograms (ECG) and echocardiograms have been suggested as potential means of detecting any cardiac abnormalities prior to intense training to avoid the risk of SCDs, but the benefits of this approach are widely debated. Moreover, the increased risk of SCDs and AMIs during training or exercise suggests that ECGs are of much greater value when acquired real-time during the actual training. The availability of immediate diagnostic data will greatly reduce the time taken to administer the appropriate resuscitation. Important factors to consider in the implementation of this solution are: - cost of overall system, accuracy of signals acquired and unobtrusive design. In this paper, we evaluate a system using printed sensors made of inks with functional properties to acquire ECGs of athletes and soldiers during physical training and basic military training respectively. Using Zigbee, we show that athletes and soldiers can be monitored in real time, simultaneously.

Quality Improvement in Critical Care: Selection and Development of Quality Indicators

PubMed Central

Martin, Claudio M.; Project, The Quality Improvement in Critical Care

2016-01-01

Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

Implementation and Evaluation of a Team Simulation Training Program.

PubMed

Rice, Yvonne; DeLetter, Mary; Fryman, Lisa; Parrish, Evelyn; Velotta, Cathie; Talley, Cynthia

2016-01-01

Care of the trauma patient requires a well-coordinated intensive effort during the golden hour to optimize survival. We hypothesized that this program would improve knowledge, satisfaction, self-confidence, and simulated team performance. A pre-, post-test design with N = 7 BSN nurses, 21 years of age, less than 2 years of intensive care unit and nursing experience. Trauma intensive care unit, single-center academic Level 1 trauma center. Improvement was shown in perception of team structure (paired t test 13.71-12.57; p = .0001) and communication (paired t test 14.85-12.14; p = .009). Improvement was shown in observed situation monitoring (paired t test 17.42-25.28; p = .000), mutual support (paired t test 12.57-18.57; p = .000), and communication (paired t test 15.42-25.00; p = .001). A decrease was shown in attitudes of mutual support (paired t test 25.85-19.71; p = .04) and communication (paired t test 26.14-23.00; p = .001). Mean satisfaction scores were 21.5 of a possible 25 points. Mean self-confidence scores were 38.83 out of a possible 40 points. Simulation-based team training improved teamwork attitudes, perceptions, and performance. Team communication demonstrated significant improvement in 2 of the 3 instruments. Most participants agreed or strongly agreed that they were satisfied with simulation and had gained self-confidence.

An American knowledge base in England - Alternate implementations of an expert system flight status monitor

NASA Technical Reports Server (NTRS)

Butler, G. F.; Graves, A. T.; Disbrow, J. D.; Duke, E. L.

1989-01-01

A joint activity between the Dryden Flight Research Facility of the NASA Ames Research Center (Ames-Dryden) and the Royal Aerospace Establishment (RAE) on knowledge-based systems has been agreed. Under the agreement, a flight status monitor knowledge base developed at Ames-Dryden has been implemented using the real-time AI (artificial intelligence) toolkit MUSE, which was developed in the UK. Here, the background to the cooperation is described and the details of the flight status monitor and a prototype MUSE implementation are presented. It is noted that the capabilities of the expert-system flight status monitor to monitor data downlinked from the flight test aircraft and to generate information on the state and health of the system for the test engineers provides increased safety during flight testing of new systems. Furthermore, the expert-system flight status monitor provides the systems engineers with ready access to the large amount of information required to describe a complex aircraft system.

Simultaneous Time, Wavelength and Intensity Measurement of Optical Memory Subsystems

DTIC Science & Technology

1998-07-01

SIMULTANEOUS TIME, WAVELENGTH AND INTENSITY MEASUREMENT PE - 61102F OF OPTICAL MEMORY SUBSYSTEMS PR - 2300 6. AUTHOR( S ) TA - 06 WU -03 Joseph Osman and...Rebecca Bussjager 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER AFRL/SNDP25 letnic AFRL-SN-RS-TR- 1998...12025 Electronic Pky Rome, NY 13441-4515 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSORING/MONITORING AGENCY REPORT NUMBER

Beam diagnostics at high-intensity storage rings

NASA Astrophysics Data System (ADS)

Plum, Mike

1994-10-01

Beam diagnostics at high-intensity facilities feature their own special set of problems and characteristics, issues peculiar to high-intensity storage rings include beam loss, beam halos, extraction efficiency, beam in the gap, clearing electrodes, and beam-profile measurement. The Los Alamos Proton Storage Ring (PSR) is a nice example of a high-intensity storage ring. I will discuss in some detail three diagnostic systems currently in use at the PSR: the beam-loss-monitor system, the electron-clearing system, and the beam-in-the-gap monitor. Much of our discussion is inspired by the problems we have encountered and the useful things we have learned while commissioning and developing the PSR. Another inspiration is our work on the next-generation neutron-spallation source, also known as the National Center for Neutron Research (NCNR).

Evaluation of the effects of implementing an electronic early warning score system: protocol for a stepped wedge study.

PubMed

Bonnici, Timothy; Gerry, Stephen; Wong, David; Knight, Julia; Watkinson, Peter

2016-02-09

An Early Warning Score is a clinical risk score based upon vital signs intended to aid recognition of patients in need of urgent medical attention. The use of an escalation of care policy based upon an Early Warning Score is mandated as the standard of practice in British hospitals. Electronic systems for recording vital sign observations and Early Warning Score calculation offer theoretical benefits over paper-based systems. However, the evidence for their clinical benefit is limited. Previous studies have shown inconsistent results. The majority have employed a "before and after" study design, which may be strongly confounded by simultaneously occurring events. This study aims to examine how the implementation of an electronic early warning score system, System for Notification and Documentation (SEND), affects the recognition of clinical deterioration occurring in hospitalised adult patients. This study is a non-randomised stepped wedge evaluation carried out across the four hospitals of the Oxford University Hospitals NHS Trust, comparing charting on paper and charting using SEND. We assume that more frequent monitoring of acutely ill patients is associated with better recognition of patient deterioration. The primary outcome measure is the time between a patient's first observations set with an Early Warning Score above the alerting threshold and their subsequent set of observations. Secondary outcome measures are in-hospital mortality, cardiac arrest and Intensive Care admission rates, hospital length of stay and system usability measured using the System Usability Scale. We will also measure Intensive Care length of stay, Intensive Care mortality, Acute Physiology and Chronic Health Evaluation (APACHE) II acute physiology score on admission, to examine whether the introduction of SEND has any effect on Intensive Care-related outcomes. The development of this protocol has been informed by guidance from the Agency for Healthcare Research and Quality (AHRQ) Health Information Technology Evaluation Toolkit and Delone and McLeans's Model of Information System Success. Our chosen trial design, a stepped wedge study, is well suited to the study of a phased roll out. The choice of primary endpoint is challenging. We have selected the time from the first triggering observation set to the subsequent observation set. This has the benefit of being easy to measure on both paper and electronic charting and having a straightforward interpretation. We have collected qualitative measures of system quality via a user questionnaire and organisational descriptors to help readers understand the context in which SEND has been implemented.

The Influence of Activity-Based Funding on Treatment Intensity and Length of Stay of Geriatric Rehabilitation Patients.

PubMed

Bouwstra, Hylco; Wattel, Lizette M; de Groot, Aafke J; Smalbrugge, Martin; Hertogh, Cees M

2017-06-01

Little is known about the impact of activity-based funding (ABF) to increase treatment intensity and decrease length of stay (LOS) of inpatient geriatric patients. In January 2014, ABF was implemented in The Netherlands with the aim to increase treatment intensity and shorten LOS in geriatric rehabilitation (GR). To describe the influence of ABF on treatment intensity and LOS of inpatient GR patients before and after ABF was implemented. Population-based, retrospective cohort study. Thirty nursing homes providing inpatient GR across The Netherlands. Digital medical records of patients who had received inpatient GR in Dutch nursing homes across The Netherlands were studied between January 1, 2013 and March 14, 2016. We calculated the mean treatment intensity in hours per week and median LOS in days in 3 cohorts according to the year of admittance. In addition, a historical representative cohort of GR patients who were admitted in 2007 was studied that represented the situation before the ABF reform was announced (eg, funding with a fixed price per day). In 2013, the funding with a fixed price per day was still in use but with compulsory ABF registration. In 2014 and 2015, the ABF was fully implemented. Statistical differences in treatment intensity and LOS were calculated between patients admitted in 2007 and 2013, 2013 and 2014, and 2013 and 2015. Statistical significance was set at a P value of <.02 (Bonferroni correction P = .05/3). Discharge destinations of patients discharged from March 1, 2015 to January 1, 2016 could be obtained and compared with 2007. The treatment intensity and LOS of 16,823 GR patients could be obtained and compared with the historical cohort from 2007 (n = 2950). Patients who were admitted in the year 2013 received higher treatment intensities and had the same median LOS compared with 2007. After the implementation of ABF in January 2014, the mean treatment intensity increased significantly by 37% (3.8 hours/week in 2013, 4.7 hours/week in 2014, and 5.2 hours/week in 2015). This trend was significant across all rehabilitation diagnoses. After the implementation of ABF, the median LOS decreased significantly by 7 days (46 days in 2013, 42 days in 2014, and 39 days in 2015), which was consistent in all rehabilitation categories except for patients with a total joint replacement or amputation. Patients who received inpatient GR after introduction of ABF received higher treatment intensities and had a shorter LOS compared with the year before implementation. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Monitoring subsurface hydrologic response for precipitation-induced shallow landsliding in the San Francisco Bay area, California, USA

USGS Publications Warehouse

Collins, Brian D.; Stock, Jonathan; Weber, Lisa C.; Whitman, K.; Knepprath, N.

2012-01-01

Intense winter storms in the San Francisco Bay area (SFBA) of California, USA often trigger shallow landslides. Some of these landslides mobilize into potentially hazardous debris flows. A growing body of research indicates that rainfall intensity-duration thresholds are insufficient for accurate prediction of landslide occurrence. In response, we have begun long-term monitoring of the hydrologic response of land-slide-prone hillslopes to rainfall in several areas of the SFBA. Each monitoring site is equipped with sensors for measuring soil moisture content and piezometric pressure at several soil depths along with a rain gauge connected to a cell phone or satellite telemetered data logger. The data are transmitted in near-real-time, providing the ability to monitor hydrologic conditions before, during, and after storms. Results are guiding the establishment of both antecedent and storm-specific rainfall and moisture content thresholds which must be achieved before landslide-causative positive pore water pressures are generated. Although widespread shallow landsliding has not yet occurred since the deployment of the monitoring sites, several isolated land-slides have been observed in the area of monitoring. The landslides occurred during a period when positive pore water pressures were measured as a result of intense rainfall that followed higher-than-average season precipitation totals. Continued monitoring and analysis will further guide the establishment of more general-ized thresholds for different regions of the SFBA and contribute to the development and calibration of physi-cally-based predictive models.

Measuring sports injuries on the pitch: a guide to use in practice

PubMed Central

Hespanhol, Luiz C.; Barboza, Saulo D.; van Mechelen, Willem; Verhagen, Evert

2015-01-01

Sports participation is a major ally for the promotion of physical activity. However, sports injuries are important adverse effects of sports participation and should be monitored in sports populations. The purpose of this paper is to review the basic concepts of injury monitoring and discuss the implementation of these concepts in practice. The aspects discussed are: (1) sports injury definition; (2) classification of sports injuries; (3) population at risk, prevalence, and incidence; (4) severity measures; (5) economic costs; (6) systems developed to monitor sports injuries; and (7) online technology. Only with reliable monitoring systems applied in a continuous and long-term manner will it be possible to identify the burden of injuries, to identify the possible cases at an early stage, to implement early interventions, and to generate data for sports injury prevention. The implementation of sports injuries monitoring systems in practice is strongly recommended. PMID:26537807

Neural Correlates of the Lombard Effect in Primate Auditory Cortex

PubMed Central

Eliades, Steven J.

2012-01-01

Speaking is a sensory-motor process that involves constant self-monitoring to ensure accurate vocal production. Self-monitoring of vocal feedback allows rapid adjustment to correct perceived differences between intended and produced vocalizations. One important behavior in vocal feedback control is a compensatory increase in vocal intensity in response to noise masking during vocal production, commonly referred to as the Lombard effect. This behavior requires mechanisms for continuously monitoring auditory feedback during speaking. However, the underlying neural mechanisms are poorly understood. Here we show that when marmoset monkeys vocalize in the presence of masking noise that disrupts vocal feedback, the compensatory increase in vocal intensity is accompanied by a shift in auditory cortex activity toward neural response patterns seen during vocalizations under normal feedback condition. Furthermore, we show that neural activity in auditory cortex during a vocalization phrase predicts vocal intensity compensation in subsequent phrases. These observations demonstrate that the auditory cortex participates in self-monitoring during the Lombard effect, and may play a role in the compensation of noise masking during feedback-mediated vocal control. PMID:22855821

Assessing the seasonal variability of ephemeral gully erosion using high-frequency monitoring: case study in a fully cultivated catchment (The Pommeroye, Northern France)

NASA Astrophysics Data System (ADS)

Patault, E.; Alary, C.; Franke, C.; Gauthier, A.; Abriak, N. E.

2017-12-01

Gully erosion results in on-site and off-site problems including the loss of cultivated soils, the silting of riverbeds and dams as well as infrastructure and property damage by muddy floods. Regions of intensive agricultural production situated on the European loess belt are particularly affected. Recently a growing interest has focused on ephemeral gullies since there have been recognized as a major contributor to the sediment yield in small agricultural catchment in this area. The aims of this case study are (i) to quantify the sediment yield transported by ephemeral gullies, (ii) to identify parameters that control the function of the hydro-sedimentary response and (iii) to evaluate the influence of seasonal variability on the ephemeral gully erosion. For this study a high-frequency monitoring station was implemented. For each flood event, 8 variables related to hydro-sedimentary and rainfall dynamics are calculated and the relationships between these variables are analyzed using the Pearson correlation matrix and Principal Component Analysis. During the first year of monitoring (03/2016-03/2017), 22 flood events were recorded of which 75% occurred in spring and winter. The specific sediment yield was evaluated to 30 t km-2 yr-1 which is conventional for the study region but the results show a highly variable seasonal distribution; 90% of the sedimentary transfer occurred in winter and autumn. The main reasons were a high cumulative rainfall and a long duration for the events. The maximum suspended sediment concentration at the catchment outlet was observed in spring, likely due to maximum rainfall intensities in that season. Also, a huge variability between the events is observed; e.g. one exceptional rain storm in 11/2016 represents 45% of the total sediment yield of the study period. For the monitored 22 events, 2 different types of hysteresis behavior were observed: (i) clockwise and (ii) complex. In winter, only clockwise hysteresis was observed. These results suggest that other factors have to be considered to better explain the variability of gully erosion, such as the soil surface characteristics (crop cover, crusting stage, roughness). A monitoring of these parameters on experimental plots is in progress.

Targeting binge eating through components of dialectical behavior therapy: preliminary outcomes for individually supported diary card self-monitoring versus group-based DBT.

PubMed

Klein, Angela S; Skinner, Jeremy B; Hawley, Kristin M

2013-12-01

The current study examined two condensed adaptations of dialectical behavior therapy (DBT) for binge eating. Women with full- or sub-threshold variants of either binge eating disorder or bulimia nervosa were randomly assigned to individually supported self-monitoring using adapted DBT diary cards (DC) or group-based DBT, each 15 sessions over 16 weeks. DC sessions focused on problem-solving diary card completion issues, praising diary card completion, and supporting nonjudgmental awareness of eating-related habits and urges, but not formally teaching DBT skills. Group-based DBT included eating mindfulness, progressing through graded exposure; mindfulness, emotion regulation, and distress tolerance skills; and coaching calls between sessions. Both treatments evidenced large and significant improvements in binge eating, bulimic symptoms, and interoceptive awareness. For group-based DBT, ineffectiveness, drive for thinness, body dissatisfaction, and perfectionism also decreased significantly, with medium to large effect sizes. For DC, results were not significant but large in effect size for body dissatisfaction and medium in effect size for ineffectiveness and drive for thinness. Retention for both treatments was higher than recent trends for eating disorder treatment in fee-for-service practice and for similar clinic settings, but favored DC, with the greater attrition of group-based DBT primarily attributed to its more intensive and time-consuming nature, and dropout overall associated with less pretreatment impairment and greater interoceptive awareness. This preliminary investigation suggests that with both abbreviated DBT-based treatments, substantial improvement in core binge eating symptoms is possible, enhancing potential avenues for implementation beyond more time-intensive DBT.

