Sample records for urgent needfor anew

  1. Obesity in African-American Women--The Time Bomb is Ticking: An Urgent Call for Change.

    PubMed

    Fowler, Barbara A

    2015-12-01

    The "time bomb is ticking" because there is an obesity crisis associated with higher rates of chronic diseases such as stroke, hypertension, type 2 diabetes, and some forms of cancer in African-American women compared to White women. African-American women incur higher medical costs from hospitalizations, decreased productivity in the work setting, lost wages, the needfor medical benefits and pharmacy-associated costs, and more time away from family than White women. Numerous factors, such as the socio-cultural context of eating, acceptance of a larger weight status, the emotionally liberating effects offood, and preference for highfat and high caloric, sugary-content, and sodium-laden food influences the obesity crisis in African-American women. The interplay of poverty and lower socioeconomic status, residential segregation, health literacy, availability of fast foods and scarce produce in local convenience food marts, physical inactivity, and conflicting messages from social media public service announcements (PSAs) and ads in national magazines affect the obesity crisis in African-American women. There is an urgent call for sustainable, community-driven health policy initiatives that improve access to healthy foods in lower-income, minority communities. Furthermore, African-American women are challenged to modify their health behaviors by preparing healthy meals for themselves and theirfamilies, and by engaging in physical activity.

  2. Health and Household Air Pollution from Solid Fuel Use: The Needfor Improved Exposure Assessment

    EPA Science Inventory

    Background: Nearly half the world’s population relies on solid fuel combustion to meet basic household energy needs (e.g., cooking and heating). Resulting air pollution exposures are estimated to cause 3% of the global burden of disease. Large variability and a lack of resource...

  3. Swine Influenza A Outbreak, Fort Dix, New Jersey, 1976

    PubMed Central

    Top, Franklin H.; Hodder, Richard A.; Russell, Philip K.

    2006-01-01

    In early 1976, the novel A/New Jersey/76 (Hsw1N1) influenza virus caused severe respiratory illness in 13 soldiers with 1 death at Fort Dix, New Jersey. Since A/New Jersey was similar to the 1918–1919 pandemic virus, rapid outbreak assessment and enhanced surveillance were initiated. A/New Jersey virus was detected only from January 19 to February 9 and did not spread beyond Fort Dix. A/Victoria/75 (H3N2) spread simultaneously, also caused illness, and persisted until March. Up to 230 soldiers were infected with the A/New Jersey virus. Rapid recognition of A/New Jersey, swift outbreak assessment, and enhanced surveillance resulted from excellent collaboration between Fort Dix, New Jersey Department of Health, Walter Reed Army Institute of Research, and Center for Disease Control personnel. Despite efforts to define the events at Fort Dix, many questions remain unanswered, including the following: Where did A/New Jersey come from? Why did transmission stop? PMID:16494712

  4. Cloning and Expressing Recombinant Protective Antigen Domains of B. anthracis

    DTIC Science & Technology

    2011-09-01

    future predictive modeling toolkits. 1 1. Introduction The use of Bacillus anthracis as a bio - weapon in the United States in 2001 affirmed the need...for improved sensing and detection of biological weapons of mass destruction (WMD). Protective Antigen (PA) protein of Bacillus anthracis is the...Cloning and Expressing Recombinant Protective Antigen Domains of B. anthracis by Deborah A. Sarkes, Joshua M. Kogot, Irene Val-Addo

  5. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Section 171.7 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... Upon refiling, the time limitation will begin to run anew from the date of refiling. (b) At any time... limitation will begin to run anew. (c) Any petitioner who has a food additive petition pending before the...

  6. 21 CFR 71.6 - Extension of time for studying petitions; substantive amendments; withdrawal of petitions without...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL COLOR ADDITIVE PETITIONS General... limitation will begin to run anew. If nonclinical laboratory studies are involved, additional information and... to a future filing. Upon refiling, the time limitation will begin to run anew from the date of...

  7. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Section 171.7 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... Upon refiling, the time limitation will begin to run anew from the date of refiling. (b) At any time... limitation will begin to run anew. (c) Any petitioner who has a food additive petition pending before the...

  8. An in vitro evaluation of the Anew Zephyr open-bag IOL in the prevention of posterior capsule opacification using a human capsular bag model.

    PubMed

    Eldred, Julie A; Spalton, David J; Wormstone, I Michael

    2014-09-18

    During cataract surgery an IOL is placed within the capsular bag. Clinical studies show that IOLs with a square edge profile and complete contact between the IOL and the anterior capsule (AC) are currently the best way to prevent posterior capsule opacification (PCO). This has been challenged by recent clinical and experimental observations, which suggest that if the capsular bag is kept open with separation of contact between the AC and posterior capsule (PC) by an "open-bag device" PCO is dramatically reduced. Therefore, the current study set out to evaluate the putative merits of an open-bag IOL (Anew Zephyr) in a human capsular bag model. An in vitro organ culture model using the bag-zonular-ciliary body complex isolated from fellow human donor eyes was prepared. A capsulorhexis and lens extraction were performed, and an Alcon Acrysof IOL or Anew Zephyr IOL implanted. Preparations were secured by pinning the ciliary body to a silicone ring and maintained in 6 mL Eagle's minimum essential medium (EMEM) or EMEM supplemented with 2% vol/vol human serum (HS) and 10 ng/mL TGF-β2 for 28 days. Cell growth and capsular modifications were monitored with phase-contrast and modified dark-field microscopy. In serum-free EMEM culture conditions, cells were observed growing onto the PC of preparations implanted with an Anew Zephyr IOL, but this was retarded relative to observations in match-paired capsular bags implanted with an Alcon Acrysof IOL. In the case of cultures maintained in 2% HS-EMEM plus TGF-β2, the movement on to the PC was again delayed with the presence of an Anew Zephyr IOL. Differences in the degree of growth on the PC and matrix modifications were apparent with the different donors, but in each case the match-paired Alcon Acrysof implanted bag exhibited significantly greater coverage and modification of the capsule. The Anew Zephyr open-bag IOL performs consistently better than the Alcon Acrysof IOL in the human capsular bag model. We propose that the benefits observed with the Anew Zephyr result from a reduction in growth factor levels available within the capsular bag and a barrier function imposed by the ring haptic. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  9. The new A/New Jersey/76 influenza strain (Memorandum)*

    PubMed Central

    1976-01-01

    This Memorandum reviews the information available on the new strain of influenza virus, A/New Jersey/76 (Hsw1N1), that first appeared at Fort Dix, NJ, USA, in February 1976. Recommendations are given concerning measures to be taken to detect spread of this strain and to meet the challenge if an epidemic should occur. PMID:1085659

  10. Response of normal children to influenza A/New Jersey/76 virus vaccine administered by jet injector.

    PubMed

    McIntosh, K; Orr, I; Andersen, M; Arthur, J H; Blakeman, G J

    1977-12-01

    Ninety-seven children six to 10 years old received monovalent influenza A/New Jersey/76 virus vaccine by jet injector. Comparison with groups receiving vaccine intramuscularly revealed that local reactions (tenderness and erythema) were more frequent and more severe in the group vaccinated by jet injector. Antibody response, however, was similar for all groups.

  11. Densification of PZT Ceramics with V2O5 Additive.

    DTIC Science & Technology

    1979-01-01

    Additions of V2O5 from 0.1 to 8.0 w/o to a coprecipitated Pb(Zr.53 Ti.47) O3 ceramic promoted rapid densification below 1025 C, eliminating the need...for PbO atmosphere control. Dielectric properties were found to be dependent on the amount of V2O5 added and on the microstructure developed, but were...comparable to reported values for this PZT composition for additions of V2O5 or = 1.5 W/O. The indicated densification mechanism is one of activated sintering catalyzed by generation of oxygen defects on decomposition of the V2O5 .

  12. Diatom Milking: A Review and New Approaches

    PubMed Central

    Vinayak, Vandana; Manoylov, Kalina M.; Gateau, Hélène; Blanckaert, Vincent; Hérault, Josiane; Pencréac’h, Gaëlle; Marchand, Justine; Gordon, Richard; Schoefs, Benoît

    2015-01-01

    The rise of human populations and the growth of cities contribute to the depletion of natural resources, increase their cost, and create potential climatic changes. To overcome difficulties in supplying populations and reducing the resource cost, a search for alternative pharmaceutical, nanotechnology, and energy sources has begun. Among the alternative sources, microalgae are the most promising because they use carbon dioxide (CO2) to produce biomass and/or valuable compounds. Once produced, the biomass is ordinarily harvested and processed (downstream program). Drying, grinding, and extraction steps are destructive to the microalgal biomass that then needs to be renewed. The extraction and purification processes generate organic wastes and require substantial energy inputs. Altogether, it is urgent to develop alternative downstream processes. Among the possibilities, milking invokes the concept that the extraction should not kill the algal cells. Therefore, it does not require growing the algae anew. In this review, we discuss research on milking of diatoms. The main themes are (a) development of alternative methods to extract and harvest high added value compounds; (b) design of photobioreactors; (c) biodiversity and (d) stress physiology, illustrated with original results dealing with oleaginous diatoms. PMID:25939034

  13. The Canadian influenza decision, 1976.

    PubMed Central

    Morrison, A. B.; Liston, A. J.; Abbott, J. D.

    1976-01-01

    This paper explains the Canadian decision process following the isolation and identification of A/New Jersey/8/76 at Fort Dix, New Jersey in February 1976. The cause for concern was the emergence of a swine-like strain related to that which caused the 1918-19 pandemic, together with proved man-to-man transmission. This concern was reinforced since all new influenza A strains known to have infected the number of persons involved at Fort Dix have become strains of epidemic importance. The Fort Dix outbreak gave sufficient warning to allow implementation of a national vaccination program, to prevent and protect against influenza. In the past such an opportunity had not occurred, and vaccine use had, at best, constituted an intervention in the course of an outbreak. The National Advisory Committee on Immunizing Agents had all available information when it reached its decision to recommend vaccination with bivalent (A/Victoria and A/New Jersey) or with monovalent (A/New Jersey) vaccine for selective, high-risk groups. This was an independent, scientifically based decision. PMID:991022

  14. Social workers' role in disease management.

    PubMed

    Claiborne, N; Vandenburgh, H

    2001-11-01

    This article discusses social work's participation in a new paradigm for health care delivery, disease management. Attempts to improve health care quality havefocused on evidence-based methods of evaluating health care outcomes as well as quality of life issues with which social workers have been traditionally concerned. The fit between social work's ecological perspective and disease management and the needfor social workers to participate as patient case managers on interdisciplinary disease management teams are discussed. Quality and cost benefits can occur when social workers address such issues as adherence, psychosocialfactors, and depression in terms of the patient's global recovery and concurrent enhancement of quality of life. Potential barriers to disease management implementation with social work participation are discussed.

  15. The Birthday Problem Anew

    ERIC Educational Resources Information Center

    Braza, Peter A.

    2006-01-01

    Accurate and accessible expressions for the probability of having a matching birthday are obtained by using Stirling's formula and Taylor series. For interest, the results are applied to the planets of our solar system.

  16. Turning Children into Sex Experts.

    ERIC Educational Resources Information Center

    Kasun, Jacqueline

    1979-01-01

    Proponents of sex education in the public schools have stressed a particular world view and the establishment of a chosen ideology. The public and congress would do well to examine this posture anew. (Author/EB)

  17. Fears for literacy and numeracy as new nurses fail basic tests.

    PubMed

    Learner, Sue

    2006-08-16

    The Nursing and Midwifery Council (NMC) has voiced concern over nurses' poor levels of English and maths after a third of newly qualified nurses failed a basic test set by a hospital as part of anew selection process.

  18. A New Poetry Anew.

    ERIC Educational Resources Information Center

    Grumman, Bob

    1994-01-01

    Classifies the various forms that exist in a type of poetry dubbed "burstnorm" poetry, a form of lyrical poetry. Differentiates burstnorm from two other types, "plaintext" and "songmode poetry." Describes three types of burstnorm poetry: surrealistic, pluraesthetic, and language poetry. Discusses further subtypes of…

  19. The Nervous System.

    ERIC Educational Resources Information Center

    Miller, Richard E.

    1996-01-01

    Attempts to step outside the debate about personal writing in academic discourse and rework its configurations. Suggests that academics think anew about writing as a place where the personal and the academic, the private and the public, the individual and the institutional, are always inextricably interwoven. (TB)

  20. U.S. Haiti Policy: An Evolving Comprehensive, Multilateral Approach

    DTIC Science & Technology

    2011-03-24

    disaster; a cholera -stricken capital region; and an unresolved NOV 10 national election. Haiti can start anew, building on the current ravages. Former...have sustained limited military engagements to respond to threats emanating in Venezuela, Mexico , and throughout the Americas as drug cartels and

  1. Watt steam governor stability

    NASA Astrophysics Data System (ADS)

    Denny, Mark

    2002-05-01

    The physics of the fly-ball governor, introduced to regulate the speed of steam engines, is here analysed anew. The original analysis is generalized to arbitrary governor geometry. The well-known stability criterion for the linearized system breaks down for large excursions from equilibrium; we show approximately how this criterion changes.

  2. Academetron, Automaton, Phantom: Uncanny Digital Pedagogies

    ERIC Educational Resources Information Center

    Bayne, Sian

    2010-01-01

    This paper explores the possibility of an uncanny digital pedagogy. Drawing on theories of the uncanny from psychoanalysis, cultural studies and educational philosophy, it considers how being online defamiliarises teaching, asking us to question and consider anew established academic practices and conventions. It touches on recent thinking on…

  3. A Harvest of Humility: Agrarian Practice and Christian Higher Education

    ERIC Educational Resources Information Center

    Groppe, Elizabeth

    2014-01-01

    Humility, the keystone of the virtues in the Christian spiritual tradition, has been dismissed by modern philosophers, critiqued by feminist theologians, and overpowered by our industrial and technological culture. The incorporation of agricultural experience in Christian higher education presents the opportunity to cultivate anew the virtue of…

  4. Developing a Quality Curriculum.

    ERIC Educational Resources Information Center

    Glatthorn, Allan A.

    In the face of increasing demands for school reform, educational leaders are looking anew at the core elements of the instructional program, including the curriculum. This book serves as a guide to both understanding and practicing sound curriculum development. It lays out the steps of a quality curriculum-development process and emphasizes that…

  5. Perceiving Learning Anew: Social Interaction, Dignity, and Educational Rights

    ERIC Educational Resources Information Center

    Espinoza, Manuel Luis; Vossoughi, Shirin

    2014-01-01

    What are the origins of educational rights? In this essay, Espinoza and Vossoughi assert that educational rights are "produced," "affirmed," and "negated" not only through legislative and legal channels but also through an evolving spectrum of educational activities embedded in everyday life. Thus, they argue that the…

  6. [Not Available].

    PubMed

    1987-10-31

    Stars of the television series Emmerdale Farm were on hand for the opening of anew wing at Leeds' St Mary's Hospital, specially named after the programme. Actor Frazer Hines and co star Jean Rogers joined patient Maud Brown (centre) in the new Emmerdale Wing, together with nurses Jennet Worthington, Kathy Elcock, Mandy West and Clare Jones.

  7. Precise Electrochemical Drilling of Repeated Deep Holes

    NASA Technical Reports Server (NTRS)

    Kincheloe, J. P.

    1985-01-01

    Tooling enables maintenance of close tolerances. Tooling includes guide that holds electrochemical drilling electrodes in proper relative alinement and guide-positioning fixture clamps directly on reference surfaces of strut. High precision achieved by positioning tooling anew on each strut before drilling: Tolerances of (0.008 mm) maintained in some details.

  8. Putting Parameters in Their Proper Place

    ERIC Educational Resources Information Center

    Montrul, Silvina; Yoon, James

    2009-01-01

    Seeing the logical problem of second language acquisition as that of primarily selecting and re-assembling bundles of features anew, Lardiere proposes to dispense with the deductive learning approach and its broad range of consequences subsumed under the concept of parameters. While we agree that feature assembly captures more precisely the…

  9. Tools for Energized Teaching: Revitalize Instruction with Ease

    ERIC Educational Resources Information Center

    Wilson, Kenneth

    2006-01-01

    "Challenge yourself to break out of your old routines. Think anew." Ken Wilson, educator, trainer and consultant has assembled a versatile, practical and generic book to use across disciplines and with all age levels. This collection of accessible, user-friendly tools incorporates and connects current education research--without the jargon. "This…

  10. Plant a Seed

    ERIC Educational Resources Information Center

    Cohen, Todd; Feldbaum, Mindy

    2012-01-01

    With every student who graduates college to pursue a career in the green workforce, the case for green-collar job training at the nation's community colleges is made anew. As federal stimulus dollars wind down, community colleges are determined to maintain and expand green-focused education and job training successes. The American Association of…

  11. Starting Anew

    ERIC Educational Resources Information Center

    Lum, Lydia

    2006-01-01

    Hundreds of higher education faculty lost their jobs in the aftermath of Hurricane Katrina. New Orleans' colleges and universities were forced to cancel fall semester classes after the city's levee system failed, submerging 80 percent of the city just weeks before the academic year began. Damage assessments began even before the deadly storm's…

  12. A Conceptual Framework for Intercultural/International Communication.

    ERIC Educational Resources Information Center

    Weiss, Tim

    The ambiguities of intercultural communication are examined in this paper. The concept posed is that although every culture sees the world according to that culture's heritage and history, immediate contexts also shape meanings. In multicultural contexts, those meanings must be constructed partly anew each time by speakers, writers, listeners, and…

  13. Education Reforms: Lessons from History

    ERIC Educational Resources Information Center

    Hunt, Thomas C.

    2005-01-01

    Policy makers in education have long embraced reform. Unfortunately, education reforms have consistently been plagued by the reformers' lack of knowledge and appreciation of the history of education. Accordingly, the latest reform, touted as a panacea, meets with failure, and the search for the magic elixir begins anew. The ahistorical nature of…

  14. 42 CFR 401.617 - Suspension of collection action.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Suspension of collection action. 401.617 Section 401.617 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... that— (i) The applicable statute of limitations has been tolled, waived or has started running anew; or...

  15. 42 CFR 401.617 - Suspension of collection action.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Suspension of collection action. 401.617 Section 401.617 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... that— (i) The applicable statute of limitations has been tolled, waived or has started running anew; or...

  16. What Is the Role of the Public Library?

    ERIC Educational Resources Information Center

    Shubert, Joseph F.

    Changes in today's technology make it necessary for library administrators to look anew at the role, the mission, and the future of the public library. Economic development and education strategists recognize three types of rural communities--rural poor, traditional middle America, and communities in transition--each with different values,…

  17. Experts Extol Anew the Advantages of Saving for College.

    ERIC Educational Resources Information Center

    Evangelauf, Jean

    1988-01-01

    With tuition rising and anxiety mounting over students too deeply in debt, an effort to change the psychology of paying for college is gaining steam. The Reagan Administration is expected to propose a new savings bond whose interest would be tax free if the bond is cashed in for college. (MLW)

  18. Holistic Principles: Not Enhancing the Old but Seeing A-New. A Rejoinder.

    ERIC Educational Resources Information Center

    Heshusius, Lous

    1989-01-01

    The author replies to responses to her article, "The Newtonian Mechanistic Paradigm, Special Education, and Contours of Alternatives" (EC 220 916). Topics covered include the degree of objectivity versus the idea of objectivity, theory-data separation versus theory-laden data, Piagetian theory and the question of theory versus paradigm,…

  19. Lifting off the Ground to Return Anew: Mediated Praxis, Transformative Learning, and Social Design Experiments

    ERIC Educational Resources Information Center

    Gutierrez, Kris D.; Vossoughi, Shirin

    2010-01-01

    This article examines a praxis model of teacher education and advances a new method for engaging novice teachers in reflective practice and robust teacher learning. Social design experiments--cultural historical formations designed to promote transformative learning for adults and children--are organized around expansive notions of learning and…

  20. The Education of the Categorical Imperative

    ERIC Educational Resources Information Center

    Johnston, James Scott

    2006-01-01

    In this article, I examine anew the moral philosophy of Immanuel Kant and its contributions to educational theory. I make four claims. First, that Kant should be read as having the Categorical Imperative develop out of subjective maxims. Second, that moral self-perfection is the aim of moral education. Third, that moral self-perfection develops by…

  1. Nationwide Standards Eyed Anew

    ERIC Educational Resources Information Center

    Olson, Lynn

    2005-01-01

    With the federal No Child Left Behind Act underscoring the wide variation in what states demand of their students, people on both sides of the political aisle are again making the case for national standards, curricula, and tests. It wasn't so long ago--during the Clinton and George H.W. Bush administrations--that similar proposals went down in…

  2. 24 CFR 17.74 - Standards for suspension or termination of collection action.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... termination of collection action. 17.74 Section 17.74 Housing and Urban Development Office of the Secretary... payment on the Department's claim or effect a compromise, but his future prospects justify retention of... or started anew or (2) future collection can be effected by offset notwithstanding the statute of...

  3. The Shaped Charge Concept. Part 2. The History of Shaped Charges

    DTIC Science & Technology

    1990-09-01

    research of Evans. Ubbel•ode. LAmurd-Jones, Devonihire, and An&ew. 1hW U.K. Mufied cadmium liners (which probably produce molten jets) msd steel liners...34 Mathematical Jet Theory of Lined Hollow Charges." BRL Report No. 370, U.S. Army Ballistic Research Laboratory. Aberdeen Proving Ground, MD, 18 June

  4. Exploring Vocation: Reframing Undergraduate Education as a Quest for Purpose

    ERIC Educational Resources Information Center

    Sullivan, William M.

    2014-01-01

    This article describes the Program on the Theological Exploration of Vocation (PTEV), a unique experiment in undergraduate education. This project challenged a group of 88 colleges and universities affiliated with a variety of Christian denominations, from Orthodox and Roman Catholic to Evangelical Protestant and Quaker, to think anew about what…

  5. 14 CFR 1261.416 - Suspending or terminating collection action.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... sufficiently in advance of the bar of the applicable statute of limitations, such as 28 U.S.C. 2415, to permit... applicable statute of limitations has been tolled or started running anew; or (ii) Future collection can be effected by offset, notwithstanding the statute of limitations, with due regard to the 10-year limitation...

  6. 14 CFR 1261.416 - Suspending or terminating collection action.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... sufficiently in advance of the bar of the applicable statute of limitations, such as 28 U.S.C. 2415, to permit... applicable statute of limitations has been tolled or started running anew; or (ii) Future collection can be effected by offset, notwithstanding the statute of limitations, with due regard to the 10-year limitation...

  7. 14 CFR 1261.416 - Suspending or terminating collection action.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... sufficiently in advance of the bar of the applicable statute of limitations, such as 28 U.S.C. 2415, to permit... applicable statute of limitations has been tolled or started running anew; or (ii) Future collection can be effected by offset, notwithstanding the statute of limitations, with due regard to the 10-year limitation...

  8. 14 CFR 1261.416 - Suspending or terminating collection action.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... sufficiently in advance of the bar of the applicable statute of limitations, such as 28 U.S.C. 2415, to permit... applicable statute of limitations has been tolled or started running anew; or (ii) Future collection can be effected by offset, notwithstanding the statute of limitations, with due regard to the 10-year limitation...