Improving metabolic monitoring in patients maintained on antipsychotics in Penang, Malaysia.

PubMed

Hor, Esther Sl; Subramaniam, Sivasangari; Koay, Jun Min; Bharathy, Arokiamary; Vasudevan, Umadevi; Panickulam, Joseph J; Ng, InnTiong; Arif, Nor Hayati; Russell, Vincent

2016-02-01

To evaluate the monitoring of metabolic parameters among outpatients maintained on antipsychotic medications in a general hospital setting in Malaysia and to assess the impact of a local monitoring protocol. By performing a baseline audit of files from a random sample of 300 patients prescribed antipsychotic medications for at least 1 year; we determined the frequency of metabolic monitoring. The findings informed the design of a new local protocol, on which clinical staff was briefed. We re-evaluated metabolic monitoring immediately after implementation, in a small sample of new referrals and current patients. We explored staff perceptions of the initiative with a follow-up focus group, 6 months post-implementation. The baseline audit revealed a sub-optimal frequency of metabolic parameter recording. Re-audit, following implementation of the new protocol, revealed improved monitoring but persisting deficits. Dialogue with the clinical staff led to further protocol modification, clearer definition of staff roles and use of a standard recording template. Focus group findings revealed positive perceptions of the initiative, but persisting implementation barriers, including cultural issues surrounding waist circumference measurement. Responding to challenges in achieving improved routine metabolic monitoring of patients maintained on antipsychotics required on-going dialogue with the clinical staff, in order to address both service pressures and cultural concerns. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Applying Adult Ventilator-associated Pneumonia Bundle Evidence to the Ventilated Neonate.

PubMed

Weber, Carla D

2016-06-01

Ventilator-associated pneumonia (VAP) in neonates can be reduced by implementing preventive care practices. Implementation of a group, or bundle, of evidence-based practices that improve processes of care has been shown to be cost-effective and to have better outcomes than implementation of individual single practices. The purpose of this article is to describe a safe, effective, and efficient neonatal VAP prevention protocol developed for caregivers in the neonatal intensive care unit (NICU). Improved understanding of VAP causes, effects of care practices, and rationale for interventions can help reduce VAP risk to neonatal patients. In order to improve care practices to affect VAP rates, initial and annual education occurred on improved protocol components after surveying staff practices and auditing documentation compliance. In 2009, a tertiary care level III NICU in the Midwestern United States had 14 VAP cases. Lacking evidence-based VAP prevention practices for neonates, effective adult strategies were modified to meet the complex needs of the ventilated neonate. A protocol was developed over time and resulted in an annual decrease in VAP until rates were zero for 20 consecutive months from October 2012 to May 2014. This article describes a VAP prevention protocol developed to address care practices surrounding hand hygiene, intubation, feeding, suctioning, positioning, oral care, and respiratory equipment in the NICU. Implementation of this VAP prevention protocol in other facilities with appropriate monitoring and tracking would provide broader support for standardization of care. Individual components of this VAP protocol could be studied to strengthen the inclusion of each; however, bundled interventions are often considered stronger when implemented as a whole.

Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients.

PubMed

Günther, Anders C; Bottai, Matteo; Schandl, Anna R; Storm, Hanne; Rossi, Patrik; Sackey, Peter V

2013-03-19

Many intensive care unit (ICU) patients describe pain and other adverse feelings that may impact long-term psychological morbidity. Sympathetically mediated palmar skin conductance variability is related to emotionally induced perspiration and correlates with pain levels in the perioperative setting but has not been studied in ICU patients. Twenty non-intubated and 20 intubated general ICU patients were included in this observational study. Patients were monitored with the MED-STORM Pain Monitoring System®. The number of skin conductance fluctuations per second (NSCF) was measured in parallel with bedside observation during one hour of intensive care, including rest, procedures and patient-staff interactions. Arousal-agitation level was monitored with the motor activity assessment scale (MAAS). Pain was monitored with the numeric rating scale (0 to 10) in patients able to communicate or by observation in patients unable to communicate. In non-intubated patients, NSCF increased with increasing stimulation/pain but also with higher MAAS (P=0.002). An interaction effect was found, with increased NSCF response to stimulation/pain with increasing MAAS (P<0.001). In critically ill patients, NSCF may be more useful evaluating emotional distress rather than pain alone. It needs to be assessed whether NSCF monitoring is clinically useful and whether controlling emotional distress with the aid of such monitoring may impact on patient care and outcomes.

Volunteer water monitoring: A guide for state managers

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

Not Available

1990-08-01

Contents: executive summary; volunteers in water monitoring; planning a volunteer monitoring program; implementing a volunteer monitoring program; providing credible information; costs and funding; and descriptions of five successful programs.

Detection and Characterization of Low Temperature Peat Fires during the 2015 Fire Catastrophe in Indonesia Using a New High-Sensitivity Fire Monitoring Satellite Sensor (FireBird)

PubMed Central

Atwood, Elizabeth C.; Englhart, Sandra; Lorenz, Eckehard; Halle, Winfried; Wiedemann, Werner; Siegert, Florian

2016-01-01

Vast and disastrous fires occurred on Borneo during the 2015 dry season, pushing Indonesia into the top five carbon emitting countries. The region was affected by a very strong El Niño-Southern Oscillation (ENSO) climate phenomenon, on par with the last severe event in 1997/98. Fire dynamics in Central Kalimantan were investigated using an innovative sensor offering higher sensitivity to a wider range of fire intensities at a finer spatial resolution (160 m) than heretofore available. The sensor is onboard the TET-1 satellite, part of the German Aerospace Center (DLR) FireBird mission. TET-1 images (acquired every 2–3 days) from the middle infrared were used to detect fires continuously burning for almost three weeks in the protected peatlands of Sebangau National Park as well as surrounding areas with active logging and oil palm concessions. TET-1 detection capabilities were compared with MODIS active fire detection and Landsat burned area algorithms. Fire dynamics, including fire front propagation speed and area burned, were investigated. We show that TET-1 has improved detection capabilities over MODIS in monitoring low-intensity peatland fire fronts through thick smoke and haze. Analysis of fire dynamics revealed that the largest burned areas resulted from fire front lines started from multiple locations, and the highest propagation speeds were in excess of 500 m/day (all over peat > 2m deep). Fires were found to occur most often in concessions that contained drainage infrastructure but were not cleared prior to the fire season. Benefits of implementing this sensor system to improve current fire management techniques are discussed. Near real-time fire detection together with enhanced fire behavior monitoring capabilities would not only improve firefighting efforts, but also benefit analysis of fire impact on tropical peatlands, greenhouse gas emission estimations as well as mitigation measures to reduce severe fire events in the future. PMID:27486664

Sources of particulate matter components in the Athabasca oil sands region: investigation through a comparison of trace element measurement methodologies

NASA Astrophysics Data System (ADS)

Phillips-Smith, Catherine; Jeong, Cheol-Heon; Healy, Robert M.; Dabek-Zlotorzynska, Ewa; Celo, Valbona; Brook, Jeffrey R.; Evans, Greg

2017-08-01

The province of Alberta, Canada, is home to three oil sands regions which, combined, contain the third largest deposit of oil in the world. Of these, the Athabasca oil sands region is the largest. As part of Environment and Climate Change Canada's program in support of the Joint Canada-Alberta Implementation Plan for Oil Sands Monitoring program, concentrations of trace elements in PM2. 5 (particulate matter smaller than 2.5 µm in diameter) were measured through two campaigns that involved different methodologies: a long-term filter campaign and a short-term intensive campaign. In the long-term campaign, 24 h filter samples were collected once every 6 days over a 2-year period (December 2010-November 2012) at three air monitoring stations in the regional municipality of Wood Buffalo. For the intensive campaign (August 2013), hourly measurements were made with an online instrument at one air monitoring station; daily filter samples were also collected. The hourly and 24 h filter data were analyzed individually using positive matrix factorization. Seven emission sources of PM2. 5 trace elements were thereby identified: two types of upgrader emissions, soil, haul road dust, biomass burning, and two sources of mixed origin. The upgrader emissions, soil, and haul road dust sources were identified through both the methodologies and both methodologies identified a mixed source, but these exhibited more differences than similarities. The second upgrader emissions and biomass burning sources were only resolved by the hourly and filter methodologies, respectively. The similarity of the receptor modeling results from the two methodologies provided reassurance as to the identity of the sources. Overall, much of the PM2. 5-related trace elements were found to be anthropogenic, or at least to be aerosolized through anthropogenic activities. These emissions may in part explain the previously reported higher levels of trace elements in snow, water, and biota samples collected near the oil sands operations.

Detection and Characterization of Low Temperature Peat Fires during the 2015 Fire Catastrophe in Indonesia Using a New High-Sensitivity Fire Monitoring Satellite Sensor (FireBird).

PubMed

Atwood, Elizabeth C; Englhart, Sandra; Lorenz, Eckehard; Halle, Winfried; Wiedemann, Werner; Siegert, Florian

2016-01-01

Vast and disastrous fires occurred on Borneo during the 2015 dry season, pushing Indonesia into the top five carbon emitting countries. The region was affected by a very strong El Niño-Southern Oscillation (ENSO) climate phenomenon, on par with the last severe event in 1997/98. Fire dynamics in Central Kalimantan were investigated using an innovative sensor offering higher sensitivity to a wider range of fire intensities at a finer spatial resolution (160 m) than heretofore available. The sensor is onboard the TET-1 satellite, part of the German Aerospace Center (DLR) FireBird mission. TET-1 images (acquired every 2-3 days) from the middle infrared were used to detect fires continuously burning for almost three weeks in the protected peatlands of Sebangau National Park as well as surrounding areas with active logging and oil palm concessions. TET-1 detection capabilities were compared with MODIS active fire detection and Landsat burned area algorithms. Fire dynamics, including fire front propagation speed and area burned, were investigated. We show that TET-1 has improved detection capabilities over MODIS in monitoring low-intensity peatland fire fronts through thick smoke and haze. Analysis of fire dynamics revealed that the largest burned areas resulted from fire front lines started from multiple locations, and the highest propagation speeds were in excess of 500 m/day (all over peat > 2m deep). Fires were found to occur most often in concessions that contained drainage infrastructure but were not cleared prior to the fire season. Benefits of implementing this sensor system to improve current fire management techniques are discussed. Near real-time fire detection together with enhanced fire behavior monitoring capabilities would not only improve firefighting efforts, but also benefit analysis of fire impact on tropical peatlands, greenhouse gas emission estimations as well as mitigation measures to reduce severe fire events in the future.

Real-time fluorescence microscopy monitoring of porphyrin biodistribution

NASA Astrophysics Data System (ADS)

Kimel, Sol; Gottfried, Varda; Kunzi-Rapp, Karin; Akguen, Nermin; Schneckenburger, Herbert

1996-01-01

In vivo uptake of the natural porphyrins, uroporphyrin III (UP), coproporphyrin III (CP) and protoporphyrin IX (PP), was monitored by fluorescence microscopy. Experiments were performed using the chick chorioallantoic membrane (CAM) model, which allowed video documentation of fluorescence both in real time and after integration over a chosen time interval (usually 2 s). Sensitizers at a concentration of 50 (mu) M (100 (mu) L) were injected into a medium-sized vein (diameter approximately 40 micrometer) using an ultra-fine 10 micrometer diameter needle. Fluorescence images were quantitated by subtracting the fluorescence intensity of surrounding CAM tissue (Fmatrix) from the intravascular fluorescence intensity (Fintravascular), after transformation of the video frames into digital form. The differential fluorescence intensity, Fintravascular - Fmatrix, is a measure of the biodistribution. Real time measurements clearly showed that CP and UP fluorescence is associated with moving erythrocytes and not with endothelial cells of the vessel wall. Fluorescence intensity was monitored, up to 60 minutes after injection, by averaging the fluorescence over time intervals of 2 s and recording the integrated images. The fluorescence intensity reached its maximum in about 20 - 30 min after injection, presumably after monomerization inside erythrocyte membranes. The results are interpreted in terms of physical-chemical characteristics (e.g. hydrophilicity) and correlated with the photodynamically induced hemostasis in CAM blood vessels.

Transformer partial discharge monitoring based on optical fiber sensing

NASA Astrophysics Data System (ADS)

Wang, Kun; Tong, Xinglin; Zhu, Xiaolong

2014-06-01

The power transformer is the most important equipment of the high voltage power grid, however, some traditional methods of online partial discharge monitoring have some limitations. Based on many advantages of the optical fiber sensing technology, we have done some research on fiber optics Fabry-Perot (FP) sensing which can be useful for the transformer on online partial discharge monitoring. This research aimed at improving the reliability of power system safety monitoring. We have done some work as follows: designing a set for fiber optics FP sensor preparation, according to the fabrication procedure strictly making out the sensors, building a reasonable signal demodulation system for fiber optics FP sensing, doing a preliminary analysis about online partial discharge signal monitoring, including the research on different discharge intensities with the same measuring distance and different measuring distances with the same discharge intensity, and then making a detailed analysis of the experimental results.

Physiologic Monitor Alarm Rates at 5 Children's Hospitals.

PubMed

Schondelmeyer, Amanda C; Brady, Patrick W; Goel, Veena V; Cvach, Maria; Blake, Nancy; Mangeot, Colleen; Bonafide, Christopher P

2018-06-01

Alarm fatigue has been linked to patient morbidity and mortality in hospitals due to delayed or absent responses to monitor alarms. We sought to describe alarm rates at 5 freestanding children's hospitals during a single day and the types of alarms and proportions of patients monitored by using a point-prevalence, cross-sectional study design. We collected audible alarms on all inpatient units and calculated overall alarm rates and rates by alarm type per monitored patient per day. We found a total of 147,213 alarms during the study period, with 3-fold variation in alarm rates across hospitals among similar unit types. Across hospitals, onequarter of monitored beds were responsible for 71%, 61%, and 63% of alarms in medical-surgical, neonatal intensive care, and pediatric intensive care units, respectively. Future work focused on addressing nonactionable alarms in patients with the highest alarm counts may decrease alarm rates. © 2018 Society of Hospital Medicine.

Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey.

PubMed

Cortegiani, Andrea; Russotto, Vincenzo; Raineri, Santi Maurizio; Gregoretti, Cesare; Giarratano, Antonino; Mercadante, Sebastiano

2018-06-01

The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. Eight hundred and five persons responded to the full list of questions. The highest proportion of respondents was of 36-45 years of age (34%) and catholic (66%). Almost 70% of responders declared that palliative/supportive care are applied in their ICU in case of futility of intensive treatments. Decision on withdrawing/withholding of life-sustaining treatments resulted from team consensus in most cases (58%). In more than 70% of responders' ICUs, there is no collaboration with palliative/supportive care experts. Systematic recording of most frequent symptoms experienced by critically ill patients (e.g., pain, dyspnea, thirst) was not common. Vasopressors, extracorporeal therapies, blood component transfusions and invasive monitoring were the most commonly modified/interrupted measures in case of futility. Almost 85% of respondents have not received training in palliative/supportive care. The proportion of respondents whose institution has a palliative care team and who had training in palliative care was not homogenous across the country. These data suggest that training in palliative care and its clinical application should be implemented in Italy. Efforts should be made to improve and homogenize the management of dying patients in ICU.

An Updated Algorithm for Estimation of Pesticide Exposure Intensity in the Agricultural Health Study

EPA Science Inventory

An algorithm developed to estimate pesticide exposure intensity for use in epidemiologic analyses was revised based on data from two exposure monitoring studies. In the first study, we estimated relative exposure intensity based on the results of measurements taken during the app...

Assessment of SRS ambient air monitoring network

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

Abbott, K.; Jannik, T.

Three methodologies have been used to assess the effectiveness of the existing ambient air monitoring system in place at the Savannah River Site in Aiken, SC. Effectiveness was measured using two metrics that have been utilized in previous quantification of air-monitoring network performance; frequency of detection (a measurement of how frequently a minimum number of samplers within the network detect an event), and network intensity (a measurement of how consistent each sampler within the network is at detecting events). In addition to determining the effectiveness of the current system, the objective of performing this assessment was to determine what, ifmore » any, changes could make the system more effective. Methodologies included 1) the Waite method of determining sampler distribution, 2) the CAP88- PC annual dose model, and 3) a puff/plume transport model used to predict air concentrations at sampler locations. Data collected from air samplers at SRS in 2015 compared with predicted data resulting from the methodologies determined that the frequency of detection for the current system is 79.2% with sampler efficiencies ranging from 5% to 45%, and a mean network intensity of 21.5%. One of the air monitoring stations had an efficiency of less than 10%, and detected releases during just one sampling period of the entire year, adding little to the overall network intensity. By moving or removing this sampler, the mean network intensity increased to about 23%. Further work in increasing the network intensity and simulating accident scenarios to further test the ambient air system at SRS is planned« less

Impact of treatment and monitoring on Prince George's County DWI's [sic

DOT National Transportation Integrated Search

1989-12-01

The state of Maryland maintains this nation's most intensive monitoring system for convicted drinking drivers. Each offender placed in the program by the court is required to attend a face-to-face interview once a week. In addition to the Monitor Pro...

An inexpensive open-source ultrasonic sensing system for monitoring fluid levels

USDA-ARS?s Scientific Manuscript database

Fluid levels are measured in a variety of agricultural applications, and are often measured manually, which can be time-consuming and labor-intensive. Rapid advances in electronic technologies have made a variety of inexpensive sensing, monitoring, and control capabilities available. A monitoring ...

Continuous noninvasive monitoring in the neonatal ICU.

PubMed

Sahni, Rakesh

2017-04-01

Standard hemodynamic monitoring such as heart rate and systemic blood pressure may only provide a crude estimation of organ perfusion during neonatal intensive care. Pulse oximetry monitoring allows for continuous noninvasive monitoring of hemoglobin oxygenation and thus provides estimation of end-organ oxygenation. This review aims to provide an overview of pulse oximetry and discuss its current and potential clinical use during neonatal intensive care. Technological advances in continuous assessment of dynamic changes in systemic oxygenation with pulse oximetry during transition to extrauterine life and beyond provide additional details about physiological interactions among the key hemodynamic factors regulating systemic blood flow distribution along with the subtle changes that are frequently transient and undetectable with standard monitoring. Noninvasive real-time continuous systemic oxygen monitoring has the potential to serve as biomarkers for early-organ dysfunction, to predict adverse short-term and long-term outcomes in critically ill neonates, and to optimize outcomes. Further studies are needed to establish values predicting adverse outcomes and to validate targeted interventions to normalize abnormal values to improve outcomes.

Effect of a laboratory result pager on provider behavior in a neonatal intensive care unit.

PubMed

Samal, L; Stavroudis, Ta; Miller, Re; Lehmann, Hp; Lehmann, Cu

2011-01-01

A computerized laboratory result paging system (LRPS) that alerts providers about abnormal results ("push") may improve upon active laboratory result review ("pull"). However, implementing such a system in the intensive care setting may be hindered by low signal-to-noise ratio, which may lead to alert fatigue. To evaluate the impact of an LRPS in a Neonatal Intensive Care Unit. Utilizing paper chart review, we tallied provider orders following an abnormal laboratory result before and after implementation of an LRPS. Orders were compared with a predefined set of appropriate orders for such an abnormal result. The likelihood of a provider response in the post-implementation period as compared to the pre-implementation period was analyzed using logistic regression. The provider responses were analyzed using logistic regression to control for potential confounders. The likelihood of a provider response to an abnormal laboratory result did not change significantly after implementation of an LRPS. (Odds Ratio 0.90, 95% CI 0.63-1.30, p-value 0.58) However, when providers did respond to an alert, the type of response was different. The proportion of repeat laboratory tests increased. (26/378 vs. 7/278, p-value = 0.02). Although the laboratory result pager altered healthcare provider behavior in the Neonatal Intensive Care Unit, it did not increase the overall likelihood of provider response.

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

PubMed

Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K

2014-02-01

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

VA's expansion of supportive housing: successes and challenges on the path toward Housing First.

PubMed

Austin, Erika Laine; Pollio, David E; Holmes, Sally; Schumacher, Joseph; White, Bert; Lukas, Carol Vandeusen; Kertesz, Stefan

2014-05-01

The U.S. Department of Veterans Affairs (VA) is transitioning to a Housing First approach to placement of veterans in permanent supportive housing through the use of rental vouchers, an ambitious organizational transformation. This qualitative study examined the experiences of eight VA facilities undertaking this endeavor in 2012. A multidisciplinary team interviewed facility leadership, midlevel managers, and frontline staff (N=95 individuals) at eight VA facilities representing four U.S. regions. The team used a semistructured interview protocol and the constant comparative method to explore how individuals throughout the organizations experienced and responded to the challenges of transitioning to a Housing First approach. Frontline staff faced challenges in rapidly housing homeless veterans because of difficult rental markets, the need to coordinate with local public housing authorities, and a lack of available funds for move-in costs. Staff sought to balance their time spent on housing activities with intensive case management of highly vulnerable veterans. Finding low-demand sheltering options (that is, no expectations regarding sobriety or treatment participation, as in the Housing First model) for veterans waiting for housing presented a significant challenge to implementation of Housing First. Facility leadership supported Housing First implementation through resource allocation, performance monitoring, and reliance on midlevel managers to understand and meet the challenges of implementation. The findings highlight the considerable practical challenges and innovative solutions arising from a large-scale effort to implement Housing First, with particular attention to the experiences of individuals at all levels within an organization.

Creating Clinical Fuzzy Automata with Fuzzy Arden Syntax.

PubMed

de Bruin, Jeroen S; Steltzer, Heinz; Rappelsberger, Andrea; Adlassnig, Klaus-Peter

2017-01-01

Formal constructs for fuzzy sets and fuzzy logic are incorporated into Arden Syntax version 2.9 (Fuzzy Arden Syntax). With fuzzy sets, the relationships between measured or observed data and linguistic terms are expressed as degrees of compatibility that model the unsharpness of the boundaries of linguistic terms. Propositional uncertainty due to incomplete knowledge of relationships between clinical linguistic concepts is modeled with fuzzy logic. Fuzzy Arden Syntax also supports the construction of fuzzy state monitors. The latter are defined as monitors that employ fuzzy automata to observe gradual transitions between different stages of disease. As a use case, we re-implemented FuzzyARDS, a previously published clinical monitoring system for patients suffering from acute respiratory distress syndrome (ARDS). Using the re-implementation as an example, we show how key concepts of fuzzy automata, i.e., fuzzy states and parallel fuzzy state transitions, can be implemented in Fuzzy Arden Syntax. The results showed that fuzzy state monitors can be implemented in a straightforward manner.

Principles of Automation for Patient Safety in Intensive Care: Learning From Aviation.

PubMed

Dominiczak, Jason; Khansa, Lara

2018-06-01

The transition away from written documentation and analog methods has opened up the possibility of leveraging data science and analytic techniques to improve health care. In the implementation of data science techniques and methodologies, high-acuity patients in the ICU can particularly benefit. The Principles of Automation for Patient Safety in Intensive Care (PASPIC) framework draws on Billings's principles of human-centered aviation (HCA) automation and helps in identifying the advantages, pitfalls, and unintended consequences of automation in health care. Billings's HCA principles are based on the premise that human operators must remain "in command," so that they are continuously informed and actively involved in all aspects of system operations. In addition, automated systems need to be predictable, simple to train, to learn, and to operate, and must be able to monitor the human operators, and every intelligent system element must know the intent of other intelligent system elements. In applying Billings's HCA principles to the ICU setting, PAPSIC has three key characteristics: (1) integration and better interoperability, (2) multidimensional analysis, and (3) enhanced situation awareness. PAPSIC suggests that health care professionals reduce overreliance on automation and implement "cooperative automation" and that vendors reduce mode errors and embrace interoperability. Much can be learned from the aviation industry in automating the ICU. Because it combines "smart" technology with the necessary controls to withstand unintended consequences, PAPSIC could help ensure more informed decision making in the ICU and better patient care. Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Application of the probabilistic model BET_UNREST during a volcanic unrest simulation exercise in Dominica, Lesser Antilles

NASA Astrophysics Data System (ADS)

Constantinescu, Robert; Robertson, Richard; Lindsay, Jan M.; Tonini, Roberto; Sandri, Laura; Rouwet, Dmitri; Smith, Patrick; Stewart, Roderick

2016-11-01

We report on the first "real-time" application of the BET_UNREST (Bayesian Event Tree for Volcanic Unrest) probabilistic model, during a VUELCO Simulation Exercise carried out on the island of Dominica, Lesser Antilles, in May 2015. Dominica has a concentration of nine potentially active volcanic centers and frequent volcanic earthquake swarms at shallow depths, intense geothermal activity, and recent phreatic explosions (1997) indicate the region is still active. The exercise scenario was developed in secret by a team of scientists from The University of the West Indies (Trinidad and Tobago) and University of Auckland (New Zealand). The simulated unrest activity was provided to the exercise's Scientific Team in three "phases" through exercise injects comprising processed monitoring data. We applied the newly created BET_UNREST model through its software implementation PyBetUnrest, to estimate the probabilities of having (i) unrest of (ii) magmatic, hydrothermal or tectonic origin, which may or may not lead to (iii) an eruption. The probabilities obtained for each simulated phase raised controversy and intense deliberations among the members of the Scientific Team. The results were often considered to be "too high" and were not included in any of the reports presented to ODM (Office for Disaster Management) revealing interesting crisis communication challenges. We concluded that the PyBetUnrest application itself was successful and brought the tool one step closer to a full implementation. However, as with any newly proposed method, it needs more testing, and in order to be able to use it in the future, we make a series of recommendations for future applications.

SenseWearMini and Actigraph GT3X Accelerometer Classification of Observed Sedentary and Light-Intensity Physical Activities in a Laboratory Setting.

PubMed

Feehan, Lynne M; Goldsmith, Charles H; Leung, April Y F; Li, Linda C

Purpose: To compare the ability of SenseWear Mini (SWm) and Actigraph GT3X (AG 3 ) accelerometers to differentiate between healthy adults' observed sedentary and light activities in a laboratory setting. Methods: The 22 participants (15 women, 7 men), ages 19 to 72 years, wore SWm and AG 3 monitors and performed five sedentary and four light activities for 5 minutes each while observed in a laboratory setting. Performance was examined through comparisons of accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Correct identification of both types of activities was examined using area under the receiver operating characteristic curve (AUC). Results: Both monitors demonstrated excellent ability to identify sedentary activities (sensitivity>0.89). The SWm monitor was better at identifying light activities (specificity 0.61-0.71) than the AG 3 monitor (specificity 0.27-0.47) and thus also showed a greater ability to correctly identify both sedentary and light activities (SWm AUC 0.84; AG 3 AUC 0.62-0.73). Conclusions: SWm may be a more suitable monitor for detecting time spent in sedentary and light-intensity activities. This finding has clinical and research relevance for evaluation of time spent in lower intensity physical activities by sedentary adults.

The Significance of Forest Monitoring Programmes: the Finnish Perspective

NASA Astrophysics Data System (ADS)

Merila, P.; Derome, J.; Lindgren, M.

2007-12-01

Finland has been participating in the ICP Forests programme (the International Co-operative Programme on the Assessment and Monitoring of Air Pollution Effects on Forests) based on international agreements on the long- range transportation of air pollutants (LRTAP) and other associated monitoring programmes (e.g. Forest Focus, ICP Integrated Monitoring, ICP Vegetation) since 1985. The knowledge gained during the years has greatly increased our understanding of the overall condition of our forests and the factors affecting forest condition, the processes underlying forest ecosystem functioning, and the potential threats to our forests posed by human activities, both at home and abroad. The success of the monitoring activities in Finland is largely based on the experience gained during the early 1980's with our own national acidification project and, during the late 1980's and early 1990"s, in a number of regional monitoring projects. Finland's membership of the European Union (entry in 1996) has enabled us to further develop the infrastructure and coverage of both our extensive and intensive level networks. This broadening of our ecological understanding and development of international collaboration are now providing us with an invaluable basis for addressing the new monitoring challenges (biodiversity, climate change). The results gained in our monitoring activities clearly demonstrate the value of long-term monitoring programmes. The main results have been regularly reported both at the European (e.g. http://www.icp- forests.org/Reports.htm) and national level (e.g. http://www.metla.fi/julkaisut/workingpapers/2007/mwp045- en.htm). However, the datasets have not been intensively explored and exploited, and few of the important methodological and ecological findings have been published in peer-reviewed scientific journals. This has, understandably, not been the first priority of the international monitoring programmes. A number of the intensive forest monitoring plots in Finland have recently been included in LTER platforms, thus potentially increasing scientific collaboration between researchers across different governmental institutes and education bodies.

Developing a framework for implementing intensive care unit diaries: a focused review of the literature.

PubMed

Beg, Muna; Scruth, Elizabeth; Liu, Vincent

2016-11-01

Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies. We conducted a focused review of the literature regarding intensive care diaries based on a systematic search of several databases. Two reviewers assessed 56 studies and data were abstracted from a total of 25 eligible studies conducted between 1990 and 2014. We identified key information regarding the development, design, and implementation of the journals. We then grouped elements that appeared consistently across these studies within three main categories: (1) diary target populations; (2) diary format and content; and (3) the manner of diary return and follow-up. Most studies were conducted in European countries in adult intensive care units and targeted patients in both medical and surgical units. The timing of diary initiation was based on the elapsed length of stay or duration of mechanical ventilation. We categorised diary format and content as: entry content, authors, use of standardised headings, type of language, initiation, frequency of entries, and physical location of diaries. Diaries were hand written and many studies found that photographs were an essential element in ICU diaries. We categorised the manner of diary return and follow-up. The context in which intensive care unit diaries were returned were felt to be important factors in improving the use of diaries in recovery. In conclusion, we describe a common framework for the future development of intensive care unit diaries that revolves around the target population for the diaries, their format and content, and the timing of their use. Future studies should address how these elements impact the mechanisms by which intensive are diaries exert beneficial effects. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

[Design and implementation of online statistical analysis function in information system of air pollution and health impact monitoring].

PubMed

Lü, Yiran; Hao, Shuxin; Zhang, Guoqing; Liu, Jie; Liu, Yue; Xu, Dongqun

2018-01-01

To implement the online statistical analysis function in information system of air pollution and health impact monitoring, and obtain the data analysis information real-time. Using the descriptive statistical method as well as time-series analysis and multivariate regression analysis, SQL language and visual tools to implement online statistical analysis based on database software. Generate basic statistical tables and summary tables of air pollution exposure and health impact data online; Generate tendency charts of each data part online and proceed interaction connecting to database; Generate butting sheets which can lead to R, SAS and SPSS directly online. The information system air pollution and health impact monitoring implements the statistical analysis function online, which can provide real-time analysis result to its users.

A new approach to preparation of standard LEDs for luminous intensity and flux measurement of LEDs

NASA Astrophysics Data System (ADS)

Park, Seung-Nam; Park, Seongchong; Lee, Dong-Hoon

2006-09-01

This work presents an alternative approach for preparing photometric standard LEDs, which is based on a novel functional seasoning method. The main idea of our seasoning method is simultaneously monitoring the light output and the junction voltage to obtain quantitative information on the temperature dependence and the aging effect of the LED emission. We suggested a general model describing the seasoning process by taking junction temperature variation and aging effect into account and implemented a fully automated seasoning facility, which is capable of seasoning 12 LEDs at the same time. By independent measurements of the temperature dependence, we confirmed the discrepancy of the theoretical model to be less than 0.5 % and evaluate the uncertainty contribution of the functional seasoning to be less than 0.5 % for all the seasoned samples. To demonstrate assigning the reference value to a standard LED, the CIE averaged LED intensity (ALI) of the seasoned LEDs was measured with a spectroradiometer-based instrument and the measurement uncertainty was analyzed. The expanded uncertainty of the standard LED prepared by the new approach amounts to be 4 % ~ 5 % (k=2) depending on color without correction of spectral stray light in the spectroradiometer.

Wall Conditioning Characterization in NSTX-U

NASA Astrophysics Data System (ADS)

Caron, D.; Soukhanovskii, V.; Scotti, F.; Weller, M.

2016-10-01

Impurities in tokamak plasmas can lead to disruptive instabilities due to radiative energy loss which impede access to high-confinements mode. One source of impurities in NSTX-U are water molecules trapped in graphite plasma facing components (PFCs), which make up the walls and divertors. Hydrogen and oxygen impurities are released into the plasma due to plasma surface interactions. Extreme ultraviolet (EUV) and visible spectrometers are used in conjunction with a residual gas analyzer (RGA) to characterize the source and amount of released impurities. A high resolution visible spectrometer measured H/D Balmer- α intensity ratio on the inner wall, the upper and lower divertors, and provided a hydrogen time history for shot-to-shot trends. The RGA provided partial pressure trends of masses 2 (H2) , 16 (O2) , and 18 (H2O). Trends of O VIII and C VI spectral line intensities from the core plasma were obtained from the EUV spectrometer. The trends are correlated with wall conditioning, namely helium glow discharge cleaning and boronization. Using these trends, impurity content monitoring and recommendations for wall conditioning can be implemented. Work supported by DOE under Contracts DE-AC52-07NA27344 and DE-AC02-09CH11466.