  9. A Phenomenological Exploration of Mathematical Engagement: Approaching an Old Metaphor Anew.

    ERIC Educational Resources Information Center

    Handa, Yuichi

    2003-01-01

    Investigates the heart of the experience of mathematical engagement and the meaning derived from such activities. Analyzes dialogue between five people, two of whom are professional mathematicians, another two who are graduate students in either engineering or education, and one who lacks advanced mathematical training but maintains a positive…

  10. America's First Universal Design "Smart" Home

    ERIC Educational Resources Information Center

    Schwab, Charles M.

    2009-01-01

    By providing a $20,000 tax credit for Universal Design (UD) housing, when new housing construction begins anew, the United States has a real opportunity to save hundreds of billions of dollars in long-term healthcare while encouraging long-term economic growth. Universal Design (also known as Inclusive Design or "Aging in Place" when referring to…

  11. Re-Visiting the Competence/Performance Debate in the Acquisition of the Counting Principles

    ERIC Educational Resources Information Center

    Le Corre, Mathieu; Van de Walle, Gretchen; Brannon, Elizabeth M.; Carey, Susan.

    2006-01-01

    Advocates of the ''continuity hypothesis'' have argued that innate non-verbal counting principles guide the acquisition of the verbal count list (Gelman & Gallistel, 1978). Some studies have supported this hypothesis, but others have suggested that the counting principles must be constructed anew by each child. Defenders of the continuity…

  12. Poverty and the American Family: A Decade in Review

    ERIC Educational Resources Information Center

    Edin, Kathryn; Kissane, Rebecca Joyce

    2010-01-01

    Because of dramatic levels of economic volatility and massive changes in welfare policies, scholars in this decade worried anew about whether our official poverty measure, adopted in the 1960s, is adequate. Poverty's causes continued to be debated, with demographic factors often pitted against policy and maternal employment changes. Some scholars…

  13. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVE PETITIONS General Provisions § 171.7... limitation will begin to run anew. (c) Any petitioner who has a food additive petition pending before the... 21 Food and Drugs 3 2012-04-01 2012-04-01 false Withdrawal of petition without prejudice. 171.7...

  14. 21 CFR 171.7 - Withdrawal of petition without prejudice.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) FOOD FOR HUMAN CONSUMPTION (CONTINUED) FOOD ADDITIVE PETITIONS General Provisions § 171.7... limitation will begin to run anew. (c) Any petitioner who has a food additive petition pending before the... 21 Food and Drugs 3 2013-04-01 2013-04-01 false Withdrawal of petition without prejudice. 171.7...

  15. Lessons: Katrina and Beginning Anew

    ERIC Educational Resources Information Center

    Kirylo, James D.

    2005-01-01

    New Orleans, fondly known in better days for its spectacular cuisine, cool jazz, and good times, was the leading story on television news broadcasts the world over when a massive hurricane came. As Katrina took its destructive path, culminating in the devastating rupture of ill-prepared levee systems, the world was riveted by stories about the…

  16. Which Kind of Mathematics for Quantum Mechanics? the Relevance of H. Weyl's Program of Research

    NASA Astrophysics Data System (ADS)

    Drago, Antonino

    In 1918 Weyl's book Das Kontinuum planned to found anew mathematics upon more conservative bases than both rigorous mathematics and set theory. It gave birth to the so-called Weyl's elementary mathematics, i.e. an intermediate mathematics between the mathematics rejecting at all actual infinity and the classical one including it almost freely. The present paper scrutinises the subsequent Weyl's book Gruppentheorie und Quantenmechanik (1928) as a program for founding anew theoretical physics - through quantum theory - and at the same time developing his mathematics through an improvement of group theory; which, according to Weyl, is a mathematical theory effacing the old distinction between discrete and continuous mathematics. Evidence from Weyl's writings is collected for supporting this interpretation. Then Weyl's program is evaluated as unsuccessful, owing to some crucial difficulties of both physical and mathematical nature. The present clear-cut knowledge of Weyl's elementary mathematics allows us to re-evaluate Weyl's program in order to look for more adequate formulations of quantum mechanics in any weaker kind of mathematics than the classical one.

  17. Job-Embedded Professional Development: Reducing Teacher Isolation by Enacting Social Change

    ERIC Educational Resources Information Center

    Frank, K.

    2009-01-01

    Teacher isolation and burn-out are problems which contribute to high rates of teacher attrition and require school districts to hire new teachers each year and start anew with professional development. The purpose of this qualitative case study was to investigate whether peer coaching and mentoring programs had an effect on this problem by…

  18. Lifetimes and Legacies: Temporalities of Sociotechnical Change in a Long-Lived System

    ERIC Educational Resources Information Center

    Cohn, Marisa Leavitt

    2013-01-01

    In studying technological change, we often seek to understand the dynamics of how technologies and practice shape each other over time, examining sites of innovation, adaptation, and appropriation, of making and re-making systems anew. However less attention has been given to how formerly cutting-edge technologies become old, how people work…

  19. Three Naive Questions: Addressed to the Modern Educational Optimism

    ERIC Educational Resources Information Center

    Krstic, Predrag

    2016-01-01

    This paper aims to question anew the popular and supposedly self-evident affirmation of education, in its modern incarnation as in its historical notion. The "naive" questions suggest that we have recently taken for granted that education ought to be for the masses, that it ought to be upbringing, and that it is better than ignorance.…

  20. Effective Training for Millennial Students

    ERIC Educational Resources Information Center

    Werth, Eric P.; Werth, Loredana

    2011-01-01

    A generational shift is occurring in training environments worldwide, a shift that promises to bring with it a dramatic and long-lasting impact. Just as years ago, those of the Baby Boomer generation passed the torch to Generation X, today the process is starting anew with Generation X and those who have come to be known as the Millennials.…

  1. 3 CFR 8599 - Proclamation 8599 of November 8, 2010. World Freedom Day, 2010

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    .... This cherished day also calls upon us to reflect on our world anew and recognize that the work of... break through artificial barriers and work to implement solutions to common challenges. Civil society... principled men and women have marched, spoken out, and demanded the rights and dignity that should be enjoyed...

  2. 14 CFR § 1261.416 - Suspending or terminating collection action.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... sufficiently in advance of the bar of the applicable statute of limitations, such as 28 U.S.C. 2415, to permit... applicable statute of limitations has been tolled or started running anew; or (ii) Future collection can be effected by offset, notwithstanding the statute of limitations, with due regard to the 10-year limitation...

  3. Starting Anew: Exploring the Links between Radio and Journalism Education in Post-Revolutionary Romania.

    ERIC Educational Resources Information Center

    Hochheimer, John L.; Hochheimer, Joanne Dvorak

    This paper examines the evolution of Romanian radio, as well as some of the inherent problems of journalism education in Romania in the post-revolutionary era. The paper discusses the legacy of repression during the Ceausescu dictatorship, which limited radio services throughout the country and left only one journalism school, a school that…

  4. Reflecting Back and Looking Forward: Revisiting "Teaching about Writing, Righting Misconceptions" Five Years on

    ERIC Educational Resources Information Center

    Wardle, Elizabeth; Downs, Doug

    2013-01-01

    In this Retrospective, we revisit our 2007 "College Composition and Communication" article in order to clarify our primary argument, address some questions and critiques that have arisen, and consider anew the value of composition courses that study writing. We review our core argument that engaging students with the research and ideas of writing…

  5. "Ahead of All Beaten Tracks": Ryle, Heidegger and the Ways of Thinking

    ERIC Educational Resources Information Center

    Williams, Emma

    2013-01-01

    The purpose of this article is to examine two philosophical accounts of thinking--yet examine them anew by considering what I take to be their under-examined relationship. These are the accounts of Gilbert Ryle and Martin Heidegger. It is often supposed that these two philosophers belong to differing, even conflicting, philosophical traditions.…

  6. The European Court of Human Rights, Secular Education and Public Schooling

    ERIC Educational Resources Information Center

    Arthur, James; Holdsworth, Michael

    2012-01-01

    Since 9/11 the European Court of Human Rights (the European Court) has raised anew the question of the relationship between religion and public education. In its reasoning, the European Court has had to consider competing normative accounts of the secular, either to accept or deny claims to religious liberty within Europe's public education…

  7. Simba: Coming of Age for the African-American Male.

    ERIC Educational Resources Information Center

    Hill, Paul, Jr.

    Black American males lack a ceremony to usher them into manhood. Such a ritual could help to ensure proper socialization and self identity. It may counteract the negative influence of street culture. Like other major life change ceremonies, a coming-of-age rite can help to locate anew the individual within the community. Elements of this rite of…

  8. Experimentum Scholae: The World Once More...But Not (Yet) Finished

    ERIC Educational Resources Information Center

    Masschelein, Jan

    2011-01-01

    Inspired by Hannah Arendt, this contribution offers an exercise of thought as an attempt to distil anew the original spirit of what education means. It tries to articulate the event or happening that the word names, the experiences in which this happening manifests itself and the (material) forms that constitute it or make it find/take (its)…

  9. Can Deweyan Pragmatist Aesthetics Provide a Robust Framework for the Philosophy for Children Programme?

    ERIC Educational Resources Information Center

    Oral, Sevket Benhur

    2013-01-01

    In this paper, I argue that Dewey's pragmatist aesthetics, and in particular, his concept of "consummatory experience", should be engaged anew to rethink the merits of the Philosophy for Children (PFC) programme, which arose in the 1970s in the US as an innovative educational programme that aims to use philosophy to help school children (aged…

  10. To See Anew: New Technologies Are Moving Rapidly Toward Restoring or Enabling Vision in the Blind.

    PubMed

    Grifantini, Kristina

    2017-01-01

    Humans have been using technology to improve their vision for many decades. Eyeglasses, contact lenses, and, more recently, laser-based surgeries are commonly employed to remedy vision problems, both minor and major. But options are far fewer for those who have not seen since birth or who have reached stages of blindness in later life.

  11. Seeing the World Anew: Educating for a Just and Sustainable Future--New Perspectives for a Catholic Curriculum

    ERIC Educational Resources Information Center

    Riley, Maria; Danner-McDonald, Kerry

    2013-01-01

    This article uses three value constructs, Catholic social thought (CST), feminist political economy (FPE) and ecological economics (Eco-Econ) to critique current mainstream economics. Insights from these values open a way to seeing and creating a just, sustainable future. Within this value framework we propose the integration of these themes in…

  12. School, Society, and State: A New Education to Govern Modern America, 1890-1940

    ERIC Educational Resources Information Center

    Steffes, Tracy L.

    2012-01-01

    "Democracy has to be born anew every generation, and education is its midwife," wrote John Dewey in his classic work "The School and Society." In "School, Society, and State", Tracy Steffes places that idea at the center of her exploration of the connections between public school reform in the early twentieth century and American political…

  13. Seeing the World Anew: A Case Study of Ideas, Engagement, and Transfer in a 3 Year Old.

    ERIC Educational Resources Information Center

    Pugh, Kevin

    According to the philosophy of John Dewey, the goal of education is to provide students with an increased capacity for having worthwhile experiences. This paper draws on Dewey's writings to develop a theory of worthwhile experience, termed "idea-based experience." A model is proposed of how individuals are apprenticed into having an…

  14. Microstructure and Properties of a New Cr - Mn Steel without Boron Additions for Use in Hot Stamping

    NASA Astrophysics Data System (ADS)

    Zhou, H.; Zhu, G.; Li, Q.; Chen, Q.

    2015-09-01

    Anew hot-stamping steel that is alloyed with chromium and manganese and does not contain boron additions has been developed. The effect of reheating temperature and cooling rates on the mechanical properties and structure of the steel is determined. Atreatment regime that increases the ductility of the steel without a noticeable decrease in its strength is proposed.

  15. The Condition of Farm Workers and Small Farmers in 1970. Report to the National Board of National Sharecroppers Fund.

    ERIC Educational Resources Information Center

    Pierce, James M.

    In 1970, many Americans are examining anew the costs of achieving efficiency in agriculture through bigness. The exodus of small farmers continues--more than 2.7 million farmers have abandoned farming or sold out to bigger competitors since 1950--while Government agricultural policy remains attuned to the interests of large farmers. All small…

  16. Mass Spectrometric Rapid Diagnosis of Infectious Diseases.

    DTIC Science & Technology

    1980-01-01

    the analytical procedures to warrant reporting anew the whole analytical procedure. A. Sample Collection and Storage Procedure Urine samples were...positives or false-negatives. Next we have carried out a longitudinal study on urine samples obtained from groups of volunteer subjects vaccinated with...sterilization and storage procedures. 2. Developed new, simpler sample preparation techniques including one to handle tissue culture media. 3. Improved on the

  17. Practicing Critical Media Literacy Education: Developing a Community of Inquiry among Teachers Using Popular Culture

    ERIC Educational Resources Information Center

    Flores-Koulish, Stephanie

    2010-01-01

    Media literacy compels us to look anew at the most mundane, that which surrounds us: the media and our popular culture. From there media literacy compels us to accept that the media are constructed and to seek various ways to analyze them, while considering our own beliefs to evaluate for ourselves an ultimate interpretation. This process has the…

  18. Automating the Transformational Development of Software. Volume 1.

    DTIC Science & Technology

    1983-03-01

    DRACO system [Neighbors 80] uses meta-rules to derive information about which new transformations will be applicable after a particular transformation has...transformation over another. The new model, as Incorporated in a system called Glitter, explicitly represents transformation goals, methods, and selection...done anew for each new problem (compare this with Neighbor’s Draco system [Neighbors 80] which attempts to reuse domain analysis). o Is the user

  19. Computer Generated Pictorial Stores Management Displays for Fighter Aircraft.

    DTIC Science & Technology

    1983-05-01

    questionnaire rating-scale data. KRISHNAIAH FINITE INTERSECTION TESTS (FITs) - A set of tests conducted after significant MANOVA results are found to...the Social Sciences (SPSS) (Reference 2). To further examine significant performance differences, the Krishnaiah Finite Intersection Test (FIT), a...New York: McGraw-Hill Book Company, 1975. 3. C. M. Cox, P. R. Krishnaiah , J. C. Lee, J. M. Reising, and F. J. Schuurman, A study on Finite Intersection

  20. Discovery of Amadori-Type Conjugates in a Peptide Maillard Reaction and Their Corresponding Influence on the Formation of Pyrazines.

    PubMed

    Zou, Tingting; Liu, Jianbin; Song, Huanlu; Liu, Ye

    2018-06-01

    Knowledge of the role of peptides in the Maillard reaction is rather limited. In this study, peptide Maillard reaction model systems were established. Volatile and nonvolatile MRPs (Maillard reaction products) were investigated by GC-O-MS and LC-MS. Carbohydrate module labeling (CAMOLA) experiments were performed to elucidate the carbon skeleton of these compounds. Results showed that the peptide reaction system generated more pyrazines than the free amino acid group. Several new Amadori-type conjugates were identified as novel Maillard reaction products that could greatly influence the formation of pyrazines. Our work suggested anew mechanism involving these Amadori-type conjugates and subsequent investigation revealed that the conjugates could be important intermediate products in the reaction between dicarbonyl and dipeptide. Our findings demonstrate anew pyrazine generation mechanism in the dipeptide Maillard reaction. We found that a dipeptide Maillard reaction system generated more pyrazines than a reaction system composed of free amino acids. New cross-linked peptide-sugar compounds were identified and found to impact the formation of pyrazines. The results of this study may help in the preparation of thermal reaction flavors using enzymatically hydrolyzed vegetable/animal proteins, which contain a considerable amount of peptides, as one of the major reactants. © 2018 Institute of Food Technologists®.

  1. Intercontinental circulation of human influenza A(H1N2) reassortant viruses during the 2001-2002 influenza season.

    PubMed

    Xu, Xiyan; Smith, Catherine B; Mungall, Bruce A; Lindstrom, Stephen E; Hall, Henrietta E; Subbarao, Kanta; Cox, Nancy J; Klimov, Alexander

    2002-11-15

    Reassortant influenza A viruses bearing the H1 subtype of hemagglutinin (HA) and the N2 subtype of neuraminidase (NA) were isolated from humans in the United States, Canada, Singapore, Malaysia, India, Oman, Egypt, and several countries in Europe during the 2001-2002 influenza season. The HAs of these H1N2 viruses were similar to that of the A/New Caledonia/20/99(H1N1) vaccine strain both antigenically and genetically, and the NAs were antigenically and genetically related to those of recent human H3N2 reference strains, such as A/Moscow/10/99(H3N2). All 6 internal genes of the H1N2 reassortants examined originated from an H3N2 virus. This article documents the first widespread circulation of H1N2 reassortants on 4 continents. The current influenza vaccine is expected to provide good protection against H1N2 viruses, because it contains the A/New Caledonia/20/99(H1N1) and A/Moscow/10/99(H3N2)-like viruses, which have H1 and N2 antigens that are similar to those of recent H1N2 viruses.

  2. British aid to medical schools in developing countries.

    PubMed

    Hubble, D

    1972-06-17

    If the British allocation for overseas aid is increased more generous agreements could be made with host universities and with expatriate staff. It would greatly stimulate overseas service by specialist trainees if the professional colleges and the universities agreed that they would be willing to substitute in their training programmes a year or two of service in an overseas medical school for one or more of their orthodox appointments. Consideration might be given by the councils for postgraduate education to ways of facilitating service overseas by specialist trainees and young consultants. The suggestion of the Royal Commission for the expansion of departmental staff establishments and training pools requires that the temporary expatriate occupying a supernumerary post is absorbed into the establishment on his return. While this may be done now in individual cases by personal arrangement a national agreement between universities and the N.H.S. would be necessary for these secondments to be made on the large scale commensurate to the need.For other returning young doctors not yet in specialist training schemes an assurance that applications for appointments by those who had worked in developing countries would receive favourable weighting, by both university and N.H.S. selection committees, would be very helpful.

  3. Of Men & Rivers: The Story of the Vicksburg District

    DTIC Science & Technology

    1978-01-01

    scout the farthest reaches of the Louisiana Purchase. Exploration began anew throughout that vast region from modern Mississippi to New Mexico ...Texas, and by 1848 the boundary between Mexico and the United States had been pushed backward to the Rio Grande. In the summer and fall of 1850, U...vast engineering district that stretched from Central Mississippi to the territory of New Mexico . Chapter II THE FORMATIVE YEARS The wind sings

  4. USSR Report, International Affairs

    DTIC Science & Technology

    1986-01-09

    sience fiction nightmare about a future occupation of the United States by Soviet communists. Such movie tricks arouse anti-Soviet sentiments and a...New York. We spoke face to face, on narrow and broad topics. Every such meeting left a deep impression. In this delicate woman , with a light step, an...Indian woman . It was as if she personified all of the best qualities that were characteristic of the women of her country. Nehru laid the basis for

  5. The AMANDA neutrino telescope

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

    Andres, E.C.; Askebjer, P.; Barwick, S.W.

    1999-04-01

    With an effective telescope area of order 10(4) m(2) for TeVneutrinos, a threshold near similar to 50 GeV and a pointing accuracy of2.5 degrees per muon track, the AMANDA detector represents the first of anew generation of high energy neutrino telescopes, reaching a scaleenvisaged over 25 years ago. We describe early results on the calibrationof natural deep ice as a particle detector as well as on AMANDA'sperformance as a neutrino telescope.

  6. Department of Defense DOD Freedom of Information Act Program

    DTIC Science & Technology

    1998-09-01

    Enter year. month. end d",r La .. 19971024, the tee nmwa.payeynit was receive. r,. PKIOFISSIOAL HOURS. For each applIcabl activity Toot Collsotabl Cosas ...through the Federal Register, the National Technical Information Service, or the Internet , normally need not be processed under the provisions of the FOIA...court shall evaluate the case de novo (anew) and may elect to examine any requested record in camera (in private) to determine whether the denial was

  7. Security of Y-00 and Similar Quantum Cryptographic Protocols

    DTIC Science & Technology

    2004-11-16

    security of Y-00 type protocols is clarified. Key words: Quantum cryptography PACS: 03.67.Dd Anew approach to quantum cryptog- raphy called KCQ, ( keyed ...classical- noise key generation [2] or the well known BB84 quantum protocol [3]. A special case called αη (or Y-00 in Japan) has been experimentally in... quantum noise for typical op- erating parameters. It weakens both the data and key security , possibly information-theoretically and cer- tainly

  8. The US Air Force After Vietnam: Postwar Challenges and Potential for Responses

    DTIC Science & Technology

    1988-12-01

    process of assembling the data and bringing them into some preliminary historical order did not automatically constitute learning . Since what one can ...the world, as well as the heterogeneity ofpower . We learned anew that even the very greatest of power centers on earth can never truly monopolize... learn is delimited in some measure by what one already thinks, the Pentagon Papers were in themselves merely a data base; and the judgments and

  9. Achieving Success via Multi-Model Process Improvement

    DTIC Science & Technology

    2007-03-01

    Mellon University page 19 Lean Tactics: Kaizen Events Kaizen - Make people’s jobs easier by taking them apart, studying them, and making improvements...KAI” - take apart and make anew • “ZEN” - think, make good the actions of others, do good deeds and help others Kaizen tips (VAL, M&A, QPM, CAR...business - Requires firm understanding of the “before” state - “Just do it” Projects - Kaizen event with rollout plan • required use of Six Sigma

  10. Knowledge Sharing Mechanism: Enabling C2 to Adapt to Changing Environments

    DTIC Science & Technology

    2007-06-01

    seeking to improve upon it. This refinement is called kaizen , the Japanese word for continuous improvement process. With each PDCA Cycle, we can either be...in a hoshin or a kaizen mode depending on our purpose. Additionally, a successful innovation achieved during a hoshin PDCA Cycle can directly lead to a...new kaizen PDCA Cycle because the innovation has allowed us to improve an existing process or artifact. A kaizen PDCA Cycle, likewise can directly

  11. JPRS Report, Science & Technology, USSR: Computers

    DTIC Science & Technology

    1987-09-28

    history anew, "Battle of 1917" would come to your service. If you wish to control the destinies of nations, play around with the third world war ...engineering world . The time has come to return to this profession the romantic halo that once clearly and suitably shined, but that has now been almost...at bringing all of the computer technology produced in the association up to world standards within this five-year-plan. The creative potential of

  12. When is best-worst best? A comparison of best-worst scaling, numeric estimation, and rating scales for collection of semantic norms.

    PubMed

    Hollis, Geoff; Westbury, Chris

    2018-02-01

    Large-scale semantic norms have become both prevalent and influential in recent psycholinguistic research. However, little attention has been directed towards understanding the methodological best practices of such norm collection efforts. We compared the quality of semantic norms obtained through rating scales, numeric estimation, and a less commonly used judgment format called best-worst scaling. We found that best-worst scaling usually produces norms with higher predictive validities than other response formats, and does so requiring less data to be collected overall. We also found evidence that the various response formats may be producing qualitatively, rather than just quantitatively, different data. This raises the issue of potential response format bias, which has not been addressed by previous efforts to collect semantic norms, likely because of previous reliance on a single type of response format for a single type of semantic judgment. We have made available software for creating best-worst stimuli and scoring best-worst data. We also made available new norms for age of acquisition, valence, arousal, and concreteness collected using best-worst scaling. These norms include entries for 1,040 words, of which 1,034 are also contained in the ANEW norms (Bradley & Lang, Affective norms for English words (ANEW): Instruction manual and affective ratings (pp. 1-45). Technical report C-1, the center for research in psychophysiology, University of Florida, 1999).