A Business Case for Tele-Intensive Care Units

PubMed Central

Coustasse, Alberto; Deslich, Stacie; Bailey, Deanna; Hairston, Alesia; Paul, David

2014-01-01

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. Conclusions: Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU. PMID:25662529

LEAD SAFE YARDS: DEVELOPING AND IMPLEMENTING A MONITORING, ASSESSMENT, AND OUTREACH PROGRAM FOR YOUR COMMUNITY

EPA Science Inventory

The USEPA has developed a technology transfer handbook on how to plan and implement a residential soil lead monitoring, assessment, mitigation and outreach program for residential communities. The handbook provides guidance on 1) identifying potentially impacted communities, 2) c...

Integrated sUAS Greenhouse Gas Measurements and Imagery for Land Use Emissions Monitoring

NASA Astrophysics Data System (ADS)

Barbieri, L.; Wyngaard, J.; Galford, G. L.; Adair, C.

2016-12-01

Agriculture, Forestry and Other Land Uses (AFOLU) constitute the second largest anthropogenic source of greenhouse gas (GHG) emissions globally. Agriculture is the dominant source of emissions within that sector. There are a variety of agricultural land management strategies that can be implemented to reduce GHG emissions, but determining the best strategies is challenging. Emissions estimates are currently derived from GHG monitoring methods (e.g., static chambers, eddy flux towers) that are time and labor intensive, expensive, and use in-situ equipment. These methods lack the flexible, spatio-temporal monitoring necessary to reduce the high uncertainty in regional GHG emissions estimates. Small Unmanned Aerial Systems (sUAS) provide the rapid response data collection needed to monitor important field management events (e.g., manure spreading). Further, the ease of deployment of sUAS makes monitoring large regional extents over full-seasons more viable. To our knowledge, we present the first integration of sUAS remotely sensed imagery and GHG concentrations in agriculture and land use monitoring. We have developed and tested open-source hardware and software utilizing low-cost equipment (e.g., NDIR gas sensors and Canon cameras). Initial results show agreement with more traditional, proprietary equipment but at a fraction of the costs. Here we present data from test flights over agricultural areas under various management practices. The suite of data includes sUAS overpasses for imagery and CO2 concentration measurements, paired with field-based GHG measurements (static chambers). We have developed a set of best practices for sUAS data collection (e.g., time of day effects variability in localized atmospheric GHG concentrations) and discuss currently known challenges (e.g., accounting for external environmental factors such as wind speed). We present results on all sUAS GHG sampling methods paired with imagery and simultaneous static chamber monitoring for a comprehensive assessment of methods for use in GHG emission hotspot detection across landscapes.

Assessing NIR & MIR Spectral Analysis as a Method for Soil C Estimation Across a Network of Sampling Sites

NASA Astrophysics Data System (ADS)

Spencer, S.; Ogle, S.; Borch, T.; Rock, B.

2008-12-01

Monitoring soil C stocks is critical to assess the impact of future climate and land use change on carbon sinks and sources in agricultural lands. A benchmark network for soil carbon monitoring of stock changes is being designed for US agricultural lands with 3000-5000 sites anticipated and re-sampling on a 5- to10-year basis. Approximately 1000 sites would be sampled per year producing around 15,000 soil samples to be processed for total, organic, and inorganic carbon, as well as bulk density and nitrogen. Laboratory processing of soil samples is cost and time intensive, therefore we are testing the efficacy of using near-infrared (NIR) and mid-infrared (MIR) spectral methods for estimating soil carbon. As part of an initial implementation of national soil carbon monitoring, we collected over 1800 soil samples from 45 cropland sites in the mid-continental region of the U.S. Samples were processed using standard laboratory methods to determine the variables above. Carbon and nitrogen were determined by dry combustion and inorganic carbon was estimated with an acid-pressure test. 600 samples are being scanned using a bench- top NIR reflectance spectrometer (30 g of 2 mm oven-dried soil and 30 g of 8 mm air-dried soil) and 500 samples using a MIR Fourier-Transform Infrared Spectrometer (FTIR) with a DRIFT reflectance accessory (0.2 g oven-dried ground soil). Lab-measured carbon will be compared to spectrally-estimated carbon contents using Partial Least Squares (PLS) multivariate statistical approach. PLS attempts to develop a soil C predictive model that can then be used to estimate C in soil samples not lab-processed. The spectral analysis of soil samples either whole or partially processed can potentially save both funding resources and time to process samples. This is particularly relevant for the implementation of a national monitoring network for soil carbon. This poster will discuss our methods, initial results and potential for using NIR and MIR spectral approaches to either replace or augment traditional lab-based carbon analyses of soils.

Parallel computer processing and modeling: applications for the ICU

NASA Astrophysics Data System (ADS)

Baxter, Grant; Pranger, L. Alex; Draghic, Nicole; Sims, Nathaniel M.; Wiesmann, William P.

2003-07-01

Current patient monitoring procedures in hospital intensive care units (ICUs) generate vast quantities of medical data, much of which is considered extemporaneous and not evaluated. Although sophisticated monitors to analyze individual types of patient data are routinely used in the hospital setting, this equipment lacks high order signal analysis tools for detecting long-term trends and correlations between different signals within a patient data set. Without the ability to continuously analyze disjoint sets of patient data, it is difficult to detect slow-forming complications. As a result, the early onset of conditions such as pneumonia or sepsis may not be apparent until the advanced stages. We report here on the development of a distributed software architecture test bed and software medical models to analyze both asynchronous and continuous patient data in real time. Hardware and software has been developed to support a multi-node distributed computer cluster capable of amassing data from multiple patient monitors and projecting near and long-term outcomes based upon the application of physiologic models to the incoming patient data stream. One computer acts as a central coordinating node; additional computers accommodate processing needs. A simple, non-clinical model for sepsis detection was implemented on the system for demonstration purposes. This work shows exceptional promise as a highly effective means to rapidly predict and thereby mitigate the effect of nosocomial infections.

High frequency monitoring of the coastal marine environment using the MAREL buoy.

PubMed

Blain, S; Guillou, J; Tréguer, P; Woerther, P; Delauney, L; Follenfant, E; Gontier, O; Hamon, M; Leilde, B; Masson, A; Tartu, C; Vuillemin, R

2004-06-01

The MAREL Iroise data buoy provides physico-chemical measurements acquired in surface marine water in continuous and autonomous mode. The water is pumped 1.5 m from below the surface through a sampling pipe and flows through the measuring cell located in the floating structure. Technological innovations implemented inside the measuring cell atop the buoy allow a continuous cleaning of the sensor, while injection of chloride ions into the circuit prevents biological fouling. Specific sensors for temperature, salinity, oxygen and fluorescence investigated in this paper have been evaluated to guarantee measurement precision over a 3 month period. A bi-directional link under Internet TCP-IP protocols is used for data, alarms and remote-control transmissions with the land-based data centre. Herein, we present a 29 month record for 4 parameters measured using a MAREL buoy moored in a coastal environment (Iroise Sea, Brest, France). The accuracy of the data provided by the buoy is assessed by comparison with measurements of sea water weekly sampled at the same site as part of SOMLIT (Service d'Observation du Milieu LIToral), the French network for monitoring of the coastal environment. Some particular events (impact of intensive fresh water discharges, dynamics of a fast phytoplankton bloom) are also presented, demonstrating the worth of monitoring a highly variable environment with a high frequency continuous reliable system.

Multimodal intraoperative monitoring: an overview and proposal of methodology based on 1,017 cases

PubMed Central

Eggspuehler, Andreas; Muller, Alfred; Dvorak, Jiri

2007-01-01

To describe different currently available tests of multimodal intraoperative monitoring (MIOM) used in spine and spinal cord surgery indicating the technical parameters, application and interpretation as an easy understanding systematic overview to help implementation of MIOM and improve communication between neurophysiologists and spine surgeons. This article aims to give an overview and proposal of the different MIOM-techniques as used daily in spine and spinal cord surgery at our institution. Intensive research in neurophysiology over the past decades has lead to a profound understanding of the spinal cord, nerve functions and their intraoperative functional evaluation in anaesthetised patients. At present, spine surgeons and neurophysiologist are faced with 1,883 publications in PubMed on spinal cord monitoring. The value and the limitations of single monitoring methods are well documented. The diagnostic power of the multimodal approach in a larger study population in spine surgery, as measured with sensitivity and specificity, is dealt with elsewhere in this supplement (Sutter et al. in Eur Spine J Suppl, 2007). This paper aims to give a detailed description of the different modalities used in this study. Description of monitoring techniques of the descending and ascending spinal cord and nerve root pathways by motor evoked potentials of the spinal cord and muscles elicited after transcranial electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, continuous EMG, sensory cortical and spinal evoked potentials, as well as direct spinal cord evoked potentials applied on 1,017 patients. The method of MIOM, continuously adapted according to the site, stage of surgery and potential danger to nerve tissues, proved to be applicable with online results, reliable and furthermore teachable. PMID:17653777

Monitoring training status with HR measures: do all roads lead to Rome?

PubMed Central

Buchheit, Martin

2014-01-01

Measures of resting, exercise, and recovery heart rate are receiving increasing interest for monitoring fatigue, fitness and endurance performance responses, which has direct implications for adjusting training load (1) daily during specific training blocks and (2) throughout the competitive season. However, these measures are still not widely implemented to monitor athletes' responses to training load, probably because of apparent contradictory findings in the literature. In this review I contend that most of the contradictory findings are related to methodological inconsistencies and/or misinterpretation of the data rather than to limitations of heart rate measures to accurately inform on training status. I also provide evidence that measures derived from 5-min (almost daily) recordings of resting (indices capturing beat-to-beat changes in heart rate, reflecting cardiac parasympathetic activity) and submaximal exercise (30- to 60-s average) heart rate are likely the most useful monitoring tools. For appropriate interpretation at the individual level, changes in a given measure should be interpreted by taking into account the error of measurement and the smallest important change of the measure, as well as the training context (training phase, load, and intensity distribution). The decision to use a given measure should be based upon the level of information that is required by the athlete, the marker's sensitivity to changes in training status and the practical constrains required for the measurements. However, measures of heart rate cannot inform on all aspects of wellness, fatigue, and performance, so their use in combination with daily training logs, psychometric questionnaires and non-invasive, cost-effective performance tests such as a countermovement jump may offer a complete solution to monitor training status in athletes participating in aerobic-oriented sports. PMID:24578692

Hubble Space Telescope on-line telemetry archive for monitoring scientific instruments

NASA Astrophysics Data System (ADS)

Miebach, Manfred P.

2002-12-01

A major milestone in an effort to update the aging Hubble Space Telescope (HST) ground system was completed when HST operations were switched to a new ground system, a project called "Vision 2000 Control Center System CCS)", at the time of the third Servicing Mission in December 1999. A major CCS subsystem is the Space Telescope Engineering Data Store, the design of which is based on modern Data Warehousing technology. In fact, the Data Warehouse (DW) as implemented in the CCS Ground System that operates and monitors the Hubble Space Telescope represents, the first use of a commercial Data Warehouse to manage engineering data. By the end of February 2002, the process of populating the Data Warehouse with HST historical telemetry data had been completed, providing access to HST engineering data for a period of over 12 years with a current data volume of 2.8 Terabytes. This paper describes hands-on experience from an end user perspective, using the CCS system capabilities, including the Data Warehouse as an HST engineering telemetry archive. The Engineering Team at the Space Telescope Science Institute is using HST telemetry extensively for monitoring the Scientific Instruments, in particular for · Spacecraft anomaly resolutions · Scientific Instrument trending · Improvements of Instrument operational efficiency The overall idea is to maximize science output of the space observatory. Furthermore, the CCS provides a powerful feature to build, save, and recall real-time display pages customized to specific subsystems and operational scenarios. Engineering teams are using the real-time monitoring capabilities intensively during Servicing Missions and real time commanding to handle anomaly situations, while the Flight Operations Team (FOT) monitors the spacecraft around the clock.

Privacy issues and the monitoring of sumatriptan in the New Zealand Intensive Medicines Monitoring Programme.

PubMed

Coulter, D M

2001-12-01

The purpose of this paper is to describe how the New Zealand (NZ) Intensive Medicines Monitoring Programme (IMMP) functions in relation to NZ privacy laws and to describe the attitudes of patients to drug safety monitoring and the privacy of their personal and health information. The IMMP undertakes prospective observational event monitoring cohort studies on new drugs. The cohorts are established from prescription data and the events are obtained using prescription event monitoring and spontaneous reporting. Personal details, prescribing history of the monitored drugs and adverse events data are stored in databases long term. The NZ Health Information Privacy Code is outlined and the monitoring of sumatriptan is used to illustrate how the IMMP functions in relation to the Code. Patient responses to the programme are described. Sumatriptan was monitored in 14,964 patients and 107,646 prescriptions were recorded. There were 2344 reports received describing 3987 adverse events. A majority of the patients were involved in the recording of events data either personally or by telephone interview. There were no objections to the monitoring process on privacy grounds. Given the fact that all reasonable precautions are taken to ensure privacy, patients perceive drug safety to have greater priority than any slight risk of breach of confidentiality concerning their personal details and health information.

Further specimens of the Asian tiger mosquito Aedes albopictus (Diptera, Culicidae) trapped in southwest Germany.

PubMed

Kampen, Helge; Kronefeld, Mandy; Zielke, Dorothee; Werner, Doreen

2013-02-01

After two previous demonstrations of introductions of the Asian tiger mosquito, Aedes albopictus, into southern Germany in 2007 and 2011, another three specimens were trapped in the city of Freiburg in the Upper Rhine Valley. The females were caught in early September 2011 (n = 2) and mid-July 2012 (n = 1). The trap was located at a railway container station where cargo is transferred to trains from trucks predominantly coming from southern Europe where A. albopictus is widely distributed. The reported findings confirm vehicle transport of A. albopictus to be an important and probably frequent mode of importation, and suggest that more regular and intense monitoring for invasive mosquito species in the Upper Rhine Valley should be undertaken in order to detect an establishment and implement adequate control measures in good time.

A Healthy Lifestyle Intervention Application.

PubMed

Tufte, Trond; Babic, Ankica

2017-01-01

In this project, a mHealth tool for smart-phones has been developed using Design Science methodology, where the goal has been to promote an active lifestyle. This was undertaken by implementing social and physical activity stimulating features within the application MoveFit. Users can opt to utilize just a feature or two or engage in social activities of different intensity. Regular and expert users have evaluated the application in order to meet usability requirements. In addition a field expert and a focus group have contributed towards the application's potential to increase physical activity. There was enough data collected by the app to document its good effect; it was possible to demonstrate that the app was capable of promoting physical activity. User testing has also shown the appreciation of the various features such as social networking, activity monitoring, and route/activity creation.

New Training and Diagnostic Stategies to Counteract Muscle and Bone Loss in Microgravity

NASA Astrophysics Data System (ADS)

Talla, R.; Adamcik, G.; Barta, N.; Kozlovskaya, I. B.; Tschan, H.; Bachl, N.; Angeli, T.

2013-02-01

The Multifunctional Dynamometer for Application in Space (MDS) is a cooperation between the Vienna University of Technology, the Institute of Biomedical Problems of the Russian Academy of Sciences, Moscow and the University of Vienna to prevent the deterioration of the musculoskeletal and cardiovascular system under the influence of microgravity. It is considered that the loading intensity might be crucial to support certain physiological parameters. The MDS offers a variety of exercises with the main focus on sites which are most affected by atrophy and is able to generate high training forces by using an electrical motor. Moreover the usage of the electrical motor enables different training modes for each exercise. A comprehensive analysis, including isokinetic and isometric tests provides the monitoring of the progress and compliance of the users. The MDS was implemented in the MARS 500 project.