  13. Would Tarzan believe in God? Conditions for the emergence of religious belief.

    PubMed

    Banerjee, Konika; Bloom, Paul

    2013-01-01

    Would someone raised without exposure to religious views nonetheless come to believe in the existence of God, an afterlife, and the intentional creation of humans and other animals? Many scholars would answer yes, proposing that universal cognitive biases generate religious ideas anew within each individual mind. Drawing on evidence from developmental psychology, we argue here that the answer is no: children lack spontaneous theistic views and the emergence of religion is crucially dependent on culture. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Challenges and Opportunities for Quantitative Clinical Pharmacology in Cancer Immunotherapy: Something Old, Something New, Something Borrowed, and Something Blue.

    PubMed

    Stroh, M; Carlile, D J; Li, C-C; Wagg, J; Ribba, B; Ramanujan, S; Jin, J; Xu, J; Charoin, J-E; Xhu, Z-X; Morcos, P N; Davis, J D; Phipps, A

    2015-09-01

    Cancer immunotherapy (CIT) initiates or enhances the host immune response against cancer. Following decades of development, patients with previously few therapeutic options may now benefit from CIT. Although the quantitative clinical pharmacology (qCP) of previous classes of anticancer drugs has matured during this time, application to CIT may not be straightforward since CIT acts via the immune system. Here we discuss where qCP approaches might best borrow or start anew for CIT.

  15. Feeling Comfortable: A Humanbecoming Perspective.

    PubMed

    Dobrzykowski, Teresa M

    2017-01-01

    Feeling comfortable is a universal living experience. From the worldview of the humanbecoming paradigm, concept inventing is an appropriate method to expand understanding and knowledge of universal experiences. The purpose of this article is to provide a synthetic definition of feeling comfortable using the concept inventing process. Through concept inventing, a synthetic definition of feeling comfortable emerged as penetrating quietude amid potential upheaval arising with opportunities and restrictions with envisioning the familiar anew. Further development of the concept through qualitative research is recommended.

  16. The Coast Artillery Journal. Volume 62, Number 5, May 1925

    DTIC Science & Technology

    1925-05-01

    and domestic peace in France, and the destruction of the Spanish hegemony of the western world. She was resolute in her refusal of the sovereignty of...the most formidable army. This is the one great central but easily forgotten fact of human history which each age has to discover anew. The hegemony of...has been able to acquire the hegemony of the modern world, because no modern nation has ever succeeded in combining superior land power and superior

  17. Translations on Eastern Europe Political, Sociological, and Military Affairs, Number 1334

    DTIC Science & Technology

    1976-12-16

    drums In liquid form Natural asphalt Marble in blocks Copper wire Soda ash Tannin extract 40,000 tons 10,000 tons 10,000 tons 55,000 tons...Legumes 300 5 Seed grain 300 6 Tobacco and tobacco products 6,200 7 Wine , including bottled wine 2,300 8 Sorghum straw 600 9 Hemp and tow 500 10...procedure be made simple . All this could be achieved only by regulating expropriation anew. Some Important New Provisions Space limitations do not

  18. The Coast Artillery Journal. Volume 63, Number 1, July 1925

    DTIC Science & Technology

    1925-07-01

    he won. (N 0, Gentle Reader, I made no mention of my own winnings; please don’t interrupt). It worked out some- thing like this: Suppose Tommy Jones...erroneous judgment the latter would pay Tommy five (count them) five marbles. 1Vhereupon Tommy would start the game anew by con- cealing another covey of...marbles-and right here is where the brains came in. Tommy would size up his opponent in a fashion roughly as follows: "Bill is what the crossword

  19. Acquisition Program Teamwork and Performance Seen Anew: Exposing the Interplay of Architecture and Behaviors in Complex Defense Programs

    DTIC Science & Technology

    2016-04-30

    fåÑçêãÉÇ=`Ü~åÖÉ= - 194 - Panel 16. Improving Governance of Complex Systems Acquisition Thursday, May 5, 2016 11:15 a.m. – 12:45 p.m. Chair: Rear...Admiral David Gale, USN, Program Executive Officer, SHIPS Complex System Governance for Acquisition Joseph Bradley, President, Leading Change, LLC...Bryan Moser, Lecturer, MIT John Dickmann, Vice President, Sonalysts Inc. A Complex Systems Perspective of Risk Mitigation and Modeling in

  20. New physics with ultra-high-energy neutrinos

    DOE PAGES

    Marfatia, D.; McKay, D. W.; Weiler, T. J.

    2015-07-03

    Now that PeV neutrinos have been discovered by IceCube, we optimistically entertain the possibility that neutrinos with energy above 100PeV exist. Here, we evaluate the dependence of event rates of such neutrinos on the neutrino-nucleon cross section at observatories that detect particles, atmospheric fluorescence, or Cherenkov radiation, initiated by neutrino interactions. We consider how (i)a simple scaling of the total standard model neutrino-nucleon cross section, (ii) a new elastic neutral current interaction, and (iii) anew completely inelastic interaction, individually impact event rates.

  1. Taxonomic and faunistic studies on the genus Harutaeographa (Lepidoptera, Noctuidae, Orthosiini) with description of a new species

    PubMed Central

    Benedek, Balázs; Saldaitis, Aidas; Rimsaite, Jolanta

    2012-01-01

    Abstract Description of anew Harutaeographa Yoshimoto, 1993 species, Harutaeographa shui sp. n. from China’s Sichuan province, is given. Harutaeographa yangzisherpani transformis Hreblay & Ronkay, 1999 is combined as a synonym of Harutaeographa yangzisherpani yangzisherpani Hreblay & Ronkay, 1999. Additional distributional data for Harutaeographa pallida Yoshimoto, 1993, and Harutaeographa cinerea Hreblay & Ronkay, 1998 are provided. A checklist of the genus Harutaeographa and a key to the Harutaeographa fasciculata (Hampson, 1894) species-group, based on external characters and genitalia, are presented. PMID:23378797

  2. Multiple Lookup Table-Based AES Encryption Algorithm Implementation

    NASA Astrophysics Data System (ADS)

    Gong, Jin; Liu, Wenyi; Zhang, Huixin

    Anew AES (Advanced Encryption Standard) encryption algorithm implementation was proposed in this paper. It is based on five lookup tables, which are generated from S-box(the substitution table in AES). The obvious advantages are reducing the code-size, improving the implementation efficiency, and helping new learners to understand the AES encryption algorithm and GF(28) multiplication which are necessary to correctly implement AES[1]. This method can be applied on processors with word length 32 or above, FPGA and others. And correspondingly we can implement it by VHDL, Verilog, VB and other languages.

  3. Separations method for polar molecules

    DOEpatents

    Thoma, Steven G.; Bonhomme, Francois R.

    2004-07-27

    A method for separating at least one compound from a liquid mixture containing different compounds where anew crystalline manganese phosphate composition with the formula Mn.sub.3 (PO.sub.4).sub.4.2(H.sub.3 NCH.sub.2 CH.sub.2).sub.3 N.6(H.sub.2 O) is dispersed in the liquid mixture, selectively intercalating one or more compounds into the crystalline structure of the Mn.sub.3 (PO.sub.4).sub.4.2(H.sub.3 NCH.sub.2 CH.sub.2).sub.3 N.6(H.sub.2 O).

  4. Trivalent inactivated influenza vaccine effective against influenza A(H3N2) variant viruses in children during the 2014/15 season, Japan

    PubMed Central

    Sugaya, Norio; Shinjoh, Masayoshi; Kawakami, Chiharu; Yamaguchi, Yoshio; Yoshida, Makoto; Baba, Hiroaki; Ishikawa, Mayumi; Kono, Mio; Sekiguchi, Shinichiro; Kimiya, Takahisa; Mitamura, Keiko; Fujino, Motoko; Komiyama, Osamu; Yoshida, Naoko; Tsunematsu, Kenichiro; Narabayashi, Atsushi; Nakata, Yuji; Sato, Akihiro; Taguchi, Nobuhiko; Fujita, Hisayo; Toki, Machiko; Myokai, Michiko; Ookawara, Ichiro; Takahashi, Takao

    2016-01-01

    The 2014/15 influenza season in Japan was characterised by predominant influenza A(H3N2) activity; 99% of influenza A viruses detected were A(H3N2). Subclade 3C.2a viruses were the major epidemic A(H3N2) viruses, and were genetically distinct from A/New York/39/2012(H3N2) of 2014/15 vaccine strain in Japan, which was classified as clade 3C.1. We assessed vaccine effectiveness (VE) of inactivated influenza vaccine (IIV) in children aged 6 months to 15 years by test-negative case–control design based on influenza rapid diagnostic test. Between November 2014 and March 2015, a total of 3,752 children were enrolled: 1,633 tested positive for influenza A and 42 for influenza B, and 2,077 tested negative. Adjusted VE was 38% (95% confidence intervals (CI): 28 to 46) against influenza virus infection overall, 37% (95% CI: 27 to 45) against influenza A, and 47% (95% CI: -2 to 73) against influenza B. However, IIV was not statistically significantly effective against influenza A in infants aged 6 to 11 months or adolescents aged 13 to 15 years. VE in preventing hospitalisation for influenza A infection was 55% (95% CI: 42 to 64). Trivalent IIV that included A/New York/39/2012(H3N2) was effective against drifted influenza A(H3N2) virus, although vaccine mismatch resulted in low VE. PMID:27784529

  5. Reassortment and evolution of current human influenza A and B viruses.

    PubMed

    Xu, Xiyan; Lindstrom, Stephen E; Shaw, Michael W; Smith, Catherine B; Hall, Henrietta E; Mungall, Bruce A; Subbarao, Kanta; Cox, Nancy J; Klimov, Alexander

    2004-07-01

    During the 2001-2002 influenza season, human influenza A (H1N2) reassortant viruses were detected globally. The hemagglutinin (HA) of these H1N2 viruses was similar to that of the A/New Caledonia/20/99 (H1N1) vaccine strain both antigenically and genetically, while their neuraminidase (NA) was antigenically and genetically related to that of recent human influenza H3N2 reference viruses such as A/Moscow/10/99. All six internal genes of the H1N2 reassortants originated from an H3N2 virus. After being detected only in eastern Asia during the past 10 years, Influenza B/Victoria/2/87 lineage viruses reappeared in many countries outside of Asia in 2001. Additionally, reassortant influenza B viruses possessing an HA similar to that of B/Shandong/7/97, a recent B/Victoria/2/87 lineage reference strain, and an NA closely related to that of B/Sichuan/379/99, a recent B/Yamagata/16/88 lineage reference strain, were isolated globally and became the predominant influenza B epidemic strain. The current influenza vaccine is expected to provide good protection against H1N2 viruses because it contains A/New Caledonia/20/99 (H1N1) and A/Panama/2007/99 (H3N2) like viruses whose H1 HA or N2 NA are antigenically similar to those of recent circulating H1N2 viruses. On the other hand, widespread circulation of influenza B Victoria lineage viruses required inclusion of a strain from this lineage in influenza vaccines for the 2002-2003 season.

  6. [THE CRITICAL INCIDENTS IN THE COMBINED ANESTHESIA DURING MAJOR ABDOMINAL SURGERY IN ELDERRY AND OLD PATIENTS: ROLE PREOPERATIVE LEVEL OF WAKEFULNESS.

    PubMed

    Veyler, R V; Musaeva, T S; Trembach, N V; Zabolotskikh, I B

    2016-09-01

    to determine patterns during combined anesthesia andfrequency ofcritical incidents, depending on the initial level of wakefulness and patient age. 158 patients of planning operated under combined anesthesia for colon tumors were divided into two groups of elderly patients (n= 79) and old (n= 79). Each group was divided into 3 subgroups, depending on level of wakefulness, the estimatedfor level of direct current potential: low, optimum and high levels ofwakefulness. Relations of age and level ofwakefulness with afrequency of critical incidents. In the number of registered incidents included hemodynamic incidents: hypotension, hypertension, bradycardia, arrhythmia and tachycardia; respiratory incidents: hypoxemia, hypercapnia, the needfor prolonged postoperative mechanical ventilation; metabolic incidents: hypothermia, slow recovery of neuromuscular conduction, slow postoperative awakening has been studied. The most frequent incidents in our study were hemodynamic incidents, which prevailed in the structure of hypotension and hypertension. Among of the respiratory incidents dominated by hypoxia and hypercapnia. In the group of elderly patients the most incidents occurred in the subgroup with low level of wakefulness, while in the oldest patients statistically group significant differences between the groups were not found Conclusion. Frequency of critical incidents does not only depend from the age but also from a preoperative level of wakefulness; frequency was lower in elderly patients with an optimum level of wakefulness, and the low level of wakefulness - was high regardless of age.

  7. [Suicide and euthanasia : Discourse on physician-assisted suicide].

    PubMed

    Lewitzka, Dr U; Bauer, R

    2016-05-01

    Suicidal thoughts and behavior have been a part of human nature since the beginning of mankind. In his autobiographical work From my Life: Poetry and Truth Goethe summarized two important aspects: "Suicide is an event of human nature which, whatever may be said and done with respect to it, demands the sympathy of every man, and in every epoch must be discussed anew". The authors of this article aim to motivate the readership to question and analyze this complex topic and the accompanying multifaceted positions with a summarized presentation of historical aspects and the more recent political developments.

  8. Affective Norms for Italian Words in Older Adults: Age Differences in Ratings of Valence, Arousal and Dominance

    PubMed Central

    Fairfield, Beth; Ambrosini, Ettore; Mammarella, Nicola; Montefinese, Maria

    2017-01-01

    In line with the dimensional theory of emotional space, we developed affective norms for words rated in terms of valence, arousal and dominance in a group of older adults to complete the adaptation of the Affective Norms for English Words (ANEW) for Italian and to aid research on aging. Here, as in the original Italian ANEW database, participants evaluated valence, arousal, and dominance by means of the Self-Assessment Manikin (SAM) in a paper-and-pencil procedure. We observed high split-half reliabilities within the older sample and high correlations with the affective ratings of previous research, especially for valence, suggesting that there is large agreement among older adults within and across-languages. More importantly, we found high correlations between younger and older adults, showing that our data are generalizable across different ages. However, despite this across-ages accord, we obtained age-related differences on three affective dimensions for a great number of words. In particular, older adults rated as more arousing and more unpleasant a number of words that younger adults rated as moderately unpleasant and arousing in our previous affective norms. Moreover, older participants rated negative stimuli as more arousing and positive stimuli as less arousing than younger participants, thus leading to a less-curved distribution of ratings in the valence by arousal space. We also found more extreme ratings for older adults for the relationship between dominance and arousal: older adults gave lower dominance and higher arousal ratings for words rated by younger adults with middle dominance and arousal values. Together, these results suggest that our affective norms are reliable and can be confidently used to select words matched for the affective dimensions of valence, arousal and dominance across younger and older participants for future research in aging. PMID:28046070

  9. Kapteyn series arising in radiation problems

    NASA Astrophysics Data System (ADS)

    Lerche, I.; Tautz, R. C.

    2008-01-01

    In discussing radiation from multiple point charges or magnetic dipoles, moving in circles or ellipses, a variety of Kapteyn series of the second kind arises. Some of the series have been known in closed form for a hundred years or more, others appear not to be available to analytic persuasion. This paper shows how 12 such generic series can be developed to produce either closed analytic expressions or integrals that are not analytically tractable. In addition, the method presented here may be of benefit when one has other Kapteyn series of the second kind to consider, thereby providing an additional reason to consider such series anew.

  10. [Contents of ten trace elements in Epimedium acuminatum Franch. and its different processed products].

    PubMed

    Chen, H L; Wang, J K; Ren, Y Q; Wu, Z Y

    2001-03-01

    Determine and compare the contents of ten trace elements in crude E. acuminatum and its three different processed products. Using flame atomic absorption spectrometry. The ten trace elements were found in both the crude drug and its three processed products, and in terms of contents some of the trace elements in all the three processed products are higher than those in the crude drug. According to the trace element contents, the three processed products of E. acuminatum have their own advantages. It is thus suggested that thoroughgoing clinical and experimental researches be performed anew for the long-shelved processing methods.

  11. A complex journey: transmission of microbial symbionts

    PubMed Central

    Bright, Monika; Bulgheresi, Silvia

    2010-01-01

    The perpetuation of symbioses through host generations relies on symbiont transmission. Horizontally transmitted symbionts are taken up from the environment anew by each host generation, and vertically transmitted symbionts are most often transferred through the female germ line. Mixed modes also exist. In this Review we describe the journey of symbionts from the initial contact to their final residence. We provide an overview of the molecular mechanisms that mediate symbiont attraction and accumulation, interpartner recognition and selection, as well as symbiont confrontation with the host immune system. We also discuss how the two main transmission modes shape the evolution of the symbiotic partners. PMID:20157340

  12. Engineering Genetically Encoded FRET Sensors

    PubMed Central

    Lindenburg, Laurens; Merkx, Maarten

    2014-01-01

    Förster Resonance Energy Transfer (FRET) between two fluorescent proteins can be exploited to create fully genetically encoded and thus subcellularly targetable sensors. FRET sensors report changes in energy transfer between a donor and an acceptor fluorescent protein that occur when an attached sensor domain undergoes a change in conformation in response to ligand binding. The design of sensitive FRET sensors remains challenging as there are few generally applicable design rules and each sensor must be optimized anew. In this review we discuss various strategies that address this shortcoming, including rational design approaches that exploit self-associating fluorescent domains and the directed evolution of FRET sensors using high-throughput screening. PMID:24991940

  13. What can volunteer angler tagging data tell us about the status of the Giant Trevally (ulua aukea) Caranx ignobilis fishery in Hawaii: revisiting data collected during Hawaii’s Ulua and Papio Tagging Project 2000-2016

    USGS Publications Warehouse

    Grabowski, Timothy B.; Franklin, Erik C.

    2017-01-01

    Giant Trevally (ulua aukea) Caranx ignobilis is one of the most highly prized and frequentlytargeted nearshore species. However, there is very little information on its current status inHawaiian waters. This study uses mark-recapture data collected as part of recreational anglertagging program conducted by the Hawaii Department of Land and Natural Resources-Divisionof Aquatic Resources during 2000-2012. Mark-recapture data were used to estimate vonBertalanffy growth curve parameters and survivorship. Growth curves generated from the markrecapturedata suggested that Giant Trevally from the main Hawaiian Islands may be growingfaster and reach a smaller maximum size than individuals in the Northwest Hawaiian Islands, butthere are a number of issues rendering this conclusion uncertain. The survivorship of GiantTrevally was positively associated with age, in part due to ontogenetic habitat shifts that result inolder fish moving to offshore habitats where they are less vulnerable to anglers. When comparedto stock assessments performed using commercial landings data and fisheries-independent visualsurveys, the mark-recapture data produced similar estimates for the average length of exploitedfish, a metric highly negatively correlated to fishing mortality. These results emphasize the needfor additional information on the biology of Giant Trevally in Hawaiian waters and suggest thatthe data collected from this recreational angler tagging program may be useful to generatereliable estimates of mortality for stock assessment purposes.

  14. Seismic evaluation of vulnerability for SAMA educational buildings in Tehran

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

    Amini, Omid Nassiri; Amiri, Javad Vaseghi

    2008-07-08

    Earthquake is a destructive phenomenon that trembles different parts of the earth yearly and causes many destructions. Iran is one of the (high seismicity) quack- prone parts of the world that has received a lot of pecuniary damages and life losses each year, schools are of the most important places to be protected during such crisis.There was no special surveillance on designing and building of school's building in Tehran till the late 70's, and as Tehran is on faults, instability of such buildings may cause irrecoverable pecuniary damages and especially life losses, therefore preventing this phenomenon is in an urgentmore » need.For this purpose, some of the schools built during 67-78 mostly with Steel braced frame structures have been selected, first, by evaluating the selected Samples, gathering information and Visual Survey, the prepared questionnaires were filled out. With the use of ARIA and SABA (Venezuela) Methods, new modified combined method for qualified evaluations was found and used.Then, for quantified evaluation, with the use of computer 3D models and nonlinear statically analysis methods, a number of selected buildings of qualified evaluation, were reevaluated and finally with nonlinear dynamic analysis method the real behavior of structures on the earthquakes is studied.The results of qualified and quantified evaluations were compared and a proper Pattern for seismic evaluation of Educational buildings was presented. Otherwise the results can be a guidance for the person in charge of retrofitting or if necessary rebuilding the schools.« less

  15. The design of an irradiator for the continuous processing of liquid latex

    NASA Astrophysics Data System (ADS)

    Reuter, O.; Langley, R.; Zn, Wan Manshol Bin W.

    1998-06-01

    This paper presents anew design concept for a gamma irradiation plant for the continuous processing of pumpable liquids. Typical applications of such a plant include ∗ the irradiation vulcanisation of natural latex rubber ∗ disinfection of municipal sewage sludge for agricultural use ∗ sterilisation of liquids in the pharmaceutical and cosmetics industries ∗ industrial processing of bulk liquids The authors describe the design and operation of the latex irradiator now operating on a small production scale in Malaysia and proposed developments. The design allows irradiation processing to be carried out under an inert or other gaseous environment. State-of-the-art computer control system ensures the fully automatic processing operation needed by industrial computers.

  16. The blossoms of loss: Ovid's floral metamorphoses and Poussin's realm of flora.

    PubMed

    Tutter, Adele

    2014-07-01

    Alluring and fertile, the flower connotes a locus of desire. The floral metamorphic myths narrated in Ovid's Metamorphoses (AD 8a) thematize the price of desire--the shame, grief, and rage of rejection and rivalrous defeat--and symbolize the generative transformation that frustrated desire and competitive loss can promote. In the deceptively beautiful painting Realm of Flora of 1631, Nicolas Poussin enlists these myths as allegories of his own great creative leap, an aesthetic metamorphosis that followed shattering defeats. Extending the association between creativity and object loss to competitive loss, Poussin holds a mirror to our powerful drive to prevail and create anew from the ashes of loss. © 2014 The Psychoanalytic Quarterly, Inc.

  17. [The mobile: a new addiction upon adolescents].

    PubMed

    Halayem, Soumeya; Nouira, Ons; Bourgou, Soumaya; Bouden, Asma; Othman, Sami; Halayem, Mohamed

    2010-08-01

    This survey was conducted to investigate mobile phone use and dependence in Tunisian high school students. Questionnaires were anonymously distributed to 120 adolescents looking for the modalities of use of mobiles. SMS dependency was assessed with the French version of the Igarashi scale. The two most used means for communication were SMS and missing calls. 83.2% of the sample sent more than 6 missing calls per day. According to the Igarashi scale, adolescents reported perception of excessive use in 31. Seven percent of cases, emotional reaction in 33.4% of cases and exclusive relationship maintenance thanks to mobile in 18% of cases. This study demonstrated a anew addictgion to mobile phone among tunisian high school students.

  18. How urgent is urgent? Analysing urgent out-patient referrals to an adult psychiatric service.

    PubMed

    Cubbin, S; Llewellyn-Jones, S; Donnelly, P

    2000-01-01

    It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an ¤ urgent' referral. The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. ( Int J Psych Clin Pract 2000; 4: 233 - 235).

  19. Economic Evaluation of Urgent-Start Peritoneal Dialysis Versus Urgent-Start Hemodialysis in the United States

    PubMed Central

    Liu, Frank Xiaoqing; Ghaffari, Arshia; Dhatt, Harman; Kumar, Vijay; Balsera, Cristina; Wallace, Eric; Khairullah, Quresh; Lesher, Beth; Gao, Xin; Henderson, Heather; LaFleur, Paula; Delgado, Edna M.; Alvarez, Melissa M.; Hartley, Janett; McClernon, Marilyn; Walton, Surrey; Guest, Steven

    2014-01-01

    Abstract Patients presenting late in the course of kidney disease who require urgent initiation of dialysis have traditionally received temporary vascular catheters followed by hemodialysis. Recent changes in Medicare payment policy for dialysis in the USA incentivized the use of peritoneal dialysis (PD). Consequently, the use of more expeditious PD for late-presenting patients (urgent-start PD) has received new attention. Urgent-start PD has been shown to be safe and effective, and offers a mechanism for increasing PD utilization. However, there has been no assessment of the dialysis-related costs over the first 90 days of care. The objective of this study was to characterize the costs associated with urgent-start PD, urgent-start hemodialysis (HD), or a dual approach (urgent-start HD followed by urgent-start PD) over the first 90 days of treatment from a provider perspective. A survey of practitioners from 5 clinics known to use urgent-start PD was conducted to provide inputs for a cost model representing typical patients. Model inputs were obtained from the survey, literature review, and available cost data. Sensitivity analyses were also conducted. The estimated per patient cost over the first 90 days for urgent-start PD was $16,398. Dialysis access represented 15% of total costs, dialysis services 48%, and initial hospitalization 37%. For urgent-start HD, total per patient costs were $19,352, and dialysis access accounted for 27%, dialysis services 42%, and initial hospitalization 31%. The estimated cost for dual patients was $19,400. Urgent-start PD may offer a cost saving approach for the initiation of dialysis in eligible patients requiring an urgent-start to dialysis. PMID:25526471

  20. Informed consent in direct-to-consumer personal genome testing: the outline of a model between specific and generic consent.

    PubMed

    Bunnik, Eline M; Janssens, A Cecile J W; Schermer, Maartje H N

    2014-09-01

    Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we argue that current practices of information provision are insufficient and that there is a place--and a need--for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. © 2012 John Wiley & Sons Ltd.

  1. Anatomy of an upgraded pulverized coal facility: Combustion modification through flue gas scrubbing

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

    Watts, J.U.; Savichky, W.J.; O`Dea, D.T.

    1997-12-31

    Regeneration is a biological term for formation or creating anew. In the case of Milliken station, a species of steam generation (Tangentus coali) regeneration refers to refitting critical systems with the latest technological advances to reduce emissions while maintaining or improving performance. The plant has undergone a series of operations which provided anatomical changes as well as a face lift. Each of the two units were place in suspended animation (outage) to allow these changes to be made. The paper describes the project which includes retrofitting combustion systems, pulverizers, boiler liners, scrubbers, and control room. This retrofit is meant tomore » increase thermal efficiency while reducing the formation of nitrogen oxides.« less

  2. Technical concept of the UK Tornado stand-off reconnaissance system

    NASA Astrophysics Data System (ADS)

    Dyer, Gavin R.

    1996-11-01

    The operational limitations exposed during the Gulf War have led to the formulation of a requirement for anew generation of tactical reconnaissance pod for the Royal Air Force Tornado aircraft. The pod will contain a high resolution Electro-Optical sensor capable of day and night-time operations, digital recording of the imagery for airborne replay and ground exploitation, and a data-link for real time/near real time imagery transmission. The program requirement includes a deployable ground exploitation system to provide a comprehensive independent capability. The interoperability of the air and ground segments with other systems is addressed through NATO standardization agreements. This system will provide the Tornado with a highly flexible stand-off imaging system for day/night operations from a range of altitudes.

  3. The transition from animal spirits to animal electricity: a neuroscience paradigm shift.

    PubMed

    Clower, W T

    1998-12-01

    The Animal Spirits Paradigm had been in place for over a thousand years as a general way of looking at the nervous system, and was completely ingrained into the fabric of scientific thinking. However, the community of researchers in the 17th and 18th centuries abandoned their long-held assumptions, and started anew with the novel assertion that the currency of nervous function was, instead of Animal Spirits, a uniquely amimal electricity. This conceptual rearrangement represented a scientific revolution in thinking, a change in absolute perspective that required the reinterpretation of old data within a completely novel framework. The manner in which this transition occurred followed the general form of scientific paradigm shifts as outlined by Thomas Kuhn (Kuhn, 1962)

  4. Grain reconstruction of porous media: application to a low-porosity Fontainebleau sandstone.

    PubMed

    Thovert, J F; Yousefian, F; Spanne, P; Jacquin, C G; Adler, P M

    2001-06-01

    The fundamental issue of reconstructing a porous medium is examined anew in this paper, thanks to a sample of low-porosity Fontainebleau sandstone that has been analyzed by computed microtomography. Various geometric properties are determined on the experimental sample. A statistical property, namely, the probability density of the covering radius, is determined. This is used in order to reconstruct a porous medium by means of a Poissonian generation of polydisperse spheres. In a second part, the properties of the real experimental sample and of the reconstructed one are compared. The most important success of the present reconstruction technique is the fact that the numerical sample percolates despite its low porosity. Moreover, other geometrical features and conductivity are found to be in good agreement.

  5. 76 FR 80907 - TRICARE Prime Urgent Care Demonstration Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-27

    ... DEPARTMENT OF DEFENSE Office of the Secretary TRICARE Prime Urgent Care Demonstration Project....S. Code, section 1092, entitled Department Of Defense TRICARE Prime Urgent Care Demonstration Project. The demonstration project is intended to test whether allowing four visits to an urgent care...

  6. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care.

    PubMed

    Yadav, Geeta; Goldberg, Hanna R; Barense, Morgan D; Bell, Chaim M

    2016-01-01

    Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4-3.4), followed by Urgent care (9.0 weeks; IQR = 2.1-12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4-16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care.

  7. A Single Camera Motion Capture System for Human-Computer Interaction

    NASA Astrophysics Data System (ADS)

    Okada, Ryuzo; Stenger, Björn

    This paper presents a method for markerless human motion capture using a single camera. It uses tree-based filtering to efficiently propagate a probability distribution over poses of a 3D body model. The pose vectors and associated shapes are arranged in a tree, which is constructed by hierarchical pairwise clustering, in order to efficiently evaluate the likelihood in each frame. Anew likelihood function based on silhouette matching is proposed that improves the pose estimation of thinner body parts, i. e. the limbs. The dynamic model takes self-occlusion into account by increasing the variance of occluded body-parts, thus allowing for recovery when the body part reappears. We present two applications of our method that work in real-time on a Cell Broadband Engine™: a computer game and a virtual clothing application.

  8. Corporate Resources

    NASA Astrophysics Data System (ADS)

    Zak, Dennis

    Learning is a lifelong journey. Despite the fact that you've just finished 4-8 years of college, your learning is just beginning anew with the first day of your new job. During the interview process, students invariably ask prospective employers about opportunities to continue learning in their new roles as employees. Students receive as many varied answers as they have interviews. New hires will soon understand that the main purpose of most food-related enterprises is to make a profit from the goods or services the company manufacture and/or sell. The enterprise is not in the business to specifically train or educate students. Education of students is left to the many high-quality colleges and universities across the country. Having said that, there are many opportunities to continue learning while being employed by the food industry.

  9. BACK TO THE ORIGINS OF THE REPUDIATION OF WUNDT: OSWALD KÜLPE AND RICHARD AVENARIUS.

    PubMed

    Russo Krauss, Chiara

    2017-01-01

    This essay provides a fresh account of the break between Oswald Külpe and his master Wilhelm Wundt. Kurt Danziger's reconstruction of the "repudiation" of Wundt, which has become the canon for this significant episode of history of psychology, focused on the supposed influence of Ernst Mach on this set of events, overshadowing the other exponent of Empiriocriticism: Richard Avenarius. Analyzing archival documents and examining anew the primary sources, the paper shows that Avenarius was himself a member of Wundt's circle, and that his "repudiation" of the master paved the way for Külpe. The essay points out the original anti-Wundtian aspects of Avenarius' notion of psychology, thus showing how they were then adopted by Külpe. © 2016 Wiley Periodicals, Inc.

  10. [Review of theories on the foundations of the incest taboo].

    PubMed

    Salem, G

    1980-04-01

    Mainly because of its universality the incest taboo has been a field of investigation open to a number of disciplines. The author reviews the most important theories concerning the bases of this taboo, arranged according to the point of view, finalist or determinist. He then considers the anew in the light of recent acquisitions stemming from ethology and family theory. It has been demonstrated that an instinctive barrier against incest exists in the family life of wild animals, bringing into play defence mechanisms analogous to those that obtain in the human family. Developing the subject, the author shows on the one hand how this discovery calls in question certain postulates hitherto regarded as definitive, and on the other hand how it opens the way to a more synthetic view of the problem.

  11. A Cross-Sectional Survey of Population-Wide Wait Times for Patients Seeking Medical vs. Cosmetic Dermatologic Care

    PubMed Central

    Yadav, Geeta; Goldberg, Hanna R.; Barense, Morgan D.; Bell, Chaim M.

    2016-01-01

    Background Though previous work has examined some aspects of the dermatology workforce shortage and access to dermatologic care, little research has addressed the effect of rising interest in cosmetic procedures on access to medical dermatologic care. Our objective was to determine the wait times for Urgent and Non-Urgent medical dermatologic care and Cosmetic dermatology services at a population level and to examine whether wait times for medical care are affected by offering cosmetic services. Methods A population-wide survey of dermatology practices using simulated calls asking for the earliest appointment for a Non-Urgent, Urgent and Cosmetic service. Results Response rates were greater than 89% for all types of care. Wait times across all types of care were significantly different from each other (all P < 0.05). Cosmetic care was associated with the shortest wait times (3.0 weeks; Interquartile Range (IQR) = 0.4–3.4), followed by Urgent care (9.0 weeks; IQR = 2.1–12.9), then Non-Urgent Care (12.7 weeks; IQR = 4.4–16.4). Wait times for practices offering only Urgent care were not different from practices offering both Urgent and Cosmetic care (10.3 vs. 7.0 weeks). Interpretation Longer wait times and greater variation for Urgent and Non-Urgent dermatologic care and shorter wait times and less variation for Cosmetic care. Wait times were significantly longer in regions with lower dermatologist density. Provision of Cosmetic services did not increase wait times for Urgent care. These findings suggest an overall dermatology workforce shortage and a need for a more streamlined referral system for dermatologic care. PMID:27632206

  12. How we do it: analysing GP referral priorities: the unforeseen effect of 'Choose and Book'.

    PubMed

    Pothier, D D; Repanos, C; Awad, Z

    2006-08-01

    The introduction of Choose and Book may have a significant effect on the proportion of urgent referrals seen by ENT surgeons. Much of the responsibility for prioritisation will be transferred to the GP. Patients who are considered urgent by the ENT surgeon will be added to those considered urgent by the GP. Our results show that there was little agreement between GPs and ENT surgeon on what constitutes an urgent referral. The combined effect of joint prioritisation and the removal of the 'soon' category resulted in a 270% increase in 'urgent' referrals in our sample. This potentially unforeseen consequence of the Choose and Book system should be taken into consideration by ENT departments to allow for an expansion of the 'urgent' category.

  13. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    PubMed Central

    2009-01-01

    Background This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care. PMID:19968871

  14. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program.

    PubMed

    Chiou, Shang-Jyh; Campbell, Claudia; Horswell, Ronald; Myers, Leann; Culbertson, Richard

    2009-12-07

    This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

  15. Subliminal psychodynamic activation: methodological problems and questions in Silverman's experiments.

    PubMed

    Fudin, R

    1999-08-01

    Analyses of procedures in Lloyd H. Silverman's subliminal psychodynamic activation experiments identify problems and questions. Given the information provided, none of his experiments can be replicated, and none of his positive results were found under luminance conditions he reckoned in 1983 were typical of such outcomes. Furthermore, there is no evidence in any of his experiments that all stimuli were presented completely within the fovea, a condition critical to the production of positive findings (Silverman & Geisler, 1986). These considerations and the fact that no experiment using Silverman's procedures can yield unambiguous positive results (Fudin, 1986) underscore the need to start anew research in this area. Such research should be undertaken with a greater appreciation of methodological issues involved in exposing and encoding subliminal stimuli than that found in all but a few experiments on subliminal psychodynamic activation.

  16. [Priesthood and pharmacy in France after the French Revolution].

    PubMed

    Bonnemain, Bruno

    2005-01-01

    Contrary to Tournier's assertion (thesis of 1938), the law of germinal (the seventh month of the eleventh year of the French Republican Calendar) had not been respected by the regular/secular priesthood because it was so ambiguous that they could seize the opportunity to carry on practising the art of medicine or manufacturing and selling drugs. In fact there were three reasons for the lack of steadiness of authorities: the practice of charity, financial concerns and the rise of the science which incited to illegal practice of pharmacy although professionals protested against. On the other hand, the priesthood officials tardily took the decision of forbidding the practice of medicine, surgery and pharmacy until 1936 when it was anew forbidden after a meeting of French cardinals and bishops. In 1941, with the agreement of all concerned persons the problem came to its end.

  17. [Shared decision-making and communication theory: grounding the tango].

    PubMed

    Kasper, Jürgen; Légaré, France; Scheibler, Fülöp; Geiger, Friedemann

    2010-01-01

    Shared decision-making (SDM) has the potential to overcome outdated social role models in the health care system. The concept, however, adheres to archaic epistemological assumptions as can be inferred from the rudimentary stage of the measurement methods used and from the information monopoly that the physician still holds in this concept. Advantages of an up-to-date model of knowledge for understanding and operationalising SDM are outlined. To this purpose, essential definitions of the concept are reflected in terms of epistemology. Accordingly, information emerges through a process of social construction. Likewise, interpersonal relations do not represent a static condition; rather, they develop anew with each interaction. Therefore, constructs suitable to focus on dyadic interaction processes can be used as indicators of sharing in SDM. Theories and methods of the interpersonal paradigm are advocated. Copyright © 2010. Published by Elsevier GmbH.

  18. Branching Search

    NASA Astrophysics Data System (ADS)

    Eliazar, Iddo

    2017-12-01

    Search processes play key roles in various scientific fields. A widespread and effective search-process scheme, which we term Restart Search, is based on the following restart algorithm: i) set a timer and initiate a search task; ii) if the task was completed before the timer expired, then stop; iii) if the timer expired before the task was completed, then go back to the first step and restart the search process anew. In this paper a branching feature is added to the restart algorithm: at every transition from the algorithm's third step to its first step branching takes place, thus multiplying the search effort. This branching feature yields a search-process scheme which we term Branching Search. The running time of Branching Search is analyzed, closed-form results are established, and these results are compared to the coresponding running-time results of Restart Search.

  19. Risks associated with managing asthma without a preventer: urgent healthcare, poor asthma control and over-the-counter reliever use in a cross-sectional population survey.

    PubMed

    Reddel, Helen K; Ampon, Rosario D; Sawyer, Susan M; Peters, Matthew J

    2017-09-25

    Overuse of asthma relievers, particularly without anti-inflammatory preventers, increases asthma risks. This study aimed to identify how many reliever-only users have urgent healthcare, explore their attitudes and beliefs about asthma and its treatment, and investigate whether purchasing over-the-counter relievers was associated with worse asthma outcomes than by prescription. Cross-sectional population-based Internet survey in Australia. Of 2686 participants ≥16 years with current asthma randomly drawn from a web-based panel, 1038 (50.7% male) used only reliever medication. Urgent asthma-related healthcare; Asthma Control Test (ACT); patient attitudes about asthma and medications; reliever purchase (with/without prescription). Of 1038 reliever-only participants, 23.3% had required urgent healthcare for asthma in the previous year, and only 36.0% had a non-urgent asthma review. Those needing urgent healthcare were more likely than those without such events to be male (56.5% vs 49.0%, p=0.003) and current smokers (29.4% vs 23.3%, p=0.009). Only 30.6% had well-controlled asthma (ACT ≥20) compared with 71.0% of those with no urgent healthcare (p<0.0001), and 20.8% used relievers regularly to prevent asthma symptoms (vs 5.5% of those without urgent healthcare). Those with urgent healthcare were more frustrated by their asthma and less happy with how they managed it, and they were less confident about their ability to manage worsening asthma, but just as likely as those without urgent healthcare to manage worsening asthma themselves rather than visit a doctor. Reliever-only users purchasing over-the-counter relievers were no more likely than those purchasing relievers by prescription to have uncontrolled asthma (35.9% vs 40.6%, p=0.23) but were less likely to have had a non-urgent asthma review. One-quarter of the reliever-only population had needed urgent asthma healthcare in the previous year, demonstrating the importance of identifying such patients. Their attitudes and beliefs suggest opportunities for targeting this population in the community. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  20. Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

    PubMed

    Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

    2016-05-01

    This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

  1. Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases.

    PubMed

    Kubat, Eric; Hansen, Nathan; Nguyen, Huy; Wren, Sherry M; Eisenberg, Dan

    2016-03-01

    The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery. We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve. One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations. Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.

  2. [Video-assisted thoracoscopic surgery as an alternative to urgent thoracotomy following open chest trauma in selected cases].

    PubMed

    Samiatina, Diana; Rubikas, Romaldas

    2004-01-01

    To prove that video-assisted thoracoscopic surgery in selected cases is an alternative to urgent thoracotomy following open chest trauma. Retrospective analysis of case reports of patients operated for open chest trauma during 1997-2002. Comparison of two methods of surgical treatment: urgent video-assisted thoracoscopy and urgent thoracotomy. Duration of drain presence in the pleural cavity, duration of postoperative treatment, pain intensity and cosmetic effect were evaluated. Data analysis was performed using SPSS statistical software. Statistical evaluation of differences between groups was performed using Mann-Whitney U test. The differences between groups were considered to be statistically significant when the probability of deviation was p<0.05. During 1997-2002, 121 patients with open chest trauma were operated. Thirty three patients underwent urgent video-assisted thoracoscopy, 88 patients were operated through thoracotomy incision: 69 due to isolated open chest trauma, 17 due to thoracoabdominal injury and 2 due to abdominothoracic injury. Almost thirteen percent (12.5%) of patients after urgent thoracotomy underwent urgent laparotomy due to damaged diaphragm and other organs of peritoneal cavity. Duration of drain presence in the pleural cavity after video-assisted thoracoscopy was 4.57 days and after urgent thoracotomy - 6.88 days (p<0.05). Duration of post-operative treatment after video-assisted thoracoscopy was 8.21 days and after urgent thoracotomy - 14.89 days (p<0.05). Amount of consumed non-narcotic analgesics after video-assisted thoracoscopy was 1056.98 mg and after urgent thoracotomy - 1966.70 mg (p<0.05). Video-assisted thoracoscopy is minimally invasive method of thoracic surgery allowing for the evaluation of the pathological changes in the lung, pericardium, diaphragm, mediastinum, thoracic wall and pleura, including the localization of these changes, and the type and severity of the injury. The number of early post-operative complications following video-assisted thoracoscopy is lower. Compared to operations through thoracotomy incision, video assisted thoracoscopies entail the shortening of the duration of drain presence in the pleural cavity and the duration of post-operative treatment. Video-assisted thoracoscopy should be performed on all patients with open chest trauma and stable hemodynamics and the respiration function. Video-assisted thoracoscopy is an informative diagnostic and treatment method allowing for the selection of patients for urgent thoracotomy.

  3. History of phototherapy in dermatology.

    PubMed

    Hönigsmann, Herbert

    2013-01-01

    Over many centuries, treatment with sunlight or "heliotherapy" was used in the treatment of skin diseases. More than 3500 years ago, ancient Egyptian and Indian healers used the ingestion of plant extracts or seeds in addition to sunlight for treating "leucoderma". Modern phototherapy began with Nobel Prize winner Niels Finsen who developed a "chemical rays" lamp with which he treated patients with skin tuberculosis. However, it took several decades until phototherapy was introduced anew into the dermatological armamentarium. It was the development of photochemotherapy (PUVA) in 1974 that marked the beginning of a huge upsurge in photodermatology. The subsequent development of high intensity UV sources with defined spectra facilitated an optimized therapy for psoriasis and led to an expansion of indications for photo(chemo)therapy also in combination with topical and systemic agents. The introduction of extracorporeal photopheresis in 1987 for cutaneous T-cell lymphoma and of topical photodynamic therapy widely expanded the therapeutic possibilities in dermato-oncology.

  4. Skin friction and heat transfer correlations for high-speed low-density flow past a flat plate

    NASA Technical Reports Server (NTRS)

    Woronowicz, Michael S.; Baganoff, Donald

    1991-01-01

    The independent and dependent variables associated with drag and heat transfer to a flat plate at zero incidence in high-speed, rarefied flow are analyzed anew to reflect the importance of kinetic effects occurring near the plate surface on energy and momentum transfer, rather than following arguments normally used to describe continuum, higher density flowfields. A new parameter, the wall Knudsen number Knx,w, based on an estimate of the mean free path length of molecules having just interacted with the surface of the plate, is introduced and used to correlate published drag and heat transfer data. The new parameter is shown to provide better correlation than either the viscous interaction parameter X or the widely-used slip parameter Voo for drag and heat transfer data over a wide range of Mach numbers, Reynolds numbers, and plate-to-freestream stagnation temperature ratios.

  5. Lydgate's Danse Macabre and the Trauma of the Hundred Years War.

    PubMed

    Perry, R D

    2015-01-01

    This essay argues that the foundational traumatic lacuna behind John Lydgate's Danse Macabre is the social agon between those who wage the Hundred Years War and those who fight in it. Drawing from the insights of trauma theory to discuss the poem's form, the essay uncovers Lydgate's persistent concern with the damage caused by the war and the concomitant political unrest it causes. It argues further that Lydgate theorized this agon using the emergent genre of tragedy, which is beginning to be practiced anew in late-medieval England. Tragic discourse is riven by concerns about the efficacy of human action and the radical contingency of fortune, creating a crisis of agency that can be used as a form of political critique. Ultimately, Lydgate blends the genre of tragedy with the mirror for princes and estates satire genres to argue that, while everyone must eventually dance with death, during war some estates lead the dance.

  6. Lydgate's Danse Macabre and the Trauma of the Hundred Years War.

    PubMed

    Perry, R D

    2015-01-01

    This essay argues that the foundational traumatic lacuna behind John Lydgate's Danse Macabre is the social agon between those who wage the Hundred Years War and those who fight in it. Drawing from the insights of trauma theory to discuss the poem's form, the essay uncovers Lydgate's persistent concern with the damage caused by the war and the concomitant political unrest it causes. It argues further that Lydgate theorized this agon using the emergent genre of tragedy, which is beginning to be practiced anew in late-medieval England. Tragic discourse is riven by concerns about the efficacy of human action and the radical contingency of fortune, creating a crisis of agency that can be used as a form of political critique. Ultimately, Lydgate blends the genre of tragedy with the mirror for princes and estates satire genres to argue that, while everyone must eventually dance with death, during war some estates lead the dance.

  7. The RWJ Executive Nurse Fellows Program, Part 2: Mentoring for leadership success.

    PubMed

    Bellack, Janis P; Morjikian, Robin L

    2005-12-01

    This article is the second in a 3-part series describing the RWJ Executive Nurse Fellows Program, an advanced leadership program for nurses in senior executive roles who aspire to help lead and shape the US healthcare system of the future. Part 1 (October 2005) described the program, its core leadership competencies, and the primary components. This article discusses the mentor experience that is a cornerstone of the 3-year fellowship program. Fellows are encouraged to have this experience with senior-level executives outside of healthcare in order to broaden their leadership perspectives. Examples of these mentor experiences are described from the viewpoints of both fellows and mentors, including successes, challenges, and lessons learned. Part 3 (February 2006) will explain how fellows are required to create a business plan for their leadership project because it is so important for nurse leaders to offer a strong business case for proceeding with anew initiative, service, or program.