Tailoring the Blast Exposure Conditions in the Shock Tube for Generating Pure, Primary Shock Waves: The End Plate Facilitates Elimination of Secondary Loading of the Specimen

PubMed Central

Misistia, Anthony; Kahali, Sudeepto; Sundaramurthy, Aravind; Chandra, Namas

2016-01-01

The end plate mounted at the mouth of the shock tube is a versatile and effective implement to control and mitigate the end effects. We have performed a series of measurements of incident shock wave velocities and overpressures followed by quantification of impulse values (integral of pressure in time domain) for four different end plate configurations (0.625, 2, 4 inches, and an open end). Shock wave characteristics were monitored by high response rate pressure sensors allocated in six positions along the length of 6 meters long 229 mm square cross section shock tube. Tests were performed at three shock wave intensities, which was controlled by varying the Mylar membrane thickness (0.02, 0.04 and 0.06 inch). The end reflector plate installed at the exit of the shock tube allows precise control over the intensity of reflected waves penetrating into the shock tube. At the optimized distance of the tube to end plate gap the secondary waves were entirely eliminated from the test section, which was confirmed by pressure sensor at T4 location. This is pronounced finding for implementation of pure primary blast wave animal model. These data also suggest only deep in the shock tube experimental conditions allow exposure to a single shock wave free of artifacts. Our results provide detailed insight into spatiotemporal dynamics of shock waves with Friedlander waveform generated using helium as a driver gas and propagating in the air inside medium sized tube. Diffusion of driver gas (helium) inside the shock tube was responsible for velocity increase of reflected shock waves. Numerical simulations combined with experimental data suggest the shock wave attenuation mechanism is simply the expansion of the internal pressure. In the absence of any other postulated shock wave decay mechanisms, which were not implemented in the model the agreement between theory and experimental data is excellent. PMID:27603017

Tailoring the Blast Exposure Conditions in the Shock Tube for Generating Pure, Primary Shock Waves: The End Plate Facilitates Elimination of Secondary Loading of the Specimen.

PubMed

Kuriakose, Matthew; Skotak, Maciej; Misistia, Anthony; Kahali, Sudeepto; Sundaramurthy, Aravind; Chandra, Namas

2016-01-01

The end plate mounted at the mouth of the shock tube is a versatile and effective implement to control and mitigate the end effects. We have performed a series of measurements of incident shock wave velocities and overpressures followed by quantification of impulse values (integral of pressure in time domain) for four different end plate configurations (0.625, 2, 4 inches, and an open end). Shock wave characteristics were monitored by high response rate pressure sensors allocated in six positions along the length of 6 meters long 229 mm square cross section shock tube. Tests were performed at three shock wave intensities, which was controlled by varying the Mylar membrane thickness (0.02, 0.04 and 0.06 inch). The end reflector plate installed at the exit of the shock tube allows precise control over the intensity of reflected waves penetrating into the shock tube. At the optimized distance of the tube to end plate gap the secondary waves were entirely eliminated from the test section, which was confirmed by pressure sensor at T4 location. This is pronounced finding for implementation of pure primary blast wave animal model. These data also suggest only deep in the shock tube experimental conditions allow exposure to a single shock wave free of artifacts. Our results provide detailed insight into spatiotemporal dynamics of shock waves with Friedlander waveform generated using helium as a driver gas and propagating in the air inside medium sized tube. Diffusion of driver gas (helium) inside the shock tube was responsible for velocity increase of reflected shock waves. Numerical simulations combined with experimental data suggest the shock wave attenuation mechanism is simply the expansion of the internal pressure. In the absence of any other postulated shock wave decay mechanisms, which were not implemented in the model the agreement between theory and experimental data is excellent.

Safety of herbal products in Thailand: an analysis of reports in the thai health product vigilance center database from 2000 to 2008.

PubMed

Saokaew, Surasak; Suwankesawong, Wimon; Permsuwan, Unchalee; Chaiyakunapruk, Nathorn

2011-04-01

The use of herbal products continues to expand rapidly across the world and concerns regarding the safety of these products have been raised. In Thailand, Thai Vigibase, developed by the Health Product Vigilance Center (HPVC) under the Thai Food and Drug Administration, is the national database that collates reports from health product surveillance systems and programmes. Thai Vigibase can be used to identify signals of adverse events in patients receiving herbal products. The purpose of the study was to describe the characteristics of reported adverse events in patients receiving herbal products in Thailand. Thai Vigibase data from February 2000 to December 2008 involving adverse events reported in association with herbal products were used. This database includes case reports submitted through the spontaneous reporting system and intensive monitoring programmes. Under the spontaneous reporting system, adverse event reports are collected nationwide via a national network of 22 regional centres covering more than 800 public and private hospitals, and health service centres. An intensive monitoring programme was also conducted to monitor the five single herbal products listed in the Thai National List of Essential Medicines (NLEM), while another intensive monitoring programme was developed to monitor the four single herbal products that were under consideration for inclusion in the NLEM. The database contained patient demographics, adverse events associated with herbal products, and details on seriousness, causality and quality of reports. Descriptive statistics were used for data analyses. A total of 593 reports with 1868 adverse events involving 24 different products were made during the study period. The age range of individuals was 1-86 years (mean 47 years). Most case reports were obtained from the intensive monitoring programme. Of the reports, 72% involved females. The herbal products for which adverse events were frequently reported were products containing turmeric (44%), followed by andrographis (10%), veld grape (10%), pennywort (7%), plai (6%), jewel vine (6%), bitter melon (5%) and snake plant (5%). Gastrointestinal problems were the most common adverse effect reported. Serious adverse events included Stevens-Johnson syndrome, anaphylactic shock and exfoliative dermatitis. Adverse event reports on herbals products were diverse, with most of them being reported through intensive monitoring programmes. Thai Vigibase is a potentially effective data source for signal detection of adverse events associated with herbal products.

Three decades of the WHO code and marketing of infant formulas.

PubMed

Forsyth, Stewart

2012-05-01

The International Code of Marketing of Breast Milk Substitutes states that governments, non-governmental organizations, experts, consumers and industry need to cooperate in activities aimed at improving infant nutrition. However, the evidence from the last three decades is that of a series of disputes, legal proceedings and boycotts. The purpose of this review is to assess the overall progress in the implementation of the Code and to examine the problematic areas of monitoring, compliance and governance. There are continuing issues of implementation, monitoring and compliance which predominantly reflect weak governance. Many Member States have yet to fully implement the Code recommendations and most States do not have adequate monitoring and reporting mechanisms. Application of the Code in developed countries may be undermined by a lack of consensus on the WHO recommendation of 6 months exclusive breastfeeding. There is evidence of continuing conflict and acrimony, especially between non-government organizations and industry. Measures need to be taken to encourage the Member States to implement the Code and to establish the governance systems that will not only ensure effective implementation and monitoring of the Code, but also deliver the Code within a spirit of participation, collaboration and trust.

Fetal monitoring during nonobstetric surgery: revisiting guidelines: a case report.

PubMed

Rothschild, Tod J; Morel, Bruce; Pace, Benjamin; Fuks, Aleksandr M

2015-01-01

Nonobstetric surgery during pregnancy is not an infrequent occurrence. Guidelines for fetal monitoring during nonobstetric surgery are limited. We describe a case of appendectomy during third trimester, complicated by in utero fetal demise (IUFD). A 30-year-old, Caucasian woman underwent open appendectomy for suspected acute appendicitis. The procedure was complicated by IUFD. Fetal monitoring was done prior to but not during surgery. Guidelines for fetal monitoring were revised, recommending continuous electronic fetal monitoring when possible during third trimester nonobstetric surgery after appropriate patient counseling. A subsequent series of 5 uncomplicated appendectomies demonstrated no difficulty in implementing these guidelines. Continuous electronic fetal monitoring during third trimester nonobstetric surgery should be available and implemented after appropriate patient counseling. This approach reduces the risk of fetal mortality.

On the Intensity Profile of Electric Lamps and Light Bulbs

ERIC Educational Resources Information Center

Bacalla, Xavier; Salumbides, Edcel John

2013-01-01

We demonstrate that the time profile of the light intensity from domestic lighting sources exhibits simple yet interesting properties that foster lively student discussions. We monitor the light intensity of an industrial fluorescent lamp (also known as TL) and an incandescent bulb using a photodetector connected to an oscilloscope. The light…

Smokefree implementation in Colombia: Monitoring, outside funding, and business support.

PubMed

Uang, Randy; Crosbie, Eric; Glantz, Stanton A

2017-01-01

To analyze successful national smokefree policy implementation in Colombia, a middle income country. Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Colombia's Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners' association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.

Presence/absence as a metric for monitoring vertebrate populations

Treesearch

Len Ruggiero; Dean Pearson

2000-01-01

Developing cost effective methods for monitoring vertebrate populations is a persistent problem in wildlife biology. Population demographic data is too costly and time intensive to acquire, so researchers have begun investigating presence/absence sampling as a means for monitoring wildlife populations. We examined three important assumptions regarding the probability...

The Mediterranean Supersite Volcanoes (MED-SUV) Project: an overview

NASA Astrophysics Data System (ADS)

Puglisi, Giuseppe

2013-04-01

In response to the EC call ENV.2012.6.4-2 (Long-term monitoring experiments in geologically active regions of Europe prone to natural hazards: the Supersite concept - FP7-ENV-2012-two-stage) a wide community of volcanological institutions proposed the project Mediterranean Supersite Volcanoes (MED-SUV), which is in the negotiation phase at the time of writing. The Consortium is composed by 18 European University and research institutes, four Small or Medium Enterprises (SME) and two non-European University and research institutes. MED-SUV will improve the consortium capacity of assessment of volcanic hazards in Supersites of Southern Italy by optimising and integrating existing and new observation/monitoring systems, by a breakthrough in understanding of volcanic processes and by increasing the effectiveness of the coordination between the scientific and end-user communities. More than 3 million of people are exposed to potential volcanic hazards in a large region in the Mediterranean Sea, where two among the largest European volcanic areas are located: Mt. Etna and Campi Flegrei/Vesuvius. This project will fully exploit the unique detailed long-term in-situ monitoring data sets available for these volcanoes and integrate with Earth Observation (EO) data, setting the basic tools for a significant step ahead in the discrimination of pre-, syn- and post-eruptive phases. The wide range of styles and intensities of volcanic phenomena observed on these volcanoes, which can be assumed as archetypes of 'closed conduit ' and 'open conduit' volcano, together with the long-term multidisciplinary data sets give an exceptional opportunity to improve the understanding of a very wide spectrum of geo-hazards, as well as implementing and testing a large variety of innovative models of ground deformation and motion. Important impacts on the European industrial sector are expected, arising from a partnership integrating the scientific community and SMEs to implement together new observation/monitoring sensors/systems. Specific experiments and studies will be carried out to improve our understanding of the volcanic internal structure and dynamics, as well as to recognise signals related to impending unrest or eruption. Hazard quantitative assessment will benefit by the outcomes of these studies and by their integration into the cutting edge monitoring approaches thus leading to a step-change in hazard awareness and preparedness and leveraging the close relationship between scientists, SMEs, and end-users.

The design of an m-Health monitoring system based on a cloud computing platform

NASA Astrophysics Data System (ADS)

Xu, Boyi; Xu, Lida; Cai, Hongming; Jiang, Lihong; Luo, Yang; Gu, Yizhi

2017-01-01

Compared to traditional medical services provided within hospitals, m-Health monitoring systems (MHMSs) face more challenges in personalised health data processing. To achieve personalised and high-quality health monitoring by means of new technologies, such as mobile network and cloud computing, in this paper, a framework of an m-Health monitoring system based on a cloud computing platform (Cloud-MHMS) is designed to implement pervasive health monitoring. Furthermore, the modules of the framework, which are Cloud Storage and Multiple Tenants Access Control Layer, Healthcare Data Annotation Layer, and Healthcare Data Analysis Layer, are discussed. In the data storage layer, a multiple tenant access method is designed to protect patient privacy. In the data annotation layer, linked open data are adopted to augment health data interoperability semantically. In the data analysis layer, the process mining algorithm and similarity calculating method are implemented to support personalised treatment plan selection. These three modules cooperate to implement the core functions in the process of health monitoring, which are data storage, data processing, and data analysis. Finally, we study the application of our architecture in the monitoring of antimicrobial drug usage to demonstrate the usability of our method in personal healthcare analysis.

40 CFR 63.653 - Monitoring, recordkeeping, and implementation plan for emissions averaging.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 63.120 of subpart G; and (ii) For closed vent systems with control devices, conduct an initial design..., monitoring, recordkeeping, and reporting equivalent to that required for Group 1 emission points complying... control device. (2) The source shall implement the following procedures for each miscellaneous process...

Monitoring and Analysing Attendance in First Year University Mathematics Tutorials

ERIC Educational Resources Information Center

Higgins, Patrick; Read, Wayne

2012-01-01

As part of an innovative tutorial structure introduced to a first year university mathematics subject, an attendance monitoring system was implemented. The system collected data that was used to investigate the relationship between student attendance and assessment performance which is reported here. The implementation of this system also assisted…

Voltage and Current Measurements in HIFX Diodes

DTIC Science & Technology

1977-08-01

Laboratories High- Intensity Flash X Ray Pacility. Sensitivities of these monitors have been measured to an accuracy of 10 percent or better by improved...importance of voltage (V) and current (1) monitors as a diagnostic tool for pulsed-electron beam machines such as High-Intensity Flash X Ray (HIFX) is well...15.4 2.7 109515. .2 7. - 3. 172.6 6.0 2.30 36. 4T. H. Martin, K. R. Prestwicht and D. L. Johnson, Summary of th e Hermes Flash X -Ray Program, Sandia

Method for monitoring irradiated fuel using Cerenkov radiation

DOEpatents

Dowdy, E.J.; Nicholson, N.; Caldwell, J.T.

1980-05-21

A method is provided for monitoring irradiated nuclear fuel inventories located in a water-filled storage pond wherein the intensity of the Cerenkov radiation emitted from the water in the vicinity of the nuclear fuel is measured. This intensity is then compared with the expected intensity for nuclear fuel having a corresponding degree of irradiation exposure and time period after removal from a reactor core. Where the nuclear fuel inventory is located in an assembly having fuel pins or rods with intervening voids, the Cerenkov light intensity measurement is taken at selected bright sports corresponding to the water-filled interstices of the assembly in the water storage, the water-filled interstices acting as Cerenkov light channels so as to reduce cross-talk. On-line digital analysis of an analog video signal is possible, or video tapes may be used for later measurement using a video editor and an electrometer. Direct measurement of the Cerenkov radiation intensity also is possible using spot photometers pointed at the assembly.

Malawi's contribution to "3 by 5": achievements and challenges.

PubMed

Libamba, Edwin; Makombe, Simon D; Harries, Anthony D; Schouten, Erik J; Yu, Joseph Kwong-Leung; Pasulani, Olesi; Mhango, Eustice; Aberle-Grasse, John; Hochgesang, Mindy; Limbambala, Eddie; Lungu, Douglas

2007-02-01

Many resource-poor countries have started scaling up antiretroviral therapy (ART). While reports from individual clinics point to successful implementation, there is limited information about progress in government institutions at a national level. Malawi started national ART scale-up in 2004 using a structured approach. There is a focus on one generic, fixed-dose combination treatment with stavudine, lamivudine and nevirapine. Treatment is delivered free of charge to eligible patients with HIV and there is a standardized system for recruiting patients, monthly follow-up, registration, monitoring and reporting of cases and outcomes. All treatment sites receive quarterly supervision and evaluation. In January 2004, there were nine public sector facilities delivering ART to an estimated 4 000 patients. By December 2005, there were 60 public sector facilities providing free ART to 37,840 patients using national standardized systems. Analysis of quarterly cohort treatment outcomes at 12 months showed 80% of patients were alive, 10% dead, 9% lost to follow-up and 1% had stopped treatment. Achievements were the result of clear national ART guidelines, implementing partners working together, an intensive training schedule focused on clinical officers and nurses, a structured system of accrediting facilities for ART delivery, quarterly supervision and monitoring, and no stock-outs of antiretroviral drugs. The main challenges are to increase the numbers of children, pregnant women and patients with tuberculosis being started on ART, and to avert high early mortality and losses to follow-up. The capacity of the health sector to cope with escalating case loads and to scale up prevention alongside treatment will determine the future success of ART delivery in Malawi.