  8. Optimizing Interactive Development of Data-Intensive Applications

    PubMed Central

    Interlandi, Matteo; Tetali, Sai Deep; Gulzar, Muhammad Ali; Noor, Joseph; Condie, Tyson; Kim, Miryung; Millstein, Todd

    2017-01-01

    Modern Data-Intensive Scalable Computing (DISC) systems are designed to process data through batch jobs that execute programs (e.g., queries) compiled from a high-level language. These programs are often developed interactively by posing ad-hoc queries over the base data until a desired result is generated. We observe that there can be significant overlap in the structure of these queries used to derive the final program. Yet, each successive execution of a slightly modified query is performed anew, which can significantly increase the development cycle. Vega is an Apache Spark framework that we have implemented for optimizing a series of similar Spark programs, likely originating from a development or exploratory data analysis session. Spark developers (e.g., data scientists) can leverage Vega to significantly reduce the amount of time it takes to re-execute a modified Spark program, reducing the overall time to market for their Big Data applications. PMID:28405637

  9. Solar Thermal Energy Storage Device: Hybrid Nanostructures for High-Energy-Density Solar Thermal Fuels

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

    None

    2012-01-09

    HEATS Project: MIT is developing a thermal energy storage device that captures energy from the sun; this energy can be stored and released at a later time when it is needed most. Within the device, the absorption of sunlight causes the solar thermal fuel’s photoactive molecules to change shape, which allows energy to be stored within their chemical bonds. A trigger is applied to release the stored energy as heat, where it can be converted into electricity or used directly as heat. The molecules would then revert to their original shape, and can be recharged using sunlight to begin themore » process anew. MIT’s technology would be 100% renewable, rechargeable like a battery, and emissions-free. Devices using these solar thermal fuels—called Hybrisol—can also be used without a grid infrastructure for applications such as de-icing, heating, cooking, and water purification.« less

  10. Role of electric fields in the MHD evolution of the kink instability

    DOE PAGES

    Lapenta, Giovanni; Skender, Marina

    2017-02-17

    Here, the discovery of electrostatic fields playing a crucial role in establishing plasma motion in the flux conversion and dynamo processes in reversed field pinches is revisited. In order to further elucidate the role of the electrostatic fields, a flux rope configuration susceptible to the kink instability is numerically studied with anMHDcode. Simulated nonlinear evolution of the kink instability is found to confirm the crucial role of the electrostatic fields. Anew insight is gained on the special function of the electrostatic fields: they lead the plasma towards the reconnection site at the mode resonant surface. Without this step the plasmamore » column could not relax to its nonlinear state, since no other agent is present to perform this role. While the inductive field generated directly by the kink instability is the dominant flow driver, the electrostatic field is found to allow the motion in the vicinity of the reconnection region.« less

  11. Research Ethics 2.0: New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources

    PubMed Central

    Brall, Caroline; Maeckelberghe, Els; Porz, Rouven; Makhoul, Jihad; Schröder-Bäck, Peter

    2017-01-01

    Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper, we will highlight the current challenges thereof to scientific integrity. To mark key developments in research ethics, we will distinguish between what we call research ethics 1.0 and research ethics 2.0. Whereas research ethics 1.0 focuses on individual integrity and informed consent, research ethics 2.0 entails social scientific integrity within a broader perspective of a research network. This research network can be regarded as a network of responsibilities in which every stakeholder involved has to jointly meet the ethical challenges posed to research. PMID:28288472

  12. Effects of solar activity on noise in CALIOP profiles above the South Atlantic Anomaly

    NASA Astrophysics Data System (ADS)

    Noel, V.; Chepfer, H.; Hoareau, C.; Reverdy, M.; Cesana, G.

    2014-06-01

    We show that nighttime dark noise measurements from the spaceborne lidar CALIOP contain valuable information about the evolution of upwelling high-energy radiation levels. Above the South Atlantic Anomaly (SAA), CALIOP dark noise levels fluctuate by ±6% between 2006 and 2013, and follow the known anticorrelation of local particle flux with the 11-year cycle of solar activity (with a 1-year lag). By analyzing the geographic distribution of noisy profiles, we are able to reproduce known findings about the SAA region. Over the considered period, it shifts westward by 0.3° year-1, and changes in size by 6° meridionally and 2° zonally, becoming larger with weaker solar activity. All results are in strong agreement with previous works. We predict SAA noise levels will increase anew after 2014, and will affect future spaceborne lidar missions most near 2020.

  13. Role of electric fields in the MHD evolution of the kink instability

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

    Lapenta, Giovanni; Skender, Marina

    Here, the discovery of electrostatic fields playing a crucial role in establishing plasma motion in the flux conversion and dynamo processes in reversed field pinches is revisited. In order to further elucidate the role of the electrostatic fields, a flux rope configuration susceptible to the kink instability is numerically studied with anMHDcode. Simulated nonlinear evolution of the kink instability is found to confirm the crucial role of the electrostatic fields. Anew insight is gained on the special function of the electrostatic fields: they lead the plasma towards the reconnection site at the mode resonant surface. Without this step the plasmamore » column could not relax to its nonlinear state, since no other agent is present to perform this role. While the inductive field generated directly by the kink instability is the dominant flow driver, the electrostatic field is found to allow the motion in the vicinity of the reconnection region.« less

  14. High-content screening in microfluidic devices.

    PubMed

    Cheong, Raymond; Paliwal, Saurabh; Levchenko, Andre

    2010-08-01

    Miniaturization is the key to advancing the state of the art in high-content screening (HCS) in order to enable dramatic cost savings through reduced usage of expensive biochemical reagents and to enable large-scale screening on primary cells. Microfluidic technology offers the potential to enable HCS to be performed with an unprecedented degree of miniaturization. This perspective highlights a real-world example from the authors’ work of HCS assays implemented in a highly miniaturized microfluidic format. The advantages of this technology are discussed, including cost savings, high-throughput screening on primary cells, improved accuracy, the ability to study complex time-varying stimuli, and ease of automation, integration and scaling. The reader will understand the capabilities of anew microfluidics-based platform for HCS and the advantages it provides over conventional plate-based HCS. Microfluidics technology will drive significant advancements and broader usage and applicability of HCS in drug discovery.

  15. Religion and Public Health: Moral Tradition as Both Problem and Solution.

    PubMed

    Rozier, Michael

    2017-06-01

    Despite strong religious influence in the development of medicine and medical ethics, religion has been relatively absent in the rise of preventive medicine and population health. Episodic, clinical medicine has a powerful hold on the religious imagination in health care. Nevertheless, Hebrew Scripture, elements of rabbinical teaching, and modern concepts of social justice all can be used to inspire action in health care that goes beyond clinical medicine. The Christian tradition can call upon the corporal works of mercy, virtue ethics, and Catholic social teaching, as well as the modern history Catholic sisters in the U.S. to do the same. By considering the moral imperative for public health, Jewish and Christian individuals and organizations reaffirm the notion that the human person is both sacred and social. This article suggests a need for religious traditions to consider their moral traditions anew with an eye toward prevention and population health.

  16. The ruins of neo-liberalism and the construction of a new (scientific) subjectivity

    NASA Astrophysics Data System (ADS)

    Lather, Patti

    2012-12-01

    Given my long-time interests in neoliberalism and questions of subjectivity, I am pleased to respond to Jesse Bazzul's paper, "Neoliberal Ideology, global capitalism, and science education: Engaging the question of subjectivity." In what follows, I first summarize what I see as Bazzul's contributions to pushing science education in `post' directions. I next introduce the concept of "post-neoliberalism" as a tool in this endeavor. Finally, I address what all of this might have to do with subjectivity in the context of science education. I speak as a much-involved veteran of a version of the science wars fought out in education research for the last decade (NRC 2002). My interest is to use this "battle" to think politics and science anew toward an engaged social science, without certainty, rethinking subjectivity, the unconscious and bodies where I ask "what kind of science for what kind of politics?"

  17. Scalable parallel distance field construction for large-scale applications

    DOE PAGES

    Yu, Hongfeng; Xie, Jinrong; Ma, Kwan -Liu; ...

    2015-10-01

    Computing distance fields is fundamental to many scientific and engineering applications. Distance fields can be used to direct analysis and reduce data. In this paper, we present a highly scalable method for computing 3D distance fields on massively parallel distributed-memory machines. Anew distributed spatial data structure, named parallel distance tree, is introduced to manage the level sets of data and facilitate surface tracking overtime, resulting in significantly reduced computation and communication costs for calculating the distance to the surface of interest from any spatial locations. Our method supports several data types and distance metrics from real-world applications. We demonstrate itsmore » efficiency and scalability on state-of-the-art supercomputers using both large-scale volume datasets and surface models. We also demonstrate in-situ distance field computation on dynamic turbulent flame surfaces for a petascale combustion simulation. In conclusion, our work greatly extends the usability of distance fields for demanding applications.« less

  18. Coral ontogeny affects early symbiont acquisition in laboratory-reared recruits

    NASA Astrophysics Data System (ADS)

    McIlroy, Shelby E.; Coffroth, Mary Alice

    2017-09-01

    In most coral species, the critical association with a subset of genetically diverse algal endosymbionts, Symbiodinium, is re-established anew each generation in early coral ontogeny. Yet little is known about the window during which these associations are established or the potential for altering symbiont associations through early exposure to non-native, and/or ecologically beneficial (e.g., stress tolerant), symbiont strains. This study examined the ontogenetic window of symbiont uptake in a restoration target species. Orbicella faveolata recruits, maintained aposymbiotic in laboratory tanks for 4 months, showed a significant decrease in symbiont acquisition upon exposure to natural seawater. Recruits initially inoculated with cultured Symbiodinium readily acquired additional strains from environmental symbiont populations upon exposure, but exogenous uptake also decreased in frequency after 4 months of laboratory rearing. Early exposure to Symbiodinium may benefit laboratory-reared recruits (e.g., enhance growth), but the potential for establishing long-term novel symbiotic associations may be limited.

  19. Research Ethics 2.0: New Perspectives on Norms, Values, and Integrity in Genomic Research in Times of Even Scarcer Resources.

    PubMed

    Brall, Caroline; Maeckelberghe, Els; Porz, Rouven; Makhoul, Jihad; Schröder-Bäck, Peter

    2017-01-01

    Research ethics anew gained importance due to the changing scientific landscape and increasing demands and competition in the academic field. These changes are further exaggerated because of scarce(r) resources in some countries on the one hand and advances in genomics on the other. In this paper, we will highlight the current challenges thereof to scientific integrity. To mark key developments in research ethics, we will distinguish between what we call research ethics 1.0 and research ethics 2.0. Whereas research ethics 1.0 focuses on individual integrity and informed consent, research ethics 2.0 entails social scientific integrity within a broader perspective of a research network. This research network can be regarded as a network of responsibilities in which every stakeholder involved has to jointly meet the ethical challenges posed to research. © 2017 S. Karger AG, Basel.

  20. Riding across the selection landscape: fitness consequences of annual variation in reproductive characteristics

    PubMed Central

    Tremblay, Raymond L.; Ackerman, James D.; Pérez, Maria-Eglée

    2010-01-01

    Evolutionary models estimating phenotypic selection in character size usually assume that the character is invariant across reproductive bouts. We show that variation in the size of reproductive traits may be large over multiple events and can influence fitness in organisms where these traits are produced anew each season. With data from populations of two orchid species, Caladenia valida and Tolumnia variegata, we used Bayesian statistics to investigate the effect on the distribution in fitness of individuals when the fitness landscape is not flat and when characters vary across reproductive bouts. Inconsistency in character size across reproductive periods within an individual increases the uncertainty of mean fitness and, consequently, the uncertainty in individual fitness. The trajectory of selection is likely to be muddled as a consequence of variation in morphology of individuals across reproductive bouts. The frequency and amplitude of such changes will certainly affect the dynamics between selection and genetic drift. PMID:20047875

  1. HN(α/β-COCA-J) Experiment for Measurement of 1JC‧Cα Couplings from Two-Dimensional [15N, 1H] Correlation Spectrum

    NASA Astrophysics Data System (ADS)

    Permi, Perttu; Sorsa, Tia; Kilpeläinen, Ilkka; Annila, Arto

    1999-11-01

    Anew method for measurement of one-bond 13C‧-13Cα scalar and dipolar couplings from a two-dimensional [15N, 1H] correlation spectrum is presented. The experiment is based on multiple-quantum coherence, which is created between nitrogen and carbonyl carbon for simultaneous evolution of 15N chemical shift and coupling between 13C‧ and 13Cα. Optional subspectral editing is provided by the spin-state-selective filters. The residual dipolar dipolar contribution to the 13C‧-13Cα coupling can be measured from these simplified [15N, 1H]-HSQC-like spectra. In this way, without explicit knowledge of carbon assignments, conformational changes of proteins dissolved in dilute liquid crystals can be probed conveniently, e.g., in structure activity relationship by NMR studies. The method is demonstrated with human cardiac troponin C.

  2. Early Word Comprehension in Infants: Replication and Extension

    PubMed Central

    Bergelson, Elika; Swingley, Daniel

    2014-01-01

    A handful of recent experimental reports have shown that infants of 6 to 9 months know the meanings of some common words. Here, we replicate and extend these findings. With a new set of items, we show that when young infants (age 6-16 months, n=49) are presented with side-by-side video clips depicting various common early words, and one clip is named in a sentence, they look at the named video at above-chance rates. We demonstrate anew that infants understand common words by 6-9 months, and that performance increases substantially around 14 months. The results imply that 6-9 month olds’ failure to understand words not referring to objects (verbs, adjectives, performatives) in a similar prior study is not attributable to the use of dynamic video depictions. Thus, 6-9 month olds’ experience of spoken language includes some understanding of common words for concrete objects, but relatively impoverished comprehension of other words. PMID:26664329

  3. Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions

    PubMed Central

    van Walraven, Carl; Jennings, Alison; Taljaard, Monica; Dhalla, Irfan; English, Shane; Mulpuru, Sunita; Blecker, Saul; Forster, Alan J.

    2011-01-01

    Background: Urgent, unplanned hospital readmissions are increasingly being used to gauge the quality of care. We reviewed urgent readmissions to determine which were potentially avoidable and compared rates of all-cause and avoidable readmissions. Methods: In a multicentre, prospective cohort study, we reviewed all urgent readmissions that occurred within six months among patients discharged to the community from 11 teaching and community hospitals between October 2002 and July 2006. Summaries of the readmissions were reviewed by at least four practising physicians using standardized methods to judge whether the readmission was an adverse event (poor clinical outcome due to medical care) and whether the adverse event could have been avoided. We used a latent class model to determine whether the probability that each readmission was truly avoidable exceeded 50%. Results: Of the 4812 patients included in the study, 649 (13.5%, 95% confidence interval [CI] 12.5%–14.5%) had an urgent readmission within six months after discharge. We considered 104 of them (16.0% of those readmitted, 95% CI 13.3%–19.1%; 2.2% of those discharged, 95% CI 1.8%–2.6%) to have had a potentially avoidable readmission. The proportion of patients who had an urgent readmission varied significantly by hospital (range 7.5%–22.5%; χ2 = 92.9, p < 0.001); the proportion of readmissions deemed avoidable did not show significant variation by hospital (range 1.2%–3.7%; χ2 = 12.5, p < 0.25). We found no association between the proportion of patients who had an urgent readmission and the proportion of patients who had an avoidable readmission (Pearson correlation 0.294; p = 0.38). In addition, we found no association between hospital rankings by proportion of patients readmitted and rankings by proportion of patients with an avoidable readmission (Spearman correlation coefficient 0.28, p = 0.41). Interpretation: Urgent readmissions deemed potentially avoidable were relatively uncommon, comprising less than 20% of all urgent readmissions following hospital discharge. Hospital-specific proportions of patients who were readmitted were not related to proportions with a potentially avoidable readmission. PMID:21859870

  4. Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP.

    PubMed

    Jang, Sang Eon; Park, Sang Wook; Lee, Ban Seok; Shin, Cheol Min; Lee, Sang Hyub; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho; Park, Joo Kyung; Hwang, Jin-Hyeok

    2013-07-01

    There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis. One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated. There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P < 0.001), and furthermore, intervention to discharge time was also significantly shorter by 1.1 days in the urgent group (P = 0.035). In terms of laboratory parameters, initial CRP level was the only factor correlated with hospital stay and intervention to discharge time. This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.

  5. 3 CFR - Unexpected Urgent Refugee and Migration Needs

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 3 The President 1 2013-01-01 2013-01-01 false Unexpected Urgent Refugee and Migration Needs... Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the authority vested...) of the Migration and Refugee Assistance Act of 1962 (the “Act”), as amended, (22 U.S.C. 2601(c)(1...

  6. 77 FR 58404 - Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-20

    ...] Announcing the Award of Two Urgent Single-Source Grants To Support Unaccompanied Alien Children Program...) announces the award of two urgent single-source grants from the Unaccompanied Alien Children's Program to... providing services under the Unaccompanied Alien Children's program. Award Grantee organization Location...

  7. 76 FR 27250 - Drawbridge Operation Regulation; Atlantic Intracoastal Waterway, Albemarle and Chesapeake Canal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-11

    ... Chesapeake Canal, mile 15.2, at Chesapeake, VA. The deviation is necessary to facilitate urgent mechanical... operating regulations set out in 33 CFR 117.997(i), to facilitate urgent mechanical and structural repairs... will operate on a 4-hour opening schedule. This schedule is meant to facilitate urgent mechanical and...

  8. 3 CFR - Unexpected Urgent Refugee and Migration Needs

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 3 The President 1 2013-01-01 2013-01-01 false Unexpected Urgent Refugee and Migration Needs Presidential Documents Other Presidential Documents Presidential Determination No. 2012-6 of April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the authority vested in me as President by the Constitution...

  9. Decreasing delays in urgent and expedited surgery in a university teaching hospital through audit and communication between peri-operative and surgical directorates.

    PubMed

    Cosgrove, J F; Gaughan, M; Snowden, C P; Lees, T

    2008-06-01

    National Confidential Enquiry into Patient Outcome and Death guidelines for urgent surgery recommend a fully staffed emergency operating theatre and restriction of 'after-midnight' operating to immediate life-, limb- or organ-threatening conditions. Audit performed in our institution demonstrated significant decreases in waiting times for urgent surgery and an increased seniority of medical care associated with overnight pre-operative assessment of patients by anaesthetic trainees. Nevertheless, urgent cases continued to be delayed unnecessarily. A classification of delays was developed from existing guidelines and their incidence was audited. The results were disseminated to involved directorates. A repeat of the audit demonstrated a significant decrease in delays (p = 0.001), a significant increase in the availability of surgeons (p = 0.001) and a significant decrease in the median waiting time for urgent surgery compared to the first audit cycle and a previous standard (p < 0.01). We conclude that auditing delays and disseminating the results of the audit significantly decreases delays and median waiting times for urgent surgery because of improved surgical availability.

  10. Urgent consultations at the dermatology department of Basel University Hospital, Switzerland: characterisation of patients and setting - a 12-month study with 2,222 patients data and review of the literature.

    PubMed

    Ruzza, N; Itin, P H; Beltraminelli, H

    2014-01-01

    Urgent consultations for skin disorders are commonly done in different settings. Scarce data exist about the characteristics of these patients. The aim of this study was to analyse specific characteristics of patients receiving an urgent consultation at a dermatology department in a university hospital. We prospectively recorded the data of all patients having had an urgent consultation during a period of 12 months. We registered 2,222 urgent consultations. The most frequent diagnoses were eczemas (24.8%), dermatomycoses (5.1%) and dermatitis not otherwise specified (4.8%). The most frequent treatments were topical steroids, emollients, topical antibiotics, systemic antihistamines, antibiotics and virostatics. 2.2% of patients were hospitalized, 78.8% asked for a consultation for a disease lasting less than 4 weeks, and 6.9% presented the same day as the skin disease appeared. This study shows the characteristics of patients receiving an urgent dermatologic consultation. It underlines the need for collaboration between dermatologists, other physicians, general practitioners and nurses. © 2014 S. Karger AG, Basel.

  11. Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers.

    PubMed

    Ho, Vivian; Metcalfe, Leanne; Dark, Cedric; Vu, Lan; Weber, Ellerie; Shelton, George; Underwood, Howard R

    2017-12-01

    We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospital-based EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  12. Quantitative comparison of measurements of urgent care service quality.

    PubMed

    Qin, Hong; Prybutok, Victor; Prybutok, Gayle

    2016-01-01

    Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

  13. Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data.

    PubMed

    O'Keeffe, Colin; Mason, Suzanne; Jacques, Richard; Nicholl, Jon

    2018-01-01

    The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E) data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014). Data was collected on all adult (>16 years) ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups. There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%). Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001). The odds of a non-urgent attendance were significantly higher for younger patients (aged 16-44) compared to those aged 45-64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001) and the over 65's (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001). Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45-64's (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001) and the 65+'s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001). 110,605/554,564 (19.9%) of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2.12, 95% CI: 2.09 to 2.15, P<0.001). Younger adults are significantly more likely as older counterparts to use the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.

  14. Neural mechanisms underlying urgent and evaluative behaviors: An fMRI study on the interaction of automatic and controlled processes.

    PubMed

    Megías, Alberto; Navas, Juan Francisco; Petrova, Dafina; Cándido, Antonio; Maldonado, Antonio; Garcia-Retamero, Rocio; Catena, Andrés

    2015-08-01

    Dual-process theories have dominated the study of risk perception and risk-taking over the last two decades. However, there is a lack of objective brain-level evidence supporting the two systems of processing in every-day risky behavior. To address this issue, we propose the dissociation between evaluative and urgent behaviors as evidence of dual processing in risky driving situations. Our findings show a dissociation of evaluative and urgent behavior both at the behavioral and neural level. fMRI data showed an increase of activation in areas implicated in motor programming, emotional processing, and visuomotor integration in urgent behavior compared to evaluative behavior. These results support a more automatic processing of risk in urgent tasks, relying mainly on heuristics and experiential appraisal. The urgent task, which is characterized by strong time pressure and the possibility for negative consequences among others factors, creates a suitable context for the experiential-affective system to guide the decision-making process. Moreover, we observed greater frontal activation in the urgent task, suggesting the participation of cognitive control in safe behaviors. The findings of this research are relevant for the study of the neural mechanisms underlying dual process models in risky perception and decision-making, especially because of their proximity to everyday activities. © 2015 Wiley Periodicals, Inc.

  15. 3 CFR - Unexpected Urgent Refugee and Migration Needs Relating to Syria

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 3 The President 1 2014-01-01 2014-01-01 false Unexpected Urgent Refugee and Migration Needs Relating to Syria Presidential Documents Other Presidential Documents Presidential Determination No. 2013-4 of January 29, 2013 Unexpected Urgent Refugee and Migration Needs Relating to Syria Memorandum for the Secretary of State By the authority vested i...

  16. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Libya

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Libya Presidential Documents Other Presidential Documents Presidential Determination No. 2011-8 of March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the Secretary of State By the authority vested in me...