Cost-Effective Large-Scale Occupancy–Abundance Monitoring of Invasive Brushtail Possums (Trichosurus Vulpecula) on New Zealand’s Public Conservation Land

PubMed Central

Gormley, Andrew M.; Forsyth, David M.; Wright, Elaine F.; Lyall, John; Elliott, Mike; Martini, Mark; Kappers, Benno; Perry, Mike; McKay, Meredith

2015-01-01

There is interest in large-scale and unbiased monitoring of biodiversity status and trend, but there are few published examples of such monitoring being implemented. The New Zealand Department of Conservation is implementing a monitoring program that involves sampling selected biota at the vertices of an 8-km grid superimposed over the 8.6 million hectares of public conservation land that it manages. The introduced brushtail possum (Trichosurus Vulpecula) is a major threat to some biota and is one taxon that they wish to monitor and report on. A pilot study revealed that the traditional method of monitoring possums using leg-hold traps set for two nights, termed the Trap Catch Index, was a constraint on the cost and logistical feasibility of the monitoring program. A phased implementation of the monitoring program was therefore conducted to collect data for evaluating the trade-off between possum occupancy–abundance estimates and the costs of sampling for one night rather than two nights. Reducing trapping effort from two nights to one night along four trap-lines reduced the estimated costs of monitoring by 5.8% due to savings in labour, food and allowances; it had a negligible effect on estimated national possum occupancy but resulted in slightly higher and less precise estimates of relative possum abundance. Monitoring possums for one night rather than two nights would provide an annual saving of NZ$72,400, with 271 fewer field days required for sampling. Possums occupied 60% (95% credible interval; 53–68) of sampling locations on New Zealand’s public conservation land, with a mean relative abundance (Trap Catch Index) of 2.7% (2.0–3.5). Possum occupancy and abundance were higher in forest than in non-forest habitats. Our case study illustrates the need to evaluate relationships between sampling design, cost, and occupancy–abundance estimates when designing and implementing large-scale occupancy–abundance monitoring programs. PMID:26029890

Implementation of early intensive behavioural intervention for children with autism in Switzerland.

PubMed

Studer, Nadja; Gundelfinger, Ronnie; Schenker, Tanja; Steinhausen, Hans-Christoph

2017-01-21

There is a major gap between the US and most European countries regarding the implementation of early intensive behavioural intervention (EIBI) for children with autism. The present paper reports on the current status of EIBI in Switzerland and on the effectiveness of EIBI under clinical conditions in a Swiss pilot project. The paper combines a narrative report of the care system for children with autism in Switzerland and an initial evaluation of EIBI as implemented in the Department of Child and Adolescent Psychiatry, University of Zurich. The current situation of the implementation of EIBI for children with autism in Switzerland is characterized by marked deficits in its acceptance. Major reasons include insufficient governmental approval and lacking legal and financial support. In addition, ignorance among health care providers and educational professionals has contributed to this situation precluding that children with autism receive the most beneficial assistance. The authors have initiated and been working in an intervention centre offering EIBI for a decade and report on their experience with the implementation of EIBI. Based on their clinical practice, they document that EIBI also works efficiently under ordinary mental health service conditions. EIBI needs to be implemented more intensively in Switzerland. Although the effects of EIBI as implemented in Zurich are promising, the results are not as pronounced as under controlled research conditions.

Monitoring of hydroxyapatite conversion by luminescence intensity of Eu3+ ions during mineralization of Eu3+-doped β-Ca2SiO4

NASA Astrophysics Data System (ADS)

Zhang, Yin; Chen, Jie; Li, Yadong; Seo, Hyo Jin

2014-11-01

β-Dicalcium silicate (β-Ca2SiO4) doped with Eu3+ was synthesized by sol-gel method. The luminescence intensity of the mineralization products formed during the hydroxyapatite (Ca10(PO4)6(OH)2, HA) conversion of Eu3+-doped β-Ca2SiO4, in 0.25 M K2HPO4 solution, were detected using luminescence spectroscopy. The results indicated that the luminescence intensity of Eu3+ ion gradually depressed with prolonged mineralization time, and it could hardly be detected with the complete transformation from β-Ca2SiO4:Eu3+ to hydroxyapatite. The change of Eu3+ ionic concentrations in the mineralization products and the final solutions after conversion reaction, were further examined using energy-dispersive X-ray and inductively-coupled plasma mass spectrometry, respectively. This suggested that the process of mineralization can be monitored with the luminescence intensity of Eu3+ ions in the mineralization products. The current study will open up a new and simple in vivo avenue for in situ monitoring hydroxyapatite conversion with a fiber luminescence spectrometer.

Estimated energy expenditure of nursing assistants in long term care.

PubMed

Olson, Darcie L; King, Phyllis M

2012-01-01

Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. Eight women between the ages of 19 and 54 from two facilities participated in this study. A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.

Spectral entropy in monitoring anesthetic depth.

PubMed

Escontrela Rodríguez, B; Gago Martínez, A; Merino Julián, I; Martínez Ruiz, A

2016-10-01

Monitoring the brain response to hypnotics in general anesthesia, with the nociceptive and hemodynamic stimulus interaction, has been a subject of intense investigation for many years. Nowadays, monitors of depth of anesthesia are based in processed electroencephalogram by different algorithms, some of them unknown, to obtain a simplified numeric parameter approximate to brain activity state in each moment. In this review we evaluate if spectral entropy suitably reflects the brain electric behavior in response to hypnotics and the different intensity nociceptive stimulus effect during a surgical procedure. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Method for monitoring the crystallization of an organic material from a liquid

DOEpatents

Asay, Blaine W.; Henson, Bryan F.; Sander, Robert K.; Robinson, Jeanne M.; Son, Steven F.; Dickson, Peter M.

2004-10-05

Method for monitoring the crystallization of at least one organic material from a liquid. According to the method, a liquid having at least one organic material capable of existing in at least one non-centrosymmetric phase is prepared. The liquid is interrogated with a laser beam at a chosen wavelength. As at least a portion of the at least one organic material crystallizes from the liquid, the intensity of any light scattered by the crystallized material at a wavelength equal to one-half the chosen wavelength of the interrogating laser beam is monitored. If the intensity of this scattered light, increases, then the crystals that form include at least one non-cetrosymmetric phase.

Mapping and monitoring High Nature Value farmlands: challenges in European landscapes.

PubMed

Lomba, Angela; Guerra, Carlos; Alonso, Joaquim; Honrado, João Pradinho; Jongman, Rob; McCracken, David

2014-10-01

The importance of low intensity farming for the conservation of biodiversity throughout Europe was acknowledged early in the 1990s when the concept of 'High Nature Value farmlands' (HNVf) was devised. HNVf has subsequently been given high priority within the EU Rural Development Programme. This puts a requirement on each EU Member State not only to identify the extent and condition of HNVf within their borders but also to track trends in HNVf over time. However, the diversity of rural landscapes across the EU, the scarcity of (adequate) datasets on biodiversity, land cover and land use, and the lack of a common methodology for HNVf mapping currently represent obstacles to the implementation of the HNVf concept across Europe. This manuscript provides an overview of the characteristics of HNVf across Europe together with a description of the development of the HNVf concept. Current methodological approaches for the identification and mapping of HNVf across EU-27 and Switzerland are then reviewed, the main limitations of these approaches highlighted and recommendations made as to how the identification, mapping and reporting of HNVf state and trends across Europe can potentially be improved and harmonised. In particular, we propose a new framework that is built on the need for strategic HNVf monitoring based on a hierarchical, bottom-up structure of assessment units, coincident with the EU levels of political decision and devised indicators, and which is linked strongly to a collaborative European network that can provide the integration and exchange of data from different sources and scales under common standards. Such an approach is essential if the scale of the issues facing HNVf landscapes are to be identified and monitored properly at the European level. This would then allow relevant agri-environmental measures to be developed, implemented and evaluated at the scale(s) required to maintain the habitats and species of high nature conservation value that are intimately associated with those landscapes. Copyright © 2014 Elsevier Ltd. All rights reserved.

A global threats overview for Numeniini populations: synthesising expert knowledge for a group of declining migratory birds.

USGS Publications Warehouse

Pearce-Higgins, James W.; Brown, Daniel J.; Douglas, David J.T.; Alves, José A.; Bellio, Mariagrazia; Bocher, Pierrick; Buchannan, Graeme M.; Clay, Robert P.; Conklin, Jesse R.; Crockford, Nicola; Dann, Peter; Elts, Jaanus; Friis, Christian; Fuller, Richard A.; Gill, Jennifer A.; Gosbell, Ken; Johnson, James A.; Marquez-Ferrando, Rocio; Masero, José A.; Melville, David S.; Millington, Spike; Minton, Clive; Mundkur, Taej; Nol, Erika; Pehlak, Hannes; Piersma, Theunis; Rogers, Danny I.; Ruthrauff, Daniel R.; Senner, Nathan R.; Nazeer Shah, Junid; Sheldon, Rob D.; Soloviev, Sergej A.; Tomkovich, Pavel S.; Verkuil, Yvonne I.

2017-01-01

The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species' recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.

Introduction of mobile phones for use by volunteer community health workers in support of integrated community case management in Bushenyi District, Uganda: development and implementation process.

PubMed

Tumusiime, David Katuruba; Agaba, Gad; Kyomuhangi, Teddy; Finch, Jan; Kabakyenga, Jerome; MacLeod, Stuart

2014-01-01

A substantial literature suggests that mobile phones have great potential to improve management and survival of acutely ill children in rural Africa. The national strategy of the Ugandan Ministry of Health calls for employment of volunteer community health workers (CHWs) in implementation of Integrated Community Case Management (iCCM) of common illnesses (diarrhea, acute respiratory infection, pneumonia, fever/malaria) affecting children under five years of age. A mobile phone enabled system was developed within iCCM aiming to improve access by CHWs to medical advice and to strengthen reporting of data on danger signs and symptoms for acutely ill children under five years of age. Herein critical steps in development, implementation, and integration of mobile phone technology within iCCM are described. Mechanisms to improve diagnosis, treatment and referral of sick children under five were defined. Treatment algorithms were developed by the project technical team and mounted and piloted on the mobile phones, using an iterative process involving technical support personnel, health care providers, and academic support. Using a purposefully developed mobile phone training manual, CHWs were trained over an intensive five-day course to make timely diagnoses, recognize clinical danger signs, communicate about referrals and initiate treatment with appropriate essential drugs. Performance by CHWs and the accuracy and completeness of their submitted data was closely monitored post training test period and during the subsequent nine month community trial. In the full trial, the number of referrals and correctly treated children, based on the agreed treatment algorithms, was recorded. Births, deaths, and medication stocks were also tracked. Seven distinct phases were required to develop a robust mobile phone enabled system in support of the iCCM program. Over a nine month period, 96 CHWs were trained to use mobile phones and their competence to initiate a community trial was established through performance monitoring. Local information/communication consultants, working in concert with a university based department of pediatrics, can design and implement a robust mobile phone based system that may be anticipated to contribute to efficient delivery of iCCM by trained volunteer CHWs in rural settings in Uganda.

Emailing Drones: From Design to Test Range to ARS Offices and into the Field

NASA Astrophysics Data System (ADS)

Fuka, D. R.; Singer, S.; Rodriguez, R., III; Collick, A.; Cunningham, A.; Kleinman, P. J. A.; Manoukis, N. C.; Matthews, B.; Ralston, T.; Easton, Z. M.

2017-12-01

Unmanned aerial vehicles (UAVs or `drones') are one of the newest tools available for collecting geo- and biological-science data in the field, though today's commercial drones only come in a small range of options. While scientific research has benefitted from the enhanced topographic and surface characterization data that UAVs can provide through traditional image based remote sensing techniques, drones have significantly greater mission-specific potential than are currently utilized. The reasons for this under-utilization are twofold, 1) because with their broad capabilities comes the need to be careful in implementation, and as such, FAA and other regulatory agencies around the world have blanket regulations that can inhibit new designs from being implemented, and 2) current multi-mission-multi-payload commercial drones have to be over-designed to compensate for the fact that they are very difficult to stabilize for multiple payloads, leading to a much higher cost than necessary. For this project, we explore and demonstrate a workflow to optimize the design, testing, approval, and implementation of embarrassingly inexpensive mission specific drones, with two use cases. The first will follow the process from design (at VTech and UH Hilo) to field implementation (by USDA-ARS in PA and Extension in VA) of several custom water quality monitoring drones, printed on demand at ARS and Extension offices after testing at the Pan-Pacific UAS Test Range Complex (PPUTRC). This type of customized drone can allow for an increased understanding in the transition from non-point source to point source agri-chemical and pollutant transport in watershed systems. The second use case will follow the same process, resulting in customized drones with pest specific traps built into the design. This class of customized drone can facilitate IPM pest monitoring programs nationwide, decreasing the intensive and costly quarantine and population elimination measures that currently exist. This multi-institutional project works toward an optimized workflow where scientists can quickly 1) customize drones to meet specific purposes, 2) have them tested in FAA Test Ranges, and 3) get them certified and working in the field, while 4) cutting their cost to significantly less than what is currently available.

Compact and portable X-ray imager system using Medipix3RX

NASA Astrophysics Data System (ADS)

Garcia-Nathan, T. B.; Kachatkou, A.; Jiang, C.; Omar, D.; Marchal, J.; Changani, H.; Tartoni, N.; van Silfhout, R. G.

2017-10-01

In this paper the design and implementation of a novel portable X-ray imager system is presented. The design features a direct X-ray detection scheme by making use of a hybrid detector (Medipix3RX). Taking advantages of the capabilities of the Medipix3RX, like a high resolution, zero dead-time, single photon detection and charge-sharing mode, the imager has a better resolution and higher sensitivity compared to using traditional indirect detection schemes. A detailed description of the system is presented, which consists of a vacuum chamber containing the sensor, an electronic board for temperature management, conditioning and readout of the sensor and a data processing unit which also handles network connection and allow communication with clients by acting as a server. A field programmable gate array (FPGA) device is used to implement the readout protocol for the Medipix3RX, apart from the readout the FPGA can perform complex image processing functions such as feature extraction, histogram, profiling and image compression at high speeds. The temperature of the sensor is monitored and controlled through a PID algorithm making use of a Peltier cooler, improving the energy resolution and response stability of the sensor. Without implementing data compression techniques, the system is capable of transferring 680 profiles/s or 240 images/s in a continuous mode. Implementation of equalization procedures and tests on colour mode are presented in this paper. For the experimental measurements the Medipix3RX sensor was used with a Silicon layer. One of the tested applications of the system is as an X-ray beam position monitor (XBPM) device for synchrotron applications. The XBPM allows a non-destructive real time measurement of the beam position, size and intensity. A Kapton foil is placed in the beam path scattering radiation towards a pinhole camera setup that allows the sensor to obtain an image of the beam. By using profiles of the synchrotron X-ray beam, high frequency movement of the beam position can be studied, up to 340 Hz. The system is capable of realizing an independent energy measure of the beam by using the Medipix3RX variable energy threshold feature.

Current methods of monitoring radiation exposure from CT.

PubMed

Talati, Ronak K; Dunkin, Jared; Parikh, Shrujal; Moore, William H

2013-09-01

Increased public and regulatory scrutiny of imaging-related radiation exposure requires familiarity with current dose-monitoring techniques and best practices. CT-related ionizing radiation exposure has been cited as the largest and fastest growing source of population-wide iatrogenic ionizing radiation exposure. Upcoming federal regulations require imaging centers to familiarize themselves with available dose-monitoring techniques and implement comprehensive strategies to track patient dose, with particular emphasis on CT. Because of institution-specific and vendor-specific technologies, there are significant barriers to adoption and implementation. In this article, the authors outline the core components of a universal dose-monitoring strategy and detail a few of the many available commercial platforms. In addition, the authors introduce a cloud-based hybrid model dose-tracking system with the goal of rapid implementation, multicenter scalability, real-time dose feedback for technologists, cumulative dose monitoring, and optional dose communication to patients and into the record; doing so results in improved patient loyalty, referring physician satisfaction, and opportunity for repeat business. Copyright © 2013 American College of Radiology. All rights reserved.

Social network analysis for program implementation.

PubMed

Valente, Thomas W; Palinkas, Lawrence A; Czaja, Sara; Chu, Kar-Hai; Brown, C Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach.

Social Network Analysis for Program Implementation

PubMed Central

Valente, Thomas W.; Palinkas, Lawrence A.; Czaja, Sara; Chu, Kar-Hai; Brown, C. Hendricks

2015-01-01

This paper introduces the use of social network analysis theory and tools for implementation research. The social network perspective is useful for understanding, monitoring, influencing, or evaluating the implementation process when programs, policies, practices, or principles are designed and scaled up or adapted to different settings. We briefly describe common barriers to implementation success and relate them to the social networks of implementation stakeholders. We introduce a few simple measures commonly used in social network analysis and discuss how these measures can be used in program implementation. Using the four stage model of program implementation (exploration, adoption, implementation, and sustainment) proposed by Aarons and colleagues [1] and our experience in developing multi-sector partnerships involving community leaders, organizations, practitioners, and researchers, we show how network measures can be used at each stage to monitor, intervene, and improve the implementation process. Examples are provided to illustrate these concepts. We conclude with expected benefits and challenges associated with this approach. PMID:26110842

Development of a PERCA Instrument for Ambient Peroxy Radical Measurements

NASA Astrophysics Data System (ADS)

Dusanter, S.; Duncianu, M.; Lahib, A.; Tomas, A.; Stevens, P. S.

2017-12-01

Peroxy radicals (HO2 and RO2) are key species in atmospheric chemistry, which together with the hydroxyl radical (OH), lead to the oxidation of volatile organic compounds and the formation of secondary pollutants such as ozone and secondary organic aerosols. Monitoring these short-lived species during intensive field campaigns and comparing the measured concentrations to model outputs allows assessing the reliability of chemical mechanisms implemented in atmospheric models. However, ambient measurements of peroxy radicals are still considered challenging and only a few techniques have been used for field measurements. The PEroxy Radical Chemical Amplifier (PERCA) approach, whose principle is based on amplification and a conversion of ambient peroxy radicals into nitrogen dioxide (NO2), has recently seen renewed interests due to the availability of sensitive NO2 monitors. We will present (i) the construction of a PERCA instrument, (ii) experiments conducted to quantify the radical chain length for HO2 and several RO2 radicals, including those produced during the OH-oxidation of isoprene, and (iii) a comparison of the conventional CO/NO and recently proposed ethane/NO amplification chemistries. In this context, box modelling of the PERCA chemistry will be discussed.

Eucalyptus plantations for energy production in Hawaii. 1980 annual report, January 1980-December 1980

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

Whitesell, C. D.

1980-01-01

In 1980 200 acres of eucalyptus trees were planted for a research and development biomass energy plantation bringing the total area under cultivation to 300 acres. Of this total acreage, 90 acres or 30% was planted in experimental plots. The remaining 70% of the cultivated area was closely monitored to determine the economic cost/benefit ratio of large scale biomass energy production. In the large scale plantings, standard field practices were set up for all phases of production: nursery, clearing, planting, weed control and fertilization. These practices were constantly evaluated for potential improvements in efficiency and reduced cost. Promising experimental treatmentsmore » were implemented on a large scale to test their effectiveness under field production conditions. In the experimental areas all scheduled data collection in 1980 has been completed and most measurements have been keypunched and analyzed. Soil samples and leaf samples have been analyzed for nutrient concentrations. Crop logging procedures have been set up to monitor tree growth through plant tissue analysis. An intensive computer search on biomass, nursery practices, harvesting equipment and herbicide applications has been completed through the services of the US Forest Service.« less

A software framework for real-time multi-modal detection of microsleeps.

PubMed

Knopp, Simon J; Bones, Philip J; Weddell, Stephen J; Jones, Richard D

2017-09-01

A software framework is described which was designed to process EEG, video of one eye, and head movement in real time, towards achieving early detection of microsleeps for prevention of fatal accidents, particularly in transport sectors. The framework is based around a pipeline structure with user-replaceable signal processing modules. This structure can encapsulate a wide variety of feature extraction and classification techniques and can be applied to detecting a variety of aspects of cognitive state. Users of the framework can implement signal processing plugins in C++ or Python. The framework also provides a graphical user interface and the ability to save and load data to and from arbitrary file formats. Two small studies are reported which demonstrate the capabilities of the framework in typical applications: monitoring eye closure and detecting simulated microsleeps. While specifically designed for microsleep detection/prediction, the software framework can be just as appropriately applied to (i) other measures of cognitive state and (ii) development of biomedical instruments for multi-modal real-time physiological monitoring and event detection in intensive care, anaesthesiology, cardiology, neurosurgery, etc. The software framework has been made freely available for researchers to use and modify under an open source licence.

Label-Free Biosensors Based on Bimodal Waveguide (BiMW) Interferometers.

PubMed

Herranz, Sonia; Gavela, Adrián Fernández; Lechuga, Laura M

2017-01-01

The bimodal waveguide (BiMW) sensor is a novel common path interferometric transducer based on the evanescent field detection principle, which in combination with a bio-recognition element allows the direct detection of biomolecular interactions in a label-free scheme. Due to its inherent high sensitivity it has great potential to become a powerful analytical tool for monitoring substances of interest in areas such as environmental control, medical diagnostics and food safety, among others. The BiMW sensor is fabricated using standard silicon-based technology allowing cost-effective production, and meeting the requirements of portability and disposability necessary for implementation in a point-of-care (POC) setting.In this chapter we describe the design and fabrication of the BiMW transducer, as well as its application for bio-sensing purposes. We show as an example the biosensor capabilities two different applications: (1) the immunodetection of Irgarol 1051 biocide useful in the environmental field, and (2) the detection of human growth hormone as used in clinical diagnostics. The detection is performed in real time by monitoring changes in the intensity pattern of light exiting the BiMW transducer resulting from antigen-antibody interactions on the surface of the sensor.

HIFU Monitoring and Control with Dual-Mode Ultrasound Arrays

NASA Astrophysics Data System (ADS)

Casper, Andrew Jacob

The biological effects of high-intensity focused ultrasound (HIFU) have been known and studied for decades. HIFU has been shown capable of treating a wide variety of diseases and disorders. However, despite its demonstrated potential, HIFU has been slow to gain clinical acceptance. This is due, in part, to the difficulty associated with robustly monitoring and controlling the delivery of the HIFU energy. The non-invasive nature of the surgery makes the assessment of treatment progression difficult, leading to long treatment times and a significant risk of under treatment. This thesis research develops new techniques and systems for robustly monitoring HIFU therapies for the safe and efficacious delivery of the intended treatment. Systems and algorithms were developed for the two most common modes of HIFU delivery systems: single-element and phased array applicators. Delivering HIFU with a single element transducer is a widely used technique in HIFU therapies. The simplicity of a single element offers many benefits in terms of cost and overall system complexity. Typical monitoring schemes rely on an external device (e.g. diagnostic ultrasound or MRI) to assess the progression of therapy. The research presented in this thesis explores using the same element to both deliver and monitor the HIFU therapy. The use of a dual-mode ultrasound transducer (DMUT) required the development of an FPGA based single-channel arbitrary waveform generator and high-speed data acquisition unit. Data collected from initial uncontrolled ablations led to the development of monitoring and control algorithms which were implemented directly on the FPGA. Close integration between the data acquisition and arbitrary waveform units allowed for fast, low latency control over the ablation process. Results are presented that demonstrate control of HIFU therapies over a broad range of intensities and in multiple in vitro tissues. The second area of investigation expands the DMUT research to an ultrasound phased-array. The phased-array allows for electronic steering of the HIFU focus and imaging of the acoustic medium. Investigating the dual-mode ultrasound array (DMUA) required the design and construction of a novel ultrasound-guided focused ultrasound (USgFUS) platform. The platform consisted of custom hardware designed for the unique requirements of operating a phased-array in both therapeutic and imaging modes. The platform also required the development of FPGA based signal processing and GPU based beamforming algorithms for online monitoring of the therapy process. The results presented in this thesis represent the first demonstration of a real-time USgFUS platform based around a DMUA. Experimental imaging and therapy results from series of animal experiments, including a 12 animal GLP study, are presented. In addition, in vitro control results, which build upon the DMUT work, are presented.

Implementation of New Technologies to Monitor Phytoplankton Blooms in the South of Chile

NASA Astrophysics Data System (ADS)

Rodríguez-Benito, C.; Haag, C.; Alvial, A.

2004-05-01

A pilot project has been carried out to demonstrate the applicability of remote sensing in the Xth region of Chile, related to the monitoring of algal blooms. Most of the fish farms of the country are located in this area, where considerable economic losses for this activity are the consequence of algal blooms. The implementation of new technologies to monitor this natural disaster is one of the main goals of local institutions. The project has been developed using ENVISAT/MERIS and AATSR images and oceanographic instrumentation in order to improve the information of the ongoing coastal monitoring programs.

Feedback from physical activity monitors is not compatible with current recommendations: A recalibration study.

PubMed

Thompson, Dylan; Batterham, Alan M; Peacock, Oliver J; Western, Max J; Booso, Rahuman

2016-10-01

Wearable devices to self-monitor physical activity have become popular with individuals and healthcare practitioners as a route to the prevention of chronic disease. It is not currently possible to reconcile feedback from these devices with activity recommendations because the guidelines refer to the amount of activity required on top of normal lifestyle activities (e.g., 150 minutes of moderate-to-vigorous intensity activity per week over-and-above normal moderate-to-vigorous lifestyle activities). The aim of this study was to recalibrate the feedback from self-monitoring. We pooled data from four studies conducted between 2006 and 2014 in patients and volunteers from the community that included both sophisticated measures of physical activity and 10-year risk for cardiovascular disease and type 2 diabetes (n=305). We determined the amount of moderate-to-vigorous intensity activity that corresponded to FAO/WHO/UNU guidance for a required PAL of 1.75 (Total Energy Expenditure/Basal Metabolic Rate). Our results show that, at the UK median PAL, total moderate-to-vigorous intensity physical activity will be around 735 minutes per week (~11% of waking time). We estimate that a 4% increase in moderate-to-vigorous intensity activity will achieve standardised guidance from FAO/WHO/UNU and will require ~1000 minutes of moderate-to-vigorous intensity activity per week. This study demonstrates that feedback from sophisticated wearable devices is incompatible with current physical activity recommendations. Without adjustment, people will erroneously form the view that they are exceeding recommendations by several fold. A more appropriate target from self-monitoring that accounts for normal moderate-to-vigorous lifestyle activities is ~1000 minutes per week, which represents ~15% of waking time. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

PubMed Central

Logani, Sachin; Green, Adam; Gasperino, James

2011-01-01

The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU) are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees) and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform. PMID:22110908

Neural changes in control implementation of a continuous task.

PubMed

Lungu, Ovidiu V; Binenstock, Meagan M; Pline, Megan A; Yeaton, Jennifer R; Carey, James R

2007-03-14

It is commonly agreed that control implementation, being a resource-consuming endeavor, is not exerted continuously or in simple tasks. However, most research in the field was done using tasks that varied the need for control on a trial-by-trial basis (e.g., Stroop, flanker) in a discrete manner. In this case, the anterior cingulate cortex (ACC) was found to monitor the need for control, whereas regions in the prefrontal cortex (PFC) were found to be involved in control implementation. Whether or not the same control mechanism would be used in continuous tasks was an open question. In our study, we found that in a continuous task, the same neural substrate subserves control monitoring (ACC) but that the neural substrate of control implementation changes over time. Early in the task, regions in the PFC were involved in control implementation, whereas later the control was taken over by subcortical structures, specifically the caudate. Our results suggest that humans possess a flexible control mechanism, with a specific structure dedicated to monitoring the need for control and with multiple structures involved in control implementation.

Sharp-Tailed Grouse Nest Survival and Nest Predator Habitat Use in North Dakota's Bakken Oil Field.

PubMed

Burr, Paul C; Robinson, Aaron C; Larsen, Randy T; Newman, Robert A; Ellis-Felege, Susan N

2017-01-01

Recent advancements in extraction technologies have resulted in rapid increases of gas and oil development across the United States and specifically in western North Dakota. This expansion of energy development has unknown influences on local wildlife populations and the ecological interactions within and among species. Our objectives for this study were to evaluate nest success and nest predator dynamics of sharp-tailed grouse (Tympanuchus phasianellus) in two study sites that represented areas of high and low energy development intensities in North Dakota. During the summers of 2012 and 2013, we monitored 163 grouse nests using radio telemetry. Of these, 90 nests also were monitored using miniature cameras to accurately determine nest fates and identify nest predators. We simultaneously conducted predator surveys using camera scent stations and occupancy modeling to estimate nest predator occurrence at each site. American badgers (Taxidea taxus) and striped skunks (Mephitis mephitis) were the primary nest predators, accounting for 56.7% of all video recorded nest depredations. Nests in our high intensity gas and oil area were 1.95 times more likely to succeed compared to our minimal intensity area. Camera monitored nests were 2.03 times more likely to succeed than non-camera monitored nests. Occupancy of mammalian nest predators was 6.9 times more likely in our study area of minimal gas and oil intensity compared to the high intensity area. Although only a correlative study, our results suggest energy development may alter the predator community, thereby increasing nest success for sharp-tailed grouse in areas of intense development, while adjacent areas may have increased predator occurrence and reduced nest success. Our study illustrates the potential influences of energy development on the nest predator-prey dynamics of sharp-tailed grouse in western North Dakota and the complexity of evaluating such impacts on wildlife.

Post-marketing safety monitoring of a new group B meningococcal vaccine in New Zealand, 2004-2006.

PubMed

McNicholas, Anne; Galloway, Yvonne; Stehr-Green, Paul; Reid, Stewart; Radke, Sarah; Sexton, Kerry; Kieft, Charlotte; Macdonald, Claire; Neutze, Jocelyn; Drake, Ross; Isaac, Dorothy; O'Donnell, Mary; Tatley, Michael; Oster, Philipp; O'Hallahan, Jane

2007-01-01

New Zealand introduced a new outer membrane vesicle vaccine in 2004 to combat an epidemic of group B meningococcal disease. An Independent Safety Monitoring Board oversaw intensive safety monitoring, which included hospital surveillance, health professional reporting (passive and active) and mortality monitoring. With over three million doses administered to individuals aged under 20 years, the monitoring results provide consistent evidence supporting the vaccine's safety.

Reflections on a vision for integrated research and monitoring after 15 years

USGS Publications Warehouse

Murdoch, Peter S.; McHale, Michael; Baron, Jill S.

2014-01-01

In May of 1998, Owen Bricker and his co-author Michael Ruggiero introduced a conceptual design for integrating the Nation’s environmental research and monitoring programs. The Framework for Integrated Monitoring and Related Research was an organizing strategy for relating data collected by various programs, at multiple spatial and temporal scales, and by multiple science disciplines to solve complex ecological issues that individual research or monitoring programs were not designed to address. The concept nested existing intensive monitoring and research stations within national and regional surveys, remotely sensed data, and inventories to produce a collaborative program for multi-scale, multi-network integrated environmental monitoring and research. Analyses of gaps in data needed for specific issues would drive decisions on network improvements or enhancements. Data contributions to the Framework from existing networks would help indicate critical research and monitoring programs to protect during budget reductions. Significant progress has been made since 1998 on refining the Framework strategy. Methods and models for projecting scientific information across spatial and temporal scales have been improved, and a few regional pilots of multi-scale data-integration concepts have been attempted. The links between science and decision-making are also slowly improving and being incorporated into science practice. Experiments with the Framework strategy since 1998 have revealed the foundational elements essential to its successful implementation, such as defining core measurements, establishing standards of data collection and management, integrating research and long-term monitoring, and describing baseline ecological conditions. They have also shown us the remaining challenges to establishing the Framework concept: protecting and enhancing critical long-term monitoring, filling gaps in measurement methods, improving science for decision support, and integrating the disparate integrated science efforts now underway. In the 15 years since the Bricker and Ruggiero (Ecol Appl 8(2):326–329, 1998) paper challenged us with a new paradigm for bringing sound and comprehensive science to environmental decisions, the scientific community can take pride in the progress that has been made, while also taking stock of the challenges ahead for completing the Framework vision.

Performance of an image analysis processing system for hen tracking in an environmental preference chamber.

PubMed

Kashiha, Mohammad Amin; Green, Angela R; Sales, Tatiana Glogerley; Bahr, Claudia; Berckmans, Daniel; Gates, Richard S

2014-10-01

Image processing systems have been widely used in monitoring livestock for many applications, including identification, tracking, behavior analysis, occupancy rates, and activity calculations. The primary goal of this work was to quantify image processing performance when monitoring laying hens by comparing length of stay in each compartment as detected by the image processing system with the actual occurrences registered by human observations. In this work, an image processing system was implemented and evaluated for use in an environmental animal preference chamber to detect hen navigation between 4 compartments of the chamber. One camera was installed above each compartment to produce top-view images of the whole compartment. An ellipse-fitting model was applied to captured images to detect whether the hen was present in a compartment. During a choice-test study, mean ± SD success detection rates of 95.9 ± 2.6% were achieved when considering total duration of compartment occupancy. These results suggest that the image processing system is currently suitable for determining the response measures for assessing environmental choices. Moreover, the image processing system offered a comprehensive analysis of occupancy while substantially reducing data processing time compared with the time-intensive alternative of manual video analysis. The above technique was used to monitor ammonia aversion in the chamber. As a preliminary pilot study, different levels of ammonia were applied to different compartments while hens were allowed to navigate between compartments. Using the automated monitor tool to assess occupancy, a negative trend of compartment occupancy with ammonia level was revealed, though further examination is needed. ©2014 Poultry Science Association Inc.

Demonstrating the efficacy of the FoneAstra pasteurization monitor for human milk pasteurization in resource-limited settings.