  17. 3 CFR - Unexpected Urgent Refugee and Migration Needs Resulting from Flooding in Pakistan

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... Determination No. 2010-14 of September 3, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from... the Constitution and the laws of the United States, including section 2(c)(1) of the Migration and...

  18. 3 CFR - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... Determination No. 2010-12 of August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from... the Constitution and the laws of the United States, including section 2(c)(1) of the Migration and...

  19. Comparison of the quality of night paediatric urgent care in rural and urban areas of Lublin Province, eastern Poland - Appraisals by parents of children requiring medical attention.

    PubMed

    Kołłątaj, Barbara; Kołłątaj, Witold; Wrzołek, Katarzyna; Karwat, Irena Dorota; Klatka, Maria

    2017-03-31

     Introduction. The quality of primary medical care for children in Poland is unsatisfactory. In the ranking known as 'the European Health Consumer Index', Poland (taking the patient point of view on healthcare quality) is classified on the 27th position out of the 33 possible. The unsolved problems concern inter alia the quality and availability of night paediatric urgent care. The aim was assessing the quality as well as the level of satisfaction with the night paediatric urgent care in the Lublin Province of eastern Poland. The materials for this study consisted of 540 parents of children aged 6-16 years benefiting from night paediatric urgent medical assistance in Lublin Province. The survey was conducted using the Original Survey Questionnaire. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality and accessibility of night paediatric urgent care facilities as only satisfactory. Inhabitants living in rural areas have worse access to night paediatric urgent care facilities because of having to travel greater distances, and receive less comprehensive medical assistance than inhabitants living in more urbanized areas, and they are more often referred to hospital emergency departments. During the past five years, both the availability and quality of night paediatric urgent care did not change significantly. Inhabitants of the Lublin Province (regardless of place of residence) generally assessed the quality as well as accessibility of night paediatric urgent care facilities as only satisfactory. Rural residents have more reasons for dissatisfaction than urban dwellers. Both the quality and availability of such medical care needs to be improved.

  20. Predictors of Urgent Findings on Abdominopelvic CT in Patients with Crohn's Disease Presenting to the Emergency Department.

    PubMed

    Jung, Yoon Suk; Park, Dong Il; Hong, Sung Noh; Kim, Eun Ran; Kim, Young Ho; Cheon, Jae Hee; Eun, Chang Soo; Han, Dong Soo; Lee, Chang Kyun; Kim, Jae Hak; Huh, Kyu Chan; Yoon, Soon Man; Song, Hyun Joo; Shin, Jeong Eun; Jeon, Seong Ran

    2015-04-01

    Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation, mainly as a result of abdominopelvic computed tomography (APCT) examinations. However, there are limited data on the impact of APCT on clinical management in this population. To investigate clinical predictors of urgent findings on APCT in patients with CD who presented to the emergency department (ED). A retrospective study was performed among patients with CD presenting to 11 EDs with a gastrointestinal complaint. The primary outcome, OPAN (obstruction, perforation, abscess, or non-CD-related urgent findings), included new or worsening CD-related urgent findings or non-CD-related urgent findings that required urgent or emergency treatment. Variables with P < 0.1 in univariate analyses were included in a multivariable logistic regression model. Of the 266 APCTs performed, 103 (38.7 %) had OPAN and 113 (42.5 %) required changes in treatment plan. Stricturing or penetrating disease (odds ratio [OR] 2.72, 95 % confidence interval [CI] 1.21-6.13), heart rate >100 beats/min (OR 2.33, 95 % CI 1.10-4.93), leukocyte count >10,000/mm(3) (OR 4.38, 95 % CI 2.10-9.13), and CRP >2.5 mg/dL (OR 3.11, 95 % CI 1.23-7.86) were identified as the independent predictors of OPAN, whereas biologic agent use (OR 0.37; 95 % CI 0.15-0.90) was identified as the negative predictor in patients with CD. Only 39 % of the APCTs performed in the ED among patients with CD showed urgent findings. Stricturing or penetrating disease, tachycardia, leukocytosis, and high CRP level were predictors of urgent CT findings, while biologic agent use was a negative predictor. To reduce unnecessary radiation exposure, the selection process for CD patients referred for APCT must be improved.

  1. Association of over-the-counter pharmaceutical sales with influenza-like-illnesses to patient volume in an urgent care setting.

    PubMed

    Liu, Timothy Y; Sanders, Jason L; Tsui, Fu-Chiang; Espino, Jeremy U; Dato, Virginia M; Suyama, Joe

    2013-01-01

    We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round.

  2. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire Presidential Documents Other Presidential Documents Presidential Determination No. 2011-7 of March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Cote d'Ivoire Memorandum for the Secretary of State By the...

  3. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa Presidential Documents Other Presidential Documents Presidential Determination No. 2011-12 of August 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa Memorandum for the Secretary of State By...

  4. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks for...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 3 The President 1 2011-01-01 2011-01-01 false Unexpected Urgent Refugee and Migration Needs... 8, 2010 Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks... section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the “Act”), as amended, (22 U.S.C...

  5. The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography.

    PubMed

    Kaewlai, Rathachai; Greene, Reginald E; Asrani, Ashwin V; Abujudeh, Hani H

    2010-09-01

    The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients. The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier. During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift. Urgent findings requiring immediate communication were detected in 308 (4.8%) studies. The early-morning shift of radiologists, on average, communicated these findings 2 hours earlier compared with the historical control group (P < .001). Staggered radiologist work shifts that include an early-morning shift can improve the timeliness of reporting urgent findings on overnight portable chest radiography of hospitalized patients. Published by Elsevier Inc.

  6. The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

    PubMed

    McClelland, Mark Stephen; Lazar, Danielle; Sears, Vickie; Wilson, Marcia; Siegel, Bruce; Pines, Jesse M

    2011-12-01

    Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters-a program funded by the Robert Wood Johnson Foundation (RWJF)-has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities. This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program. © 2011 by the Society for Academic Emergency Medicine.

  7. Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause.

    PubMed

    Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C; Khoury, Nabil; Hadi, Christiane M; van der Ende, Arie; Wootton, Susan H; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

    2013-08-01

    We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193) and a retrospective validation (n = 567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high (≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95% CI 93.9-100.0%) in the validation cohort and 100.0% (95% CI 97.8-100.0%) in bacterial meningitis patients. The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  8. RISK SCORE FOR IDENTIFYING ADULTS WITH CSF PLEOCYTOSIS AND NEGATIVE CSF GRAM STAIN AT LOW RISK FOR AN URGENT TREATABLE CAUSE

    PubMed Central

    Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C; Khoury, Nabil; Hadi, Christiane M; van der Ende, Arie; Wootton, Susan H.; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

    2013-01-01

    Background We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Methods Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n=193) and a retrospective validation (n=567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high ( ≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. Findings A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95%CI 93.9-100.0%) in the validation cohort and 100.0% (95%CI 97.8-100.0%) in bacterial meningitis patients. Interpretation The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. PMID:23619080

  9. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 3 The President 1 2012-01-01 2012-01-01 false Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire Presidential Documents Other Presidential Documents Presidential Determination No. 2011-11 of June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and Côte d'Ivoire Memorandum for the Secretary of...

  10. Additive Manufacture of Plasma Diagnostic Components Final Report Phase II

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

    Woodruff, Simon; Romero-Talamas, Carlos; You, Setthivoine

    There is now a well-established set of plasma diagnostics (see e.g. [3]), but these remain some of the mostexpensive assemblies in fusion systems since for every system they have to be custom built, and time fordiagnostic development can pace the project. Additive manufacturing (AM) has the potential to decreaseproduction cost and significantly lower design time of fusion diagnostic subsystems, which would realizesignificant cost reduction for standard diagnostics. In some cases, these basic components can be additivelymanufactured for less than 1/100th costs of conventional manufacturing.In our DOE Phase II SBIR, we examined the impact that AM can have on plasma diagnosticmore » cost bytaking 15 separate diagnostics through an engineering design using Conventional Manufacturing (CM) tech-niques, then optimizing the design to exploit the benefits of AM. The impact of AM techniques on cost isfound to be in several areas. First, the cost of materials falls because AM parts can be manufactured withlittle to no waste, and engineered to use less material than CM. Next, the cost of fabrication falls for AMparts relative to CM since the fabrication time can be computed exactly, and often no post-processing isrequired for the part to be functional. We find that AM techniques are well suited for plasma diagnosticssince typical diagnostic complexity comes at no additional cost. Cooling channels, for example, can be builtin to plasma-facing components at no extra cost. Fabrication costs associated with assembly are lower forAM parts because many components can be combined and printed as monoliths, thereby mitigating the needfor alignment or calibration. Finally, the cost of engineering is impacted by exploiting AM design tools thatallow standard components to be customized through web-interfaces. Furthermore, we find that conceptdesign costs can be impacted by scripting interfaces for online engineering design tools.« less

  11. Infrastructure Requirements for an Urgent-Start Peritoneal Dialysis Program

    PubMed Central

    Ghaffari, Arshia; Kumar, Vijay; Guest, Steven

    2013-01-01

    Patients with advanced chronic kidney disease nearing dialysis but without pre-established access almost uniformly initiate dialysis with a temporary central venous catheter. These catheters are associated with high rates of infection and flow disturbances, requiring removal and subsequent replacement. Many of these patients might be candidates for peritoneal dialysis (PD), but because of the absence of prior catheter placement, the default initial modality is hemodialysis. Recent reports, however, have demonstrated the feasibility of initiating PD urgently despite the late referral for access placement. Urgent-start PD clinical pathways require a unique infrastructure and treatment approach. This article reviews the salient features required to establish an urgent-start PD program. PMID:24335123

  12. Association of Over-The-Counter Pharmaceutical Sales with Influenza-Like-Illnesses to Patient Volume in an Urgent Care Setting

    PubMed Central

    Liu, Timothy Y.; Sanders, Jason L.; Tsui, Fu-Chiang; Espino, Jeremy U.; Dato, Virginia M.; Suyama, Joe

    2013-01-01

    We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round. PMID:23555647

  13. Door to disposition times for obstetric triage visits: Is there a July phenomenon?

    PubMed

    Mehra, S; Gavard, J A; Gross, G; Myles, T; Nguyen, T; Amon, E

    2016-01-01

    The July phenomenon refers to a change in patient outcomes within teaching hospitals with the arrival of new and inexperienced house staff at the start of the academic year (July to June). In our obstetric triage unit we retrospectively evaluated the door to disposition time (DTDT) for 1817 patients who presented across July, December and May of academic years 2009-2010 and 2010-2011. DTDT was examined for three visit levels: non-urgent, urgent and emergent. No significant differences in disposition time were found for emergent visits. For urgent visits the median DTDT significantly decreased from 171 min in July to 155 min in December and 135 min in May (p < 0.001). Similarly for non-urgent visits, the median DTDT was greater during July than May (179 min vs. 133 min; p < 0.05). Electronic medical records (EMRs) were implemented in November 2010. Following the introduction of EMR shorter DTDT was seen in December 2010 versus December 2009 (median, 171 min vs. 150 min; p < 0.05), respectively. Our findings suggest a 'July Phenomenon' of greater disposition intervals for urgent and non-urgent obstetric triage visits across the academic year. Additionally the use of EMRs may facilitate patient flow through the OB triage unit.

  14. The impact of an emergency fee increase on the composition of patients visiting emergency departments.

    PubMed

    Jung, Hyemin; Do, Young Kyung; Kim, Yoon; Ro, Junsoo

    2014-11-01

    This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

  15. The impact of demand management strategies on parents’ decision-making for out-of-hours primary care: findings from a survey in The Netherlands

    PubMed Central

    Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

    2017-01-01

    Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. Results The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; 95% CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; 95% CI 0.08 to 0.32). Overview of medical cost (OR 0.59; 95% CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; 95% CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Conclusion Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. PMID:28487458

  16. The impact of demand management strategies on parents' decision-making for out-of-hours primary care: findings from a survey in The Netherlands.

    PubMed

    Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul

    2017-05-09

    To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices

    PubMed Central

    Lyratzopoulos, Georgios; Mendonca, Silvia C; Gildea, Carolynn; McPhail, Sean; Peake, Michael D; Rubin, Greg; Singh, Hardeep; Hamilton, William; Walter, Fiona M; Roland, Martin; Abel, Gary A

    2018-01-01

    Background Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use. Aim To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer. Design and setting Cross-sectional ecological analysis in English general practices. Method Data were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills. Results Taking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile). Conclusion Practices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice. PMID:29255108

  18. The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

    PubMed

    Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

    2017-12-01

    We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

  19. FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials.

    PubMed

    Gupta, Ankur; Bajaj, Navkaranbir S; Arora, Pankaj; Arora, Garima; Qamar, Arman; Bhatt, Deepak L

    2018-02-01

    Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials. We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model. After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28). This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  20. The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores

    PubMed Central

    Park, Sun Wook; Song, Young Wook; Tak, Dae Hyun; Ahn, Byung Moo; Kang, Sun Hyung; Moon, Hee Seok; Sung, Jae Kyu; Jeong, Hyun Yong

    2015-01-01

    Background/Aims: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores. Methods: This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (≥2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups. Results: A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05) Conclusions: AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods. PMID:26668799

  1. Supplier-induced demand for urgent after-hours primary care services.

    PubMed

    Longden, Thomas; Hall, Jane; van Gool, Kees

    2018-05-21

    Australia is one of nine Organisation for Economic Co-operation and Development (OECD) countries that utilise deputising services to provide after-hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly advertising their services to consumers emphasising patient convenience and no copayments. The introduction of corporate entities has changed the way that deputising services operate. We use a difference-in-difference approach to estimate the amount of growth in urgent after-hours services that was not warranted by urgent medical need. These estimates are calculated by comparing the growth in urgent attendances that occurred during times of the day that are classified as "after-hours" (e.g., 6 pm-11 pm Monday to Friday) with those that are classified as "unsociable-hours" (e.g., 11 pm-7 am Monday to Friday). For the national level, we estimate that 593,141 unwarranted attendances were induced as urgent after-hours consultations in a single year. This corresponds to a national estimate of the total benefits paid for unwarranted demand of approximately $77 million. While deputising services have filled a short-fall in after-hours services, the overuse of urgent items has meant that that this has been achieved at a considerable cost to the Australian Government. Copyright © 2018 John Wiley & Sons, Ltd.

  2. The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: A case control study.

    PubMed

    Kawai, Keisuke; Yamashita, Sakino; Yamanaka, Takeharu; Gondo, Motoharu; Morita, Chihiro; Nozaki, Takehiro; Takakura, Shu; Hata, Tomokazu; Yamada, Yu; Matsubayashi, Sunao; Takii, Masato; Kubo, Chiharu; Sudo, Nobuyuki

    2011-12-05

    The prevention of serious physical complications in anorexia nervosa (AN) patients is important. The purpose of this study is to clarify which physical and social factors are related to the necessity for urgent hospitalization of anorexia nervosa (AN) patients in a long-term starvation state. We hypothesized that the change of longitudinal BMI, body composition and social background would be useful as an index of the necessity for urgent hospitalization. AN patients were classified into; urgent hospitalization, due to disturbance of consciousness or difficulty walking(n = 17); planned admission (n = 96); and outpatient treatment only groups (n = 136). The longitudinal BMI pattern and the clinical features of these groups were examined. In the hospitalization groups, comparison was done of body composition variation and the social background, including the educational level and advice from family members. After adjusting for age and duration of illness, the BMI of the urgent hospitalization group was lower than that of the other groups at one year before hospitalization (P < 0.01) and decreased more rapidly (P < 0.01). Urgent hospitalization was associated with the fat free mass (FFM) (P < 0.01). Between the groups, no considerable difference in social factors was found. The longitudinal pattern of BMI and FFM may be useful for understanding the severity in AN from the viewpoint of failure of the homeostasis system.

  3. 77 FR 42947 - Unexpected Urgent Refugee and Migration Needs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

  4. Urgent-Start Peritoneal Dialysis: A Chance for a New Beginning

    PubMed Central

    Arramreddy, Rohini; Zheng, Sijie; Saxena, Anjali B.; Liebman, Scott E.; Wong, Leslie

    2014-01-01

    Peritoneal dialysis (PD) remains greatly underutilized in the United States despite the widespread preference of home modalities among nephrologists and patients. A hemodialysis-centric model of end-stage renal disease care has perpetuated for decades due to a complex set of factors, including late end-stage renal disease referrals and patients who present to the hospital requiring urgent renal replacement therapy. In such situations, PD rarely is a consideration and patients are dialyzed through a central venous catheter, a practice associated with high infection and mortality rates. Recently, the term urgent-start PD has gained momentum across the nephrology community and has begun to change this status quo. It allows for expedited placement of a PD catheter and initiation of PD therapy within days. Several published case reports, abstracts, and poster presentations at national meetings have documented the initial success of urgent-start PD programs. From a wide experiential base, we discuss the multifaceted issues related to urgent-start PD implementation, methods to overcome barriers to therapy, and the potential impact of this technique to change the existing dialysis paradigm. PMID:24246221

  5. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to Gaza

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of Bureau of Population, Refugees, and...

  6. Frequent or urgent urination

    MedlinePlus

    Urgent urination; Urinary frequency or urgency; Urgency-frequency syndrome; Overactive bladder (OAB) syndrome; Urge syndrome ... Medicines such as water pills (diuretics) Overactive bladder syndrome Radiation therapy to the pelvis, which is used ...

  7. Norms of valence, arousal, and dominance for 13,915 English lemmas.

    PubMed

    Warriner, Amy Beth; Kuperman, Victor; Brysbaert, Marc

    2013-12-01

    Information about the affective meanings of words is used by researchers working on emotions and moods, word recognition and memory, and text-based sentiment analysis. Three components of emotions are traditionally distinguished: valence (the pleasantness of a stimulus), arousal (the intensity of emotion provoked by a stimulus), and dominance (the degree of control exerted by a stimulus). Thus far, nearly all research has been based on the ANEW norms collected by Bradley and Lang (1999) for 1,034 words. We extended that database to nearly 14,000 English lemmas, providing researchers with a much richer source of information, including gender, age, and educational differences in emotion norms. As an example of the new possibilities, we included stimuli from nearly all of the category norms (e.g., types of diseases, occupations, and taboo words) collected by Van Overschelde, Rawson, and Dunlosky (Journal of Memory and Language 50:289-335, 2004), making it possible to include affect in studies of semantic memory.

  8. Figure-ground segmentation can occur without attention.

    PubMed

    Kimchi, Ruth; Peterson, Mary A

    2008-07-01

    The question of whether or not figure-ground segmentation can occur without attention is unresolved. Early theorists assumed it can, but the evidence is scant and open to alternative interpretations. Recent research indicating that attention can influence figure-ground segmentation raises the question anew. We examined this issue by asking participants to perform a demanding change-detection task on a small matrix presented on a task-irrelevant scene of alternating regions organized into figures and grounds by convexity. Independently of any change in the matrix, the figure-ground organization of the scene changed or remained the same. Changes in scene organization produced congruency effects on target-change judgments, even though, when probed with surprise questions, participants could report neither the figure-ground status of the region on which the matrix appeared nor any change in that status. When attending to the scene, participants reported figure-ground status and changes to it highly accurately. These results clearly demonstrate that figure-ground segmentation can occur without focal attention.

  9. Gain-of-function SOS1 mutations cause a distinctive form of noonansyndrome

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

    Tartaglia, Marco; Pennacchio, Len A.; Zhao, Chen

    2006-09-01

    Noonan syndrome (NS) is a developmental disordercharacterized by short stature, facial dysmorphia, congenital heartdefects and skeletal anomalies1. Increased RAS-mitogenactivated proteinkinase (MAPK) signaling due to PTPN11 and KRAS mutations cause 50 percentof NS2-6. Here, we report that 22 of 129 NS patients without PTPN11 orKRAS mutation (17 percent) have missense mutations in SOS1, which encodesa RAS-specific guanine nucleotide exchange factor (GEF). SOS1 mutationscluster at residues implicated in the maintenance of SOS1 in itsautoinhibited form and ectopic expression of two NS-associated mutantsinduced enhanced RAS activation. The phenotype associated with SOS1defects is distinctive, although within NS spectrum, with a highprevalence of ectodermal abnormalitiesmore » but generally normal developmentand linear growth. Our findings implicate for the first timegain-of-function mutations in a RAS GEF in inherited disease and define anew mechanism by which upregulation of the RAS pathway can profoundlychange human development.« less

  10. X-ray bubble lens and x-ray hollow plastic ball lens

    NASA Astrophysics Data System (ADS)

    Kohmura, Yoshiki; Awaji, Mitsuhiro; Suzuki, Yoshio; Ishikawa, Tetsuya

    1998-11-01

    Recent development of anew refractive x-ray lens at SPring-8 is reported. This is the first refractive x-ray lens with a string of spherical lens in-spite of the string of cylindrical holes. Two types of the lends were developed which consists of a string of bubbles formed in a viscous liquid and a string of hollow plastic balls on pure water. They are sealed inside a container made from an acrylic resin. The x-ray focusing properties were investigated with the monochromated beam at an undulator beam line BL47 in SPring-8. Demagnified images of the source for these tow types of lens were observed at the energy of 19.0-24.5 keV with the focal length of approximately 5m. For the bubble lens, a gain of about 12 was observed. The observed vertical image size, 48 micrometers , was 6 times larger than the expected size. The method to improve the focusing capability is discussed.

  11. Symmetry limit theory for cantilever beam-columns subjected to cyclic reversed bending

    NASA Astrophysics Data System (ADS)

    Uetani, K.; Nakamura, Tsuneyoshi

    THE BEHAVIOR of a linear strain-hardening cantilever beam-column subjected to completely reversed plastic bending of a new idealized program under constant axial compression consists of three stages: a sequence of symmetric steady states, a subsequent sequence of asymmetric steady states and a divergent behavior involving unbounded growth of an anti-symmetric deflection mode. A new concept "symmetry limit" is introduced here as the smallest critical value of the tip-deflection amplitude at which transition from a symmetric steady state to an asymmetric steady state can occur in the response of a beam-column. A new theory is presented for predicting the symmetry limits. Although this transition phenomenon is phenomenologically and conceptually different from the branching phenomenon on an equilibrium path, it is shown that a symmetry limit may theoretically be regarded as a branching point on a "steady-state path" defined anew. The symmetry limit theory and the fundamental hypotheses are verified through numerical analysis of hysteretic responses of discretized beam-column models.

  12. [About creativity].

    PubMed

    Rubia Vila, Francisco José

    2006-01-01

    The term 'creativity', meaning to produce something out of nothing, is not accurate. A definition that included the establishment, the founding or the introduction of something anew for the first time would be rather appropiate. The most accurate interpretation of the creativity process is the one proposed by Alfred Rothenberg which establishes the hypothesis that creativity is due to what he calls a 'janusian thinking' characterized by conceiving simultaneously two or more opposed ideas, images or concepts. Two examples illustrate such way of thinking: one is Einstein's General Theory of Relativity and the other is Darwin's Theory of Natural Selection. The overcome of a dualistic thinking while keeping full consciousnees, that is, the utilization of both the primary and the secondary processes postulated by Freud, would be the key to creative thinking. From a neurophysiological point of view, it is very likely that the right hemisphere is rather connected to creativity, given that it is a mental state that requires non-focalized attention, greater right hemisphere activation, and low levels of prefrontal cortical activation allowing cognitive inhibition.