PubMed

Naicker, Mageshree; Coutsoudis, Anna; Israel-Ballard, Kiersten; Chaudhri, Rohit; Perin, Noah; Mlisana, Koleka

2015-03-01

Human milk provides crucial nutrition and immunologic protection for infants. When a mother's own milk is unavailable, donated human milk, pasteurized to destroy bacteria and viruses, is a lifesaving replacement. Flash-heat pasteurization is a simple, low-cost, and commonly used method to make milk safe, but currently there is no system to monitor milk temperature, which challenges quality control. FoneAstra, a smartphone-based mobile pasteurization monitor, removes this barrier by guiding users through pasteurization and documenting consistent and safe practice. This study evaluated FoneAstra's efficacy as a quality control system, particularly in resource-limited settings, by comparing bacterial growth in donor milk flash-heated with and without the device at a neonatal intensive care unit in Durban, South Africa. For 100 samples of donor milk, one aliquot each of prepasteurized milk, milk flash-heated without FoneAstra, and milk pasteurized with FoneAstra was cultured on routine agar for bacterial growth. Isolated bacteria were identified and enumerated. In total, 300 samples (three from each donor sample) were analyzed. Bacterial growth was found in 86 of the 100 samples before any pasteurization and one of the 100 postpasteurized samples without FoneAstra. None of the samples pasteurized using FoneAstra showed bacterial growth. Both pasteurization methods were safe and effective. FoneAstra, however, provides the additional benefits of user-guided temperature monitoring and data tracking. By improving quality assurance and standardizing the pasteurization process, FoneAstra can support wide-scale implementation of human milk banks in resource-limited settings, increasing access and saving lives.

The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil.

PubMed

Zampieri, Fernando Godinho; Soares, Márcio; Borges, Lunna Perdigão; Salluh, Jorge Ibrain Figueira; Ranzani, Otávio Tavares

2017-01-01

To describe the Epimed Monitor Database®, a Brazilian intensive care unit quality improvement database. We described the Epimed Monitor® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil. The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score - SAPS 3 - 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period. A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.

Seismic intensity monitoring: from mature basins in the North Sea to sample-scale porosity measurements.

NASA Astrophysics Data System (ADS)

De Siena, Luca; Sketsiou, Panayiota

2017-04-01

We plan the application of a joint velocity, attenuation, and scattering tomography to the North Sea basins. By using seismic phases and intensities from previous passive and active surveys our aim is to image and monitor fluids under the subsurface. Seismic intensities provide unique solutions to the problem of locating/tracking gas/fluid movements in the volcanoes and depicting sub-basalt and sub-intrusives in volcanic reservoirs. The proposed techniques have been tested in volcanic Islands (Deception Island), continental calderas (Campi Flegrei) and Quaternary Volcanoes (Mount. St. Helens) and have been proved effective at monitoring fracture opening, imaging buried fluid-filled bodies, and tracking water/gas interfaces. These novel seismic attributes are modelled in space and time and connected with the lithology of the sampled medium, specifically density and permeability, with as key output a novel computational code with strong commercial potential. Data are readily available in the framework of the NERC CDT Oil & Gas project.

CMOS image sensors as an efficient platform for glucose monitoring.

PubMed

Devadhasan, Jasmine Pramila; Kim, Sanghyo; Choi, Cheol Soo

2013-10-07

Complementary metal oxide semiconductor (CMOS) image sensors have been used previously in the analysis of biological samples. In the present study, a CMOS image sensor was used to monitor the concentration of oxidized mouse plasma glucose (86-322 mg dL(-1)) based on photon count variation. Measurement of the concentration of oxidized glucose was dependent on changes in color intensity; color intensity increased with increasing glucose concentration. The high color density of glucose highly prevented photons from passing through the polydimethylsiloxane (PDMS) chip, which suggests that the photon count was altered by color intensity. Photons were detected by a photodiode in the CMOS image sensor and converted to digital numbers by an analog to digital converter (ADC). Additionally, UV-spectral analysis and time-dependent photon analysis proved the efficiency of the detection system. This simple, effective, and consistent method for glucose measurement shows that CMOS image sensors are efficient devices for monitoring glucose in point-of-care applications.

A remote drip infusion monitoring system employing Bluetooth.

PubMed

Amano, Hikaru; Ogawa, Hidekuni; Maki, Hiromichi; Tsukamoto, Sosuke; Yonezawa, Yoshiharu; Caldwell, W Morton

2012-01-01

We have developed a remote drip infusion monitoring system for use in hospitals. The system consists of several infusion monitoring devices and a central monitor. The infusion monitoring device employing a Bluetooth module can detect the drip infusion rate and an empty infusion solution bag, and then these data are sent to the central monitor placed at the nurses' station via the Bluetooth. The central monitor receives the data from several infusion monitoring devices and then displays graphically them. Therefore, the developed system can monitor intensively the drip infusion situation of the several patients at the nurses' station.

Monitoring of international normalized ratios: comparison of community nurses with family physicians.

PubMed

Levine, Max A; Shao, Wei; Klein, Douglas

2012-08-01

To determine whether community-based, nurse-led monitoring of the international normalized ratio (INR) in patients requiring long-term warfarin therapy was comparable to traditional physician monitoring. A retrospective cohort analysis of patients taking long-term warfarin therapy. The study used data gathered from 3 family medicine clinics in a primary care network in Edmonton, Alta. Medical records of patients currently taking warfarin were examined. Implementation of nurse-led monitoring in a primary care network in place of standard family physician INR monitoring. The degree of INR control before and after the implementation of nurse-run INR monitoring was assessed. The average proportion of time spent outside of therapeutic INR ranges, as well as the average number of days between successive INR readings, was calculated and compared. The degree of control placed patients into either a good-control group (out of range ≤ 25% of the time) or a moderate-control group (out of range > 25% of the time) and these groups were compared. Before nurse monitoring, INR values were out of range 20.4% of the time; after nurse monitoring they were out of range 19.2% of the time (P = .115); the time between sequential INR readings also did not differ before and after implementation of nurse monitoring (23.9 vs 21.6 days, P = .789). Nurse-led monitoring of INR is as effective as traditional physician monitoring. Advantages of nurse-led monitoring might include freeing family physicians to see more patients or to spend less time at work. It might also represent potential cost savings.

Application of pixel-cell detector technology for Advanced Neutron Beam Monitors

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

Kopp, Daniel M.

2011-01-11

Application of Pixel-Cell Detector Technology for Advanced Neutron Beam Monitors Specifications of currently available neutron beam detectors limit their usefulness at intense neutron beams of large-scale national user facilities used for the advanced study of materials. A large number of neutron-scattering experiments require beam monitors to operate in an intense neutron beam flux of >10E+7 neutrons per second per square centimeter. For instance, a 4 cm x 4 cm intense beam flux of 6.25 x 10E+7 n/s/cm2 at the Spallation Neutron Source will put a flux of 1.00 x 10E+9 n/s at the beam monitor. Currently available beam monitors withmore » a typical efficiency of 1 x 10E-4 will need to be replaced in less than two years of operation due to wire and gas degradation issues. There is also a need at some instruments for beam position information that are beyond the capabilities of currently available He-3 and BF3 neutron beam monitors. ORDELA, Inc.’s research under USDOE SBIR Grant (DE-FG02-07ER84844) studied the feasibility of using pixel-cell technology for developing a new generation of stable, long-life neutron beam monitors. The research effort has led to the development and commercialization of advanced neutron beam detectors that will directly benefit the Spallation Neutron Source and other intense neutron sources such as the High Flux Isotope Reactor. A prototypical Pixel-Cell Neutron Beam Monitor was designed and constructed during this research effort. This prototype beam monitor was exposed to an intense neutron beam at the HFIR SNS HB-2 test beam site. Initial measurements on efficiency, uniformity across the detector, and position resolution yielded excellent results. The development and test results have provided the required data to initiate the fabrication and commercialization of this next generation of neutron-detector systems. ORDELA, Inc. has (1) identified low-cost design and fabrication strategies, (2) developed and built pixel-cell detectors and instrumented a 64-pixel-cell detector to specifications for the Cold-Neutron Chopper Spectrometer and POWGEN instruments, (3) investigated the general characteristics of this technology, (4) studied pixel-cell configurations and arrived at an optimized modular design, and (5) evaluated fabrication costs of mass production for these configurations. The resulting technology will enable a complete line of pixel-cell-based neutron detectors to be commercially under available. ORDELA, Inc has a good track history of application of innovative technology into the marketplace. Our commercialization record reflects this. For additional information, please contact Daniel Kopp at ORDELA, Inc. at +1 (865) 483-8675 or check our website at www.ordela.com.« less

The Accuracy and Validity of iOS-Based Heart Rate Apps During Moderate to High Intensity Exercise.

PubMed

Bouts, Alexa M; Brackman, Lauren; Martin, Elizabeth; Subasic, Adam M; Potkanowicz, Edward S

2018-01-01

People use their smartphones for everything from web browsing to tracking fitness metrics. However, it is unclear whether smartphone-based apps that use photoplethysmography to measure heart rate are an accurate or valid measure of exercise intensity. Purpose was to determine the accuracy and validity of two iOS-based heart rate monitors, Runtastic Heart Rate Monitor and Pulse Tracker PRO by Runtastic (Runtastic) and Instant Heart Rate+: Heart Rate and Pulse Monitor by Azumio (Instant Heart Rate), when compared to the electrocardiogram (ECG) and Polar® T31 uncoded heart rate monitor from moderate to vigorous intensity exercise. Participants were 15 male and female regularly active college students. Pre-exercise heart rate and blood pressure were recorded and then participants exercised on a stationary bike at a pedal rate of between 50-60 rpms. After completing a warm-up stage at 40% of age estimated maximum heart rate (AEMHR), exercise intensity progressed from 50% of AEMHR through to 85% of AEMHR in eight, 5-minute stages. At the end of each stage, and having achieved steady-state, heart rates were recorded from each apparatus. After completing the final stage, participants completed a cooldown at 40% of their AEMHR. Post-exercise heart rate and blood pressure were also recorded to ensure full recovery to baseline. There was a strong positive correlation between the Polar® monitor and the ECG during all stages. However, there were not strong correlations for either of the smartphone-based apps at any time point. Although there were weak correlations between the smartphone-based apps and ECG and Polar®, further studies need to be conducted to determine if inaccuracy is due to user error (finger placement, finger temperature, etc.) or the technology behind the apps.

The Accuracy and Validity of iOS-Based Heart Rate Apps During Moderate to High Intensity Exercise

PubMed Central

BOUTS, ALEXA M.; BRACKMAN, LAUREN; MARTIN, ELIZABETH; SUBASIC, ADAM M.; POTKANOWICZ, EDWARD S.

2018-01-01

People use their smartphones for everything from web browsing to tracking fitness metrics. However, it is unclear whether smartphone-based apps that use photoplethysmography to measure heart rate are an accurate or valid measure of exercise intensity. Purpose was to determine the accuracy and validity of two iOS-based heart rate monitors, Runtastic Heart Rate Monitor and Pulse Tracker PRO by Runtastic (Runtastic) and Instant Heart Rate+: Heart Rate and Pulse Monitor by Azumio (Instant Heart Rate), when compared to the electrocardiogram (ECG) and Polar® T31 uncoded heart rate monitor from moderate to vigorous intensity exercise. Participants were 15 male and female regularly active college students. Pre-exercise heart rate and blood pressure were recorded and then participants exercised on a stationary bike at a pedal rate of between 50–60 rpms. After completing a warm-up stage at 40% of age estimated maximum heart rate (AEMHR), exercise intensity progressed from 50% of AEMHR through to 85% of AEMHR in eight, 5-minute stages. At the end of each stage, and having achieved steady-state, heart rates were recorded from each apparatus. After completing the final stage, participants completed a cooldown at 40% of their AEMHR. Post-exercise heart rate and blood pressure were also recorded to ensure full recovery to baseline. There was a strong positive correlation between the Polar® monitor and the ECG during all stages. However, there were not strong correlations for either of the smartphone-based apps at any time point. Although there were weak correlations between the smartphone-based apps and ECG and Polar®, further studies need to be conducted to determine if inaccuracy is due to user error (finger placement, finger temperature, etc.) or the technology behind the apps. PMID:29541341

Improvement in safety monitoring of biologic response modifiers after the implementation of clinical care guidelines by a specialty.

PubMed

Hanson, Rebekah L; Gannon, Michael J; Khamo, Nehrin; Sodhi, Monsheel; Orr, Alexander M; Stubbings, JoAnn

2013-01-01

Tumor necrosis factor (TNF)-alpha inhibitors and other biologic response modifiers (BRMs) are frequently used to treat a variety of inflammatory diseases. Use of these agents may increase risk of serious infections, malignancies, and other complications such as worsening symptoms of heart failure or demyelinating disease. Because of these risks, a baseline assessment and routine monitoring have been recommended, but standardized guidelines for monitoring have yet to be established. To measure the compliance with the recommended safety monitoring in the Clinical Care Guidelines for BRMs at the University of Illinois Hospitals and Health Sciences System (UI Health). The Clinical Care Guidelines for BRMs was developed by a committee of pharmacists, nurses, and physicians based on an assessment of published literature and medication labeling. The guidelines included recommendations for safety monitoring prior to BRM therapy, such as the tuberculosis (TB) test, Hepatitis B surface Antigen (HBsAg) test, liver function test (LFT), complete blood count (CBC), up-to-date vaccinations, risk assessment for cancer, pregnancy testing, monitoring for contraindications with concomitant medications, concomitant disease state risk assessment, and patient education. The guidelines were introduced to UI Health in February 2012 by a systemwide email and by in-services given by the health system's Specialty Pharmacy Service. In-services were given in the clinics known to generate large numbers of BRM orders (e.g., gastroenterology and rheumatology) and at the outpatient center for infused therapies. The purpose of the in-services was to introduce providers to the guidelines and encourage their compliance. To ensure that guideline requirements were met when BRMs were ordered, a process was established to identify BRM orders, assess the orders for compliance with 4 of the safety monitoring tests from the guidelines (TB, HBsAg, LFT, and CBC), and make interventions. When necessary, Specialty Pharmacy Services coordinated with the pharmacists and other providers in the clinic to order lab tests and ensure they were completed prior to the start of therapy. Feedback was provided during the study to proactively improve compliance with the guidelines. After completion of the study, a report containing outpatient prescription orders for BRMs (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, and tocilizumab) from August 2011 through July 2012 was generated from the electronic medical record. Retrospective analyses of completion of safety monitoring were conducted for patients administered BRM treatment. Completion rates were compared before and after implementation of guidelines in February 2012. Completion was considered to have occurred when all 4 safety monitoring tests had been conducted -TB (unless known to be positive from a previous test), HBsAg, LFT, and CBC. Completion data from August 2011 through January 2012 were before the guidelines were implemented, and data from February 2012 through July 2012 were after the guidelines. Chi square analyses were performed on completion frequencies in the patients before and after the guidelines were implemented. Of the 320 unique patient BRM orders evaluated in this study, 195 (61%) were generated in the Rheumatology clinic, 99 (31%) in the Gastroenterology clinic, 21 (6.5%) in the Dermatology clinic, and 5 (1.5%) in the Transplant clinic. Before the guidelines were implemented, 54 ( 31%) of 173 patient orders complied with the safety monitoring by having all 4 clinical tests performed at the appropriate time points. After guideline implementation, 88 (60%) of 147 patient orders were compliant and had all 4 clinical tests conducted, which represents a statistically significant improvement in the rate of compliance (Pearson chi square = 26.43, degrees of freedom (df) = 1, P  less than  0.0001). This significant improvement in compliance rates after guideline implementation was observed in both the new patient group and the patients with continuing prescription orders/treatment changes. There was also an improvement in patients whose prescriptions were dispensed by UI Health and to a lesser degree those whose prescriptions were dispensed by an outside pharmacy. When the new patient group was analyzed separately (n = 92), 50 patients were treated before the guidelines were implemented, and 42 patients were treated after the guidelines were implemented. Compliance rates with safety monitoring in these 2 groups were 52% pre-implementation and 83% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 10.03, df=1, P = 0.0015). Similar results were observed in the second patient subgroup with continuing prescription orders/treatment change (n = 228). A total of 123 patients were treated before the guidelines were implemented, and 105 were treated after the guidelines were implemented. Compliance rates were 23% pre-implementation compared with 50% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 18.99, df = 1, P  less than  0.0001). Given the widespread and long-term use of BRMs, safety monitoring and management should be an important part of a comprehensive medication management program for their use. A coordinated effort may have a significant impact on compliance with safety monitoring guidelines.