  13. ["Chemistry of Concepts”and “Historical Sense”. On Philosophical Concept Formation].

    PubMed

    Blättler, Christine

    2015-06-01

    "Chemistry of Concepts" and "Historical Sense". On Philosophical Concept Formation. The question concerning concepts and their relations to objects and words has had a long and controversial history. Recently, it is challenged by an anew turn towards objects and an emphasized object-oriented ontology. The article argues that one reason for this is the reduction of concepts towards pure rational constructions and offers arguments for alternative understandings. In this context, the article proposes a re-reading of Nietzsche's particular approach and shows that Nietzsche's thought is decisively shaped by the sciences of his time, especially physiology and chemistry. Before the background of the recent increase in research interest on Nietzsche and the sciences the article examines place and function of the sciences related to the genealogy and justification of concepts. Opposing a strong naturalist reading it makes a plea for understanding Nietzsche's epistemological critique concerning concepts systematically as a triple one: philological, physiological, and historical. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Reflections on the Resurgence of Interest in the Testing Effect.

    PubMed

    Roediger, Henry L; Karpicke, Jeffrey D

    2018-03-01

    We discuss the findings from our 2006 article in Psychological Science on the testing effect and describe how the project arose. The testing effect (or retrieval-practice effect) was first reported in the experimental literature about a century before our article was published, and the effect had been replicated (and sometimes discovered anew) many times over the years. Our experiments used prose materials (unlike most prior research) and produced a more powerful effect than prior research even though we used a conservative control condition for comparison. In our discussion, we drew out possible implications for educational practice. We also reported that students in the experiment could not predict the effect; this lack of metacognitive awareness represented a new finding in this context. In a companion article the same year, we provided an historical review of the testing effect. We believe the synergistic effect of the two articles accounts in part for the resurgence in interest in this phenomenon and its application in educational settings.

  15. A planning-oriented sustainability assessment framework for peri-urban water management in developing countries.

    PubMed

    Starkl, Markus; Brunner, Norbert; López, Eduardo; Martínez-Ruiz, José Luis

    2013-12-15

    DPSIR and the three-pillar model are well-established frameworks for sustainability assessment. This paper proposes a planning-oriented sustainability assessment framework (POSAF). It is informed by those frameworks but differs insofar as it puts more emphasis on a constructivist conception which recognises that sustainability needs to be defined anew for each planning problem. In finding such a consensus definition, POSAF uses participatory scenario analysis and participatory planning, technical feasibility study, participatory assessment, analysis of trade-offs and social networks in an unusual combination and for goals that differ from the original conceptions of these methods. POSAF was applied in a peri-urban area of Mexico City for the design of improved water service provision, integrating solid waste management. It supported consensus amongst users about the importance of environmental issues, informed planners about the values of stakeholders and users, detected local differences, and identified possible conflicts at an early stage of decision-making. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Developing 21st century accreditation standards for teaching hospitals: the Taiwan experience.

    PubMed

    Huang, Chung-I; Wung, Cathy; Yang, Che-Ming

    2009-12-15

    The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot study and subsequent revision. Our new teaching hospital accreditation standards have six categories and 95 standards as follows: educational resources (20 items), teaching and training plans and outcomes (42 items), research and results (9 items), development of clinical faculty and continuing education (8 items), academic exchanges and community education (8 items), and administration (8 items). The new standards have proven feasible and posed reasonable challenges in the pilot study. We hope the new standards will strengthen teaching and research, and improve the quality of hospital services at the same time.

  17. Glaciers in Patagonia: Controversy and prospects

    NASA Astrophysics Data System (ADS)

    Kargel, J. S.; Alho, P.; Buytaert, W.; Célleri, R.; Cogley, J. G.; Dussaillant, A.; Guido, Z.; Haeberli, W.; Harrison, S.; Leonard, G.; Maxwell, A.; Meier, C.; Poveda, G.; Reid, B.; Reynolds, J.; Rodríguez, C. A. Portocarrero; Romero, H.; Schneider, J.

    2012-05-01

    Lately, glaciers have been subjects of unceasing controversy. Current debate about planned hydroelectric facilities—a US7- to 10-billion megaproject—in a pristine glacierized area of Patagonia, Chile [Romero Toledo et al., 2009; Vince, 2010], has raised anew the matter of how glaciologists and global change experts can contribute their knowledge to civic debates on important issues. There has been greater respect for science in this controversy than in some previous debates over projects that pertain to glaciers, although valid economic motivations again could trump science and drive a solution to the energy supply problem before the associated safety and environmental problems are understood. The connection between glaciers and climate change—both anthropogenic and natural—is fundamental to glaciology and to glaciers' practical importance for water and hydropower resources, agriculture, tourism, mining, natural hazards, ecosystem conservation, and sea level [Buytaert et al., 2010; Glasser et al., 2011]. The conflict between conservation and development can be sharper in glacierized regions than almost anywhere else. Glaciers occur in spectacular natural landscapes, but they also supply prodigious exploitable meltwater.

  18. Self-, other-, and joint monitoring using forward models.

    PubMed

    Pickering, Martin J; Garrod, Simon

    2014-01-01

    In the psychology of language, most accounts of self-monitoring assume that it is based on comprehension. Here we outline and develop the alternative account proposed by Pickering and Garrod (2013), in which speakers construct forward models of their upcoming utterances and compare them with the utterance as they produce them. We propose that speakers compute inverse models derived from the discrepancy (error) between the utterance and the predicted utterance and use that to modify their production command or (occasionally) begin anew. We then propose that comprehenders monitor other people's speech by simulating their utterances using covert imitation and forward models, and then comparing those forward models with what they hear. They use the discrepancy to compute inverse models and modify their representation of the speaker's production command, or realize that their representation is incorrect and may develop a new production command. We then discuss monitoring in dialogue, paying attention to sequential contributions, concurrent feedback, and the relationship between monitoring and alignment.

  19. Self-, other-, and joint monitoring using forward models

    PubMed Central

    Pickering, Martin J.; Garrod, Simon

    2014-01-01

    In the psychology of language, most accounts of self-monitoring assume that it is based on comprehension. Here we outline and develop the alternative account proposed by Pickering and Garrod (2013), in which speakers construct forward models of their upcoming utterances and compare them with the utterance as they produce them. We propose that speakers compute inverse models derived from the discrepancy (error) between the utterance and the predicted utterance and use that to modify their production command or (occasionally) begin anew. We then propose that comprehenders monitor other people’s speech by simulating their utterances using covert imitation and forward models, and then comparing those forward models with what they hear. They use the discrepancy to compute inverse models and modify their representation of the speaker’s production command, or realize that their representation is incorrect and may develop a new production command. We then discuss monitoring in dialogue, paying attention to sequential contributions, concurrent feedback, and the relationship between monitoring and alignment. PMID:24723869

  20. [Proposal for a Nationwide Johann-Peter Frank Cooperation Model under the National Leopoldina Initiative for Public Health and Global Health].

    PubMed

    Teichert, U; Kaufhold, C; Rissland, J; Tinnemann, P; Wildner, M

    2016-07-01

    The discussion on the development of public health affairs was invigorated anew by the report on public health in Germany of Leopoldina/Acatech/Union of the German Academies of Sciences and Humanities of the year 2015. The report urges strengthening of public health and global health in Germany and addresses explicitly the Public Health Service (PHS). This indispensable inclusion of the PHS in further strategic planning offers for the first time an opportunity for a comprehensive and sustainable practice/policy transfer on the federal, state and community level, and also a chance for a sustainable network with modern academic public health institutions together with representation of medical specialization in public health at universities, that has been absent so far. A Johann-Peter Frank model for cooperation and stepwise modelling of this transition with the inclusion of the Academies for Public Health Service is presented. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Recycling endosomes in human cytotoxic T lymphocytes constitute an auxiliary intracellular trafficking pathway for newly synthesized perforin.

    PubMed

    Lesteberg, Kelsey; Orange, Jordan; Makedonas, George

    2017-10-01

    Although cytotoxic T lymphocytes (CTLs) store perforin within cytoplasmic secretory granules for immediate use, perforin is synthesized anew within hours of TCR stimulation. Previously, we observed new perforin protein at an immunologic synapse independent of secretory lysosomes; herein, we aimed to determine how new perforin transits to the synapse if not via lytic granules. We analyzed antigen-specific human CTLs via imaging flow cytometry and high-resolution confocal microscopy, with attention to intracellular trafficking components and new perforin. The recycling endosome compartments identified by rab8, rab11a, rab4, and rab37 co-localized with new perforin, as well as the SNAREs vti1b and VAMP4. After ablating the function of the recycling endosome pathway, we observed a relative accumulation of new perforin in rab8 vesicles. The recycling endosome pathway may serve as an auxiliary intracellular route for the delivery of new perforin to an immunologic synapse in order to perpetuate a cytotoxic response.

  2. Recycling endosomes in human cytotoxic T lymphocytes constitute an auxiliary intracellular trafficking pathway for newly synthesized perforin

    PubMed Central

    Lesteberg, Kelsey E.; Orange, Jordan S.; Makedonas, George

    2018-01-01

    Background Although cytotoxic T lymphocytes (CTLs) store perforin within cytoplasmic secretory granules for immediate use, perforin is synthesized anew within hours of TCR stimulation. Previously, we observed new perforin protein at an immunologic synapse independent of secretory lysosomes; herein we aimed to determine how new perforin transits to the synapse if not via lytic granules. Results We analyzed antigen-specific human CTLs via imaging flow cytometry and high-resolution confocal microscopy, with attention to intracellular trafficking components and new perforin. The recycling endosome compartments identified by rab8, rab11a, rab4, and rab37 co-localized with new perforin, as well as the SNAREs vti1b and VAMP4. After ablating the function of the recycling endosome pathway, we observed a relative accumulation of new perforin in rab8 vesicles. Conclusions The recycling endosome pathway may serve as an auxiliary intracellular route for the delivery of new perforin to an immunologic synapse in order to perpetuate a cytotoxic response. PMID:28822075

  3. Virtual art revisited

    NASA Astrophysics Data System (ADS)

    Ruzanka, S.

    2014-02-01

    Virtual reality art at the turn of the millenium saw an explosion of creative exploration around this nascent technoloy. Though VR art has much in common with media art in general, the affordances of the technology gave rise to unique experiences, discourses, and artistic investigations. Women artists were at the forefront of the medium, shaping its aesthetic and technical development, and VR fostered a range of artistic concerns and experimentation that was largely distinct from closely related forms such as digital games. Today, a new wave of consumer technologies including 3D TV's, gestural and motion tracking interfaces, and headmount displays as viable, low-cost gaming peripherals drives a resurgence in interest in VR for interactive art and entertainment. Designers, game developers, and artists working with these technologies are in many cases discovering them anew. This paper explores ways of reconnecting this current moment in VR with its past. Can the artistic investigations begun in previous waves of VR be continued? How do the similarities and differences in contexts, communities, technologies, and discourses affect the development of the medium?

  4. 78 FR 9569 - Unexpected Urgent Refugee and Migration Needs Relating to Syria

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-08

    ... urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population, Refugees, and...

  5. Does Urgent Colonoscopy Improve Outcomes in the Management of Lower Gastrointestinal Bleeding?

    PubMed

    Seth, Ankur; Khan, Muhammad Ali; Nollan, Richard; Gupta, Deepansh; Kamal, Sehrish; Singh, Utkarsh; Kamal, Faisal; Howden, Colin W

    2017-03-01

    Colonoscopy continues to be an essential diagnostic and therapeutic tool in the management of lower gastrointestinal bleeding (LGIB). Studies that have evaluated the role of urgent colonoscopy for treating LGIB have reached conflicting conclusions. We conducted a systematic review and meta-analysis to evaluate the role of urgent colonoscopy in several outcomes in patients with LGIB. We searched Medline, Embase, Scopus and Cochrane databases from inception to July 10, 2016 for comparative studies evaluating the role of urgent versus elective colonoscopy in the management of LGIB. We evaluated mortality, rate of rebleeding, length of stay in hospital, identification of bleeding source, stigmata of recent hemorrhage and need for surgery. Pooled odds ratios (OR) were calculated for dichotomous variables whereas standard mean differences were calculated for continuous variables. We assessed quality using the Cochrane tool and Newcastle Ottawa Scale for randomized controlled trials and observational studies, respectively. We used the GRADE framework to interpret our findings. A total of 6 studies (2 randomized controlled trials and 4 observational studies) with 23,419 patients (9,498 urgent colonoscopy and 13,921 elective colonoscopy) were included in this meta-analysis. Pooled ORs with 95% CI for mortality, rebleeding and identification of bleeding source were 0.84 (0.46-1.53), 1.18 (0.64-2.16) and 1.49 (0.86-2.59), respectively. Stigmata of recent hemorrhage were more readily identified with urgent colonoscopy OR 2.85 (1.90-4.28). There were no differences in requirement for surgery, length of hospital stay or rate of endoscopic intervention. However, these effect sizes were limited by considerable heterogeneity, which was probably due to studies being conducted in different countries having different criteria for discharge and on variations in the type of endoscopic therapy for stigmata of recent hemorrhage. In conclusion, among patients with acute LGIB, there is no evidence that urgent colonoscopy reduces mortality, rebleeding or requirement for surgery or that it improves the rate of identification of the bleeding source. However, urgent colonoscopy does increase the rate of detection of stigmata of recent hemorrhage. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  6. Borehole Data Package for 1998 Wells Installed at Single-Shell Tank Waste Management Area TX-TY

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

    DG Horton; FN Hodges

    1999-03-23

    Four new Resource Conservation and Recovery Act (RCRA) groundwater monitoring wells were installed at the single-shell tank farm Waste Management Area (WMA) TX-TY during August through November of 1998 in fi,dfillment of Tri-Party Agreement (Eoology 1996) milestone M-24-38. The wells are 299-W1O-26, 299-W14-13, 299-W14-14, and 299-W15-40. Well 299-W1O-26 is located outside the east fence of the TY tank farm and replaces downgradient well299-W1O-18; well 299-W14-13 is located along the east fence near the northeast corner of the TX tank f- and replaces downgradient well 299-W14-12; well 299-W14-14 is located outside the east fence in the south ha.lfof the TX tankmore » fiirm and is anew downgradient well; and well 299-W15-40 is located on the west side of the TX tank farm and is anew upgradient well. The locations of all wells in the monitoring network are shown on Figure 1. The groundwater monitoring plan for WMA TX-TY (Caggiano and Goodwin 1991) describes the hydrogeology of the 200 West Area and WMA TX-TY. An Interim Change Notice to the groundwater monitoring plan provides justification for the new wells. The new wells were constructed to the speciii- cations and requirements described in Washington Administrative Code (WAC) 173-160 and WAC 173-303. This document compiles &fiormation on the drilling and construction, well development pump instal- latio~ groundwater sampling, and sediment testing applicable to wells 299-W1O-26, 299-W14-13, 299-W14-14, and 299-W15-40. Appendix A contains the geologist's log, the Well Construction Sum- mary Repo~ and Well Summary Sheet (as-built diagram); Appendix B contains results of laboratory analyses of particle size distribution, p~ conductivity, calcium carbonate conten~ major cation and anion concentrations from 1:1 water: sediment extracts, and moisture conten~ Appendix C contains geophysical logs; and Appendix D contains the analytical results from groundwater samples obtained during well construction. Aqutier tests (slug tests) were performed on all the new wells after well completions. Results of the aquifer tests will be reported elsewhere. Additiond documentation concerning well construction is on fde with Bechtel Hanfor& Inc., Richland, Washington.« less

  7. Parental satisfaction with paediatric care, triage and waiting times.

    PubMed

    Fitzpatrick, Nicholas; Breen, Daniel T; Taylor, James; Paul, Eldho; Grosvenor, Robert; Heggie, Katrina; Mahar, Patrick D

    2014-04-01

    The present study aims to determine parental and guardian's perceptions of paediatric emergency care and satisfaction with care, waiting times and triage category in a community ED. A structured questionnaire was provided to parents or guardians of paediatric patients presenting to emergency. The survey evaluated parent perceptions of waiting time, environment/facilities, professionalism and communication skills of staff and overall satisfaction of care. One hundred and thirty-three completed questionnaires were received from parents of paediatric patients. Responses were overall positive with respect to the multiple domains assessed. Parents generally considered waiting times to be appropriate and consistent with triage categories. Overall satisfaction was not significantly different for varying treatment or waiting times. Patients triaged as semi-urgent were of the opinion that waiting times were less appropriate than urgent, less-urgent or non-urgent patients. On the basis of the present study, patient perceptions and overall satisfaction of care does not appear to be primarily influenced by time spent waiting or receiving treatment. Attempts made at the triage process to ensure that semi-urgent patients have reasonable expectations of waiting times might provide an opportunity to improve these patients' expectations and perceptions. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  8. 75 FR 67015 - Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-01

    ... September 3, 2010 Unexpected Urgent Refugee And Migration Needs Resulting From Flooding InPakistan... humanitarian needs resulting from recent devastating flooding in Pakistan. You are authorized and directed to...

  9. 75 FR 34617 - Unexpected Urgent Refugee and Migration Needs Related to Somalia and Food Pipeline Breaks for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-18

    ... unexpected and urgent refugee and migration needs, including by contributions to international, governmental, and nongovernmental organizations and payment of administrative expenses of the Bureau of Population...

  10. 75 FR 67013 - Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-01

    ... August 26, 2010 Unexpected Urgent Refugee and Migration Needs Resulting from Violence in Kyrgyzstan... humanitarian needs resulting from recent violence in Kyrgyzstan. You are authorized and directed to publish...

  11. The RADCAT-3 system for closing the loop on important non-urgent radiology findings: a multidisciplinary system-wide approach.

    PubMed

    Dibble, Elizabeth H; Swenson, David W; Cobb, Cynthia; Paul, Timothy J; Karn, Andrew E; Portelli, David C; Movson, Jonathan S

    2017-04-01

    The goal of this project was to create a system that was easy for radiologists to use and that could reliably identify, communicate, and track communication of important but non-urgent radiology findings to providers and patients. Prior to 2012, our workflow for communicating important non-urgent diagnostic imaging results was cumbersome, rarely used by our radiologists, and resulted in delays in report turnaround time. In 2012, we developed a new system to communicate important non-urgent findings (the RADiology CATegorization 3 (RADCAT-3) system) that was easy for radiologists to use and documented communication of results in the electronic medical record. To evaluate the performance of the new system, we reviewed our radiology reports before (June 2011-June 2012) and after (June 2012-June 2014) the implementation of the new system to compare utilization by the radiologists and success in communicating these findings. During the 12 months prior to implementation, 250 radiology reports (0.06 % of all reports) entered our workflow for communicating important non-urgent findings. One-hundred percent were successfully communicated. During the 24 months after implementation, 13,158 radiology reports (1.4 % of all reports) entered our new RADCAT-3 workflow (3995 (0.8 % of all reports) during year 1 and 9163 (1.9 % of all reports) during year 2). 99.7 % of those reports were successfully communicated. We created a reliable system to ensure communication of important but non-urgent findings with providers and/or patients and to document that communication in the electronic medical record. The rapid adoption of the new system by radiologists suggests that they found it easy to use and had confidence in its integrity. This system has the potential to improve patient care by improving the likelihood of appropriate follow-up for important non-urgent findings that could become life threatening.

  12. Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program

    PubMed Central

    Alkatheeri, Ali M.A.; Blake, Peter G.; Gray, Daryl; Jain, Arsh K.

    2016-01-01

    ♦ Background: Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ Methods: In this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting. ♦ Results: Thirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7 %) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0 – 13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3 %) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch. ♦ Conclusions: Our results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access. PMID:26374834

  13. Success of Urgent-Start Peritoneal Dialysis in a Large Canadian Renal Program.

    PubMed

    Alkatheeri, Ali M A; Blake, Peter G; Gray, Daryl; Jain, Arsh K

    2016-01-01

    ♦ Many patients start renal replacement therapy urgently on in-center hemodialysis via a central venous catheter, which is considered suboptimal. An alternative approach to manage these patients is to start them on peritoneal dialysis (PD). In this report, we describe the first reported Canadian experience with an urgent-start PD program. Additionally we reviewed the literature in this area. ♦ In this prospective observational study, we report on our experience in a single academic center. This program started in July 2010. We included patients who initiated PD urgently, that is within 2 weeks of catheter insertion. We followed all incident PD patients until October 2013 for mechanical and infectious complications. Peritoneal dialysis catheters were inserted either percutaneously or laparoscopically and dialysis was initiated in either an inpatient or outpatient setting. ♦ Thirty patients were started on urgent PD during our study period. Follow-up ranged from 28 to 1,050 days. Twenty insertions (66.7%) were done percutaneously and 10 (33.3%) were laparoscopic. Dialysis was initiated within 2 weeks (range: 0-13 days, median = 6 days). Twenty-four patients (80%) started PD in an outpatient setting and 6 patients (20%) required immediate inpatient PD start. Three patients (10%) developed a minor peri-catheter leak during the first week of training that was managed conservatively. There were no episodes of peritonitis or exit-site/tunnel infection during the first 4 weeks post-insertion. Four patients (13.3%) from the percutaneous insertion group and 2 patients (6.7%) from laparoscopic insertions developed catheter dysfunction due to migration, which was managed by repositioning, without need for catheter replacement or modality switch. ♦ Our results are consistent with other studies in this area and demonstrate that urgent-start PD is an acceptable and safe alternative to hemodialysis in patients who need to start dialysis urgently without established dialysis access. Copyright © 2016 International Society for Peritoneal Dialysis.

  14. [Emergency Surgery and Treatments for Pneumothorax].

    PubMed

    Kurihara, Masatoshi

    2015-07-01

    The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

  15. The Lived Experiences of Persons Hospitalized for Construction of an Urgent Fecal Ostomy.

    PubMed

    Herlufsen, Per; Brødsgaard, Anne

    The purpose of this study was to describe the lived experiences of hospital stays for patients undergoing urgent ostomy surgery. Qualitative, descriptive, phenomenological study. Six persons undergoing acute hospital admission and urgent ileostomy or colostomy surgery (either permanent or temporary) participated in the study. Participants were of Danish ethnicity and between the ages of 48 and 75 years. The research setting was the surgical department at a university hospital in the Capital Region of Denmark. Data collection and analyses were guided by a Reflective Lifeworld Research approach; this approach is based on phenomenological philosophy. Data were collected during in-depth interviews using a semistructured interview guide. Their average length was 50 minutes (range, 30-65 minutes). Interviews were digitally recorded and transcribed. Transcriptions were analyzed in 4 phases according to the principles of Reflective Lifeworld Research. The phenomenon we labeled "lived experiences of acute hospitalization with construction of an urgent unplanned fecal ostomy" comprised 4 constituents: (1) undergoing unexpected bodily changes, (2) partnership with professional caregivers, (3) experience of vulnerability, and (4) a lack of continuity. These constituents can be described as a number of challenges due to both hospitalization and ostomy creation. We found that individuals experience a number of challenges due to acute hospitalization and urgent construction of a fecal ostomy. These challenges are due to the unexpected bodily changes and interpersonal and organizational conditions. Nurses should be aware of not only the physical implications of urgent creation of a fecal ostomy but also the individual and psychological implications of this event.

  16. Impact of continuing medical education in cancer diagnosis on GP knowledge, attitude and readiness to investigate - a before-after study.

    PubMed

    Toftegaard, Berit Skjødeberg; Bro, Flemming; Falborg, Alina Zalounina; Vedsted, Peter

    2016-07-26

    Continuing medical education (CME) in earlier cancer diagnosis was launched in Denmark in 2012 as part of the Danish National Cancer Plan. The CME programme was introduced to improve the recognition among general practitioners (GPs) of symptoms suggestive of cancer and improve the selection of patients requiring urgent investigation. This study aims to explore the effect of CME on GP knowledge about cancer diagnosis, attitude towards own role in cancer detection, self-assessed readiness to investigate and cancer risk assessment of urgently referred patients. We conducted a before-after study in the Central Denmark Region including 831 GPs assigned to one of eight geographical clusters. All GPs were invited to participate in the CME at three-week intervals between clusters. A questionnaire focusing on knowledge, attitude and clinical vignettes was sent to each GP one month before and seven months after the CME. The GPs were also asked to assess the risk of cancer in patients urgently referred to a fast-track cancer pathway during an eight-month period. CME-participating GPs were compared with reference (non-participating) GPs by analysing before-after differences. One quarter of all GPs participated in the CME. 202 GPs (24.3 %) completed both the baseline and the follow-up questionnaires. 532 GPs (64.0 %) assessed the risk of cancer before the CME and 524 GPs (63.1 %) assessed the risk of cancer after the CME in urgently referred consecutive patients. Compared to the reference group, CME-participating GPs statistically significantly improved their understanding of a rational probability of diagnosing cancer among patients urgently referred for suspected cancer, increased their knowledge of cancer likelihood in a 50-year-old referred patient and lowered the assessed risk of cancer in urgently referred patients. The standardised CME lowered the GP-assessed cancer risk of urgently referred patients, whereas the effect on knowledge about cancer diagnosis and attitude towards own role in cancer detection was limited. No effect was found on the GPs' readiness to investigate. CME may be effective for optimising the interpretation of cancer symptoms and thereby improve the selection of patients for urgent cancer referral. NCT02069470 on ClinicalTrials.gov. Retrospectively registered, 1/29/2014.

  17. Non-urgent accident and emergency department use as a socially shared custom: a qualitative study

    PubMed Central

    Keizer Beache, Simone; Guell, Cornelia

    2016-01-01

    Objective We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. Methods In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. Results In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. Conclusions We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. PMID:25841166

  18. [Urgent retinal detachment management by the National Health System of Spain. Project Retina 2].

    PubMed

    Rojas, J; Fernández, I; Pastor, J C; Gómez-Ulla, F; Piñero, A

    2007-05-01

    To identify problems in the urgent management of retinal detachments (RD) in hospitals of the Spanish National Health System (NHS). A questionnaire was submitted confidentially to the heads of Ophthalmic Departments of 217 hospitals of the NHS to obtain information on the management of urgent RD during the last year. Data was stored in a Microsoft Access database and statistically analyzed by Excel and Statgraphics. Qualitative variables were analyzed by Chi-Square and Fisher exact tests and quantitative variables by the Kruskall-Wallis test. A global response rate of 54.8% was achieved with higher participation of the Teaching Hospitals (TH). District Hospital and non-Teaching Hospital responses were similar and grouped as non-TH. Eighteen percent of centers, mostly non-TH, had no ophthalmologist on duty. Thirty-six percent had a vitreoretinal specialist on call. Eighty percent of centres admitted to have problems handling urgent RD during weekends. Twenty-four had no ophthalmic surgical theatre available. Fifty percent referred to have problems having an anaesthesiologist available and only 22% had ophthalmic trained personnel (nurses) available. Sixty-four percent of centres performed pars plana vitrectomy (PPV) and 77% of those were able to perform an urgent PPV. Ninety percent admitted that a patient with a macula-threatening RD occurring at the beginning of the week-end would not be treated until at least 24 hours had elapsed, although 84% considered this to be inadequate. Despite the methodological problems and bias of this questionnaire, we did identify several important problems in the management of urgent RD by NHS hospitals. The data obtained provides useful information to enable the quality of the NHS care of RD to be improved, particularly that available at the week-end.

  19. Upper Gastrointestinal Hemorrhage: Development of the Severity Score.

    PubMed

    Chaikitamnuaychok, Rangson; Patumanond, Jayanton

    2012-12-01

    Emergency endoscopy for every patient with upper gastrointestinal hemorrhage is not possible in many medical centers. Simple guidelines to select patients for emergency endoscopy are lacking. The aim of the present report is to develop a simple scoring system to classify upper gastrointestinal hemorrhage (UGIH) severity based on patient clinical profiles at the emergency departments. Retrospective data of patients with UGIH in a university affiliated hospital were analyzed. Patients were criterion-classified into 3 severity levels: mild, moderate and severe. Clinical and laboratory information were compared among the 3 groups. Significant parameters were selected as indicators of severity. Coefficients of significant multivariable parameters were transformed into item scores, which added up as individual severity scores. The scores were used to classify patients into 3 urgency levels: non-urgent, urgent and emergent groups. Score-classification and criterion-classification were compared. Significant parameters in the model were age ≥ 60 years, pulse rate ≥ 100/min, systolic blood pressure < 100 mmHg, hemoglobin < 10 g/dL, blood urea nitrogen ≥ 35 mg/dL, presence of cirrhosis and hepatic failure. The score ranged from 0 to 27, and classifying patients into 3 urgency groups: non-urgent (score < 4, n = 215, 21.2%), urgent (score 4 - 16, n = 677, 66.9%) and emergent (score > 16, n = 121, 11.9%). The score correctly classified 81.4% of the patients into their original (criterion-classified) severity groups. Under-estimation (7.5%) and over-estimation (11.1%) were clinically acceptable. Our UGIH severity scoring system classified patients into 3 urgency groups: non-urgent, urgent and emergent, with clinically acceptable small number of under- and over-estimations. Its discriminative ability and precision should be validated before adopting into clinical practice.

  20. Uncovering factors affecting use of the emergency department for less urgent health problems in urban and rural areas.

    PubMed

    Hodgins, Marilyn J; Wuest, Judith

    2007-09-01

    People who access the emergency department for less urgent health problems have been described as inappropriate users of the health-care system.Yet little is known about the factors precipitating such use and how these differ based on location of the emergency department. In this descriptive-correlational study guided by Andersen's Model of Health Services Use, 1612 people who presented to an emergency department with a less urgent health problem were interviewed. Analysis revealed rural/urban differences in the characteristics of patients, nature of the problems, actions taken, and factors precipitating the visit. Despite its popularity, the predictive capabilities of Andersen's model were limited in explaining use of self-treatment or willingness to wait for treatment. The findings show that an emergency department's roles and functions vary according to its location. Such insights provide direction for developing services that respond to the needs of people with less urgent health problems that are cognizant of geographic location.

  1. Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006-2010: an observational study.

    PubMed

    Chen, Brian K; Hibbert, James; Cheng, Xi; Bennett, Kevin

    2015-03-21

    Use of the hospital emergency department (ED) for medical conditions not likely to require immediate treatment is a controversial topic. It has been faulted for ED overcrowding, increased expenditures, and decreased quality of care. On the other hand, such avoidable ED utilization may be a manifestation of barriers to primary care access. A random 10% subsample of all ED visits with unmasked variables, or approximately 7.2% of all ED visits in California between 2006 and 2010 are used in the analysis. Using panel data methods, we employ linear probability and fractional probit models with hospital fixed effects to analyze the associations between avoidable ED utilization in California and observable patient characteristics. We also test whether shorter estimated road distances to the hospital ED are correlated with non-urgent ED utilization, as defined by the New York University ED Algorithm. We then investigate whether proximity of a Federally Qualified Health Center (FQHC) is correlated with reductions in non-urgent ED utilization among Medicaid patients. We find that relative to the reference group of adults aged 35-64, younger patients generally have higher scores for non-urgent conditions and lower scores for urgent conditions. However, elderly patients (≥65) use the ED for conditions more likely to be urgent. Relative to male and white patients, respectively, female patients and all identified racial and ethnic minorities use the ED for conditions more likely to be non-urgent. Patients with non-commercial insurance coverage also use the ED for conditions more likely to be non-urgent. Medicare and Medicaid patients who live closer to the hospital ED have higher probability scores for non-emergent visits. However, among Medicaid enrollees, those who live in zip codes with an FQHC within 0.5 mile of the zip code population centroid visit the ED for medical conditions less likely to be non-emergent. These patterns of ED utilization point to potential barriers to care among historically vulnerable groups, observable even when using rough estimates of travel distances and avoidable ED utilization.

  2. Derivation and validation of a diagnostic score based on case-mix groups to predict 30-day death or urgent readmission.

    PubMed

    van Walraven, Carl; Wong, Jenna; Forster, Alan J

    2012-01-01

    Between 5% and 10% of patients die or are urgently readmitted within 30 days of discharge from hospital. Readmission risk indexes have either excluded acute diagnoses or modelled them as multiple distinct variables. In this study, we derived and validated a score summarizing the influence of acute hospital diagnoses and procedures on death or urgent readmission within 30 days. From population-based hospital abstracts in Ontario, we randomly sampled 200 000 discharges between April 2003 and March 2009 and determined who had been readmitted urgently or died within 30 days of discharge. We used generalized estimating equation modelling, with a sample of 100 000 patients, to measure the adjusted association of various case-mix groups (CMGs-homogenous groups of acute care inpatients with similar clinical and resource-utilization characteristics) with 30-day death or urgent readmission. This final model was transformed into a scoring system that was validated in the remaining 100 000 patients. Patients in the derivation set belonged to 1 of 506 CMGs and had a 6.8% risk of 30-day death or urgent readmission. Forty-seven CMG codes (more than half of which were directly related to chronic diseases) were independently associated with this outcome, which led to a CMG score that ranged from -6 to 7 points. The CMG score was significantly associated with 30-day death or urgent readmission (unadjusted odds ratio for a 1-point increase in CMG score 1.52, 95% confidence interval [CI] 1.49-1.56). Alone, the CMG score was only moderately discriminative (C statistic 0.650, 95% CI 0.644-0.656). However, when the CMG score was added to a validated risk index for death or readmission, the C statistic increased to 0.759 (95% CI 0.753-0.765). The CMG score was well calibrated for 30-day death or readmission. In this study, we developed a scoring system for acute hospital diagnoses and procedures that could be used as part of a risk-adjustment methodology for analyses of postdischarge outcomes.

  3. A new strategy for in vivo spectral editing. Application to GABA editing using selective homonuclear polarization transfer spectroscopy

    NASA Astrophysics Data System (ADS)

    Shen, Jun; Yang, Jehoon; Choi, In-Young; Li, Shizhe Steve; Chen, Zhengguang

    2004-10-01

    A novel single-shot in vivo spectral editing method is proposed in which the signal to be detected, is regenerated anew from the thermal equilibrium magnetization of a source to which it is J-coupled. The thermal equilibrium magnetization of the signal to be detected together with those of overlapping signals are suppressed by single-shot gradient dephasing prior to the signal regeneration process. Application of this new strategy to in vivo GABA editing using selective homonuclear polarization transfer allows complete suppression of overlapping creatine and glutathione while detecting the GABA-4 methylene resonance at 3.02 ppm with an editing yield similar to that of conventional editing methods. The NAA methyl group at 2.02 ppm was simultaneously detected and can be used as an internal navigator echo for correcting the zero order phase and frequency shifts and as an internal reference for concentration. This new method has been demonstrated for robust in vivo GABA editing in the rat brain and for study of GABA synthesis after acute vigabatrin administration.

  4. Aveiro method in reproducing kernel Hilbert spaces under complete dictionary

    NASA Astrophysics Data System (ADS)

    Mai, Weixiong; Qian, Tao

    2017-12-01

    Aveiro Method is a sparse representation method in reproducing kernel Hilbert spaces (RKHS) that gives orthogonal projections in linear combinations of reproducing kernels over uniqueness sets. It, however, suffers from determination of uniqueness sets in the underlying RKHS. In fact, in general spaces, uniqueness sets are not easy to be identified, let alone the convergence speed aspect with Aveiro Method. To avoid those difficulties we propose an anew Aveiro Method based on a dictionary and the matching pursuit idea. What we do, in fact, are more: The new Aveiro method will be in relation to the recently proposed, the so called Pre-Orthogonal Greedy Algorithm (P-OGA) involving completion of a given dictionary. The new method is called Aveiro Method Under Complete Dictionary (AMUCD). The complete dictionary consists of all directional derivatives of the underlying reproducing kernels. We show that, under the boundary vanishing condition, bring available for the classical Hardy and Paley-Wiener spaces, the complete dictionary enables an efficient expansion of any given element in the Hilbert space. The proposed method reveals new and advanced aspects in both the Aveiro Method and the greedy algorithm.

  5. 2014 Summer Series - J. Craig Venter - Life at the Speed of Light

    NASA Image and Video Library

    2014-06-24

    In 2010, J. Craig Venter and his team at the Venter Institute became the first to successfully construct synthetic life, putting humankind at the threshold of the most important and exciting phase of biological research, one that will enable us to actually write the genetic code for designing new species that can be used in many ways for the betterment of mankind. The science of synthetic genomics will have a profound impact on human existence, including new chemical and energy generation, human health and medical advances, clean water and food production, positive environmental impact, and possibly even our evolution. In Life at the Speed of Light, Venter presents a fascinating and authoritative study of this emerging field from the inside, detailing its origins, current challenges and controversies, and projected effects on our lives. This scientific frontier provides an opportunity to ponder anew the age-old question: What is life? Life at the Speed of Light is a landmark work, written by a visionary at the dawn of a new era of biological engineering.

  6. Theological misinterpretations of current physical cosmology

    NASA Astrophysics Data System (ADS)

    Grünbaum, Adolf

    1996-04-01

    In earlier writings, I argued that neither of the two major physical cosmologies of the 20th century support divine creation, so that atheism has nothing to fear from the explanations required by these cosmologies. Yet theists ranging from Augustine, Aquinas, Descartes, and Leibniz to Richard Swinburne and Philip Quinn have maintained that, at every instant anew, the existence of the world requires divine creation ex nihilo as its cause. Indeed, according to some such theists, for any given moment t. God's volition that the-world-should-exist-at-t supposedly brings about its actual existence at t. In an effort to reestablish the current viability of this doctrine of perpetual divine conservation. Philip Quinn argued (1993) that it is entirely compatible with physical energy conservation in the Big Bang cosmology, as well as with the physics of the steady-state theories. But I now contend that instead, there is a logical incompatibility on both counts. Besides, the stated tenet of divine conservation has an additional defect: It speciously purchases plausibility by trading on the multiply disanalogous volitional explanations of human actions.

  7. Evidence for a new geomagnetic reversal from lava flows in Idaho: discussion of short polarity reversals in the Brunhes and late Matuyama Polarity Chrons

    USGS Publications Warehouse

    Champion, D.E.; Lanphere, M.A.; Kuntz, M.A.

    1988-01-01

    K-Ar ages and paleomagnetic data for basalt samples from a new core hole (site E) at the Idaho National Engineering Laboratory (INEL) indicate that the age of the reversed polarity event recorded in Snake River Plain lavas is older than 465 ?? 50 ka (1000 years before present) reported previously by Champion et al. (1981). A review of data documenting short reversal records from volcanic and sedimentary rocks shows that there is evidence for eight polarity subchrons in the Brunhes and two besides the Jaramillo in the late Matuyama. These 10 short subchrons begin to indicate the many short events that Cox (1968) hypothesized must exist if polarity interval lengths have a Poisson distribution. The mean sustained polarity interval length since late Matuyama Chron time is 90 000 years. The similarity of this number with the 105-year period of the Earth's orbital eccentricity suggests anew that linkage between geomagnetic, paleoclimatic, and possible underlying Earth orbital parameters should be evaluated. -from Authors

  8. No grammatical gender effect on affective ratings: evidence from Italian and German languages.

    PubMed

    Montefinese, Maria; Ambrosini, Ettore; Roivainen, Eka

    2018-06-06

    In this study, we tested the linguistic relativity hypothesis by studying the effect of grammatical gender (feminine vs. masculine) on affective judgments of conceptual representation in Italian and German. In particular, we examined the within- and cross-language grammatical gender effect and its interaction with participants' demographic characteristics (such as, the raters' age and sex) on semantic differential scales (affective ratings of valence, arousal and dominance) in Italian and German speakers. We selected the stimuli and the relative affective measures from Italian and German adaptations of the ANEW (Affective Norms for English Words). Bayesian and frequentist analyses yielded evidence for the absence of within- and cross-languages effects of grammatical gender and sex- and age-dependent interactions. These results suggest that grammatical gender does not affect judgments of affective features of semantic representation in Italian and German speakers, since an overt coding of word grammar is not required. Although further research is recommended to refine the impact of the grammatical gender on properties of semantic representation, these results have implications for any strong view of the linguistic relativity hypothesis.

  9. Fragmentation Energy-Saving Theory of Full Face Rock Tunnel Boring Machine Disc Cutters

    NASA Astrophysics Data System (ADS)

    Zhang, Zhao-Huang; Gong, Guo-Fang; Gao, Qing-Feng; Sun, Fei

    2017-07-01

    Attempts to minimize energy consumption of a tunnel boring machine disc cutter during the process of fragmentation have largely focused on optimizing disc-cutter spacing, as determined by the minimum specific energy required for fragmentation; however, indentation tests showed that rock deforms plastically beneath the cutters. Equations for thrust were developed for both the traditional, popularly employed disc cutter and anew design based on three-dimensional theory. The respective energy consumption for penetration, rolling, and side-slip fragmentations were obtained. A change in disc-cutter fragmentation angles resulted in a change in the nature of the interaction between the cutter and rock, which lowered the specific energy of fragmentation. During actual field excavations to the same penetration length, the combined energy consumption for fragmentation using the newly designed cutters was 15% lower than that when using the traditional design. This paper presents a theory for energy saving in tunnel boring machines. Investigation results showed that the disc cutters designed using this theory were more durable than traditional designs, and effectively lowered the energy consumption.

  10. Policing native pleasures: a colonial history.

    PubMed

    Jabbar, Naheem

    2012-12-01

    The moral modality of colonial power is still with us when it comes to the recreation of sexual norms of traditional or feudal society. We can examine the emergent properties of colonial knowledge anew by exploring how the colonial regime's strategic attention of regulating brothels in India differed from the analytic of power Foucault described for sexuality in European society. It turns out that amongst other things, public anxieties about the failure of adaptation by South Asians are incapable of leaving sexuality aside as a key interpretive device for their culture. The British preoccupation with reproducing the dynamics of the bourgeois matrimonial market on foreign soil in the mid-nineteenth century similarly necessitated a sociological pretext for racial purity. However, the kind of knowledge a typical traveller and employee of the East India Company brought to the Victorian public from his own researches in the brothels and streets of colonial India, which revealed how popular prostitution was as a vice amongst the officer class, was also more than a welcome imaginary relief from Christian morality; it was an alternative vision of modernity. © London School of Economics and Political Science 2012.

  11. Swept Light Sources

    NASA Astrophysics Data System (ADS)

    Johnson, Bart; Atia, Walid; Kuznetsov, Mark; Cook, Christopher; Goldberg, Brian; Wells, Bill; Larson, Noble; McKenzie, Eric; Melendez, Carlos; Mallon, Ed; Woo, Seungbum; Murdza, Randal; Whitney, Peter; Flanders, Dale

    A 1060 nm OEM laser "engine", manufactured by Axsun Technologies, is described. It consists of a swept laser and control electronics coupled with a balanced receiver, k-clock, and a 550 MS/s data acquisition board. The laser's passive mode-locking behavior induced by the rapid wavelength sweep is discussed. As they pass though the gain medium, each pulse is shifted to longer wavelength due to the rise in refractive index associated with gain depletion. New, longer wavelengths, are thus created by nonlinear means rather than by building up anew from spontaneous emission. This nonlinear mechanism enables low noise operation and fast sweep rates. The so-called "coherence revival" phenomenon associated with interference between neighboring mode-locked pulses, is discussed. Typical laser and system data is shown, including k-clock frequency, trigger waveform, pulsed and average output powers and RIN. Receiver and DAQ board noise performance is quantified. The laser RIN is estimated to be lower than -150 dB/Hz. A typical shot-noise-limited sensitivity of 103 dB is achieved for 1.9 mW sample power. The engine is designed for ophthalmic imaging and retinal images from prototype commercial systems are presented.

  12. Spitzer observatory operations: increasing efficiency in mission operations

    NASA Astrophysics Data System (ADS)

    Scott, Charles P.; Kahr, Bolinda E.; Sarrel, Marc A.

    2006-06-01

    This paper explores the how's and why's of the Spitzer Mission Operations System's (MOS) success, efficiency, and affordability in comparison to other observatory-class missions. MOS exploits today's flight, ground, and operations capabilities, embraces automation, and balances both risk and cost. With operational efficiency as the primary goal, MOS maintains a strong control process by translating lessons learned into efficiency improvements, thereby enabling the MOS processes, teams, and procedures to rapidly evolve from concept (through thorough validation) into in-flight implementation. Operational teaming, planning, and execution are designed to enable re-use. Mission changes, unforeseen events, and continuous improvement have often times forced us to learn to fly anew. Collaborative spacecraft operations and remote science and instrument teams have become well integrated, and worked together to improve and optimize each human, machine, and software-system element. Adaptation to tighter spacecraft margins has facilitated continuous operational improvements via automated and autonomous software coupled with improved human analysis. Based upon what we now know and what we need to improve, adapt, or fix, the projected mission lifetime continues to grow - as does the opportunity for numerous scientific discoveries.

  13. Genome-Scale Variation of Tubeworm Symbionts

    NASA Astrophysics Data System (ADS)

    Robidart, J.; Felbeck, H.

    2005-12-01

    Hydrothermal vent tubeworms are completely dependent on their bacterial symbionts for nutrition. Despite this dependency, many studies have concluded that bacterial symbionts are acquired anew from the environment, every generation rather than the more reliable mode of symbiont transmission from parent directly to offspring. Ribosomal 16S sequences have shown little variation of symbiont phylogeny from worm to worm, but higher resolution genome-scale analyses have found that there is genomic heterogeneity between symbionts from worms in different environments. What genes can be "spared," while resulting in an intact symbiosis? Have symbionts from one environment gained physiological capabilities that make them more fit in that environment? In order to answer these questions, subtractive hybridization was used on symbionts of Riftia pachyptila tubeworms from different environments to gain insight into which genes are present in one symbiont and absent in the other. Many genes were found to be unique to each symbiont and these results will be presented. This technique will be applied to answer many fundamental questions regarding microbial symbiont evolution to a specific physico-chemical environment, to a different host species, and more.

  14. Insulation co-ordination aspects for power stations with generator circuit-breakers

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

    Sanders, M.; Koeppl, G.; Kreuzer, J.

    1995-07-01

    The generator circuit-breaker (gen. c.b.) located between the generator and the step-up transformer, is now being applied world-wide. It has become a recognized electrical component of power stations which is largely due to economical advantages and increased power station availability. Technical protection considerations for power stations have always been the reason for discussion and the object of improvement. With the use of a gen. c.b., some points of view need to be considered anew. Not only the protection system in case of fault conditions will be influenced, but also the insulation co-ordination philosophy. Below the results of some calculations concerningmore » expected overvoltages are presented. These calculations are based on a transformer rated 264/15.5kV, 220 MVA. But the results are transferable to other power plants. Some measurements carried out on a transformer of the same rating complement the calculations. The findings may contribute to an improvement in insulation co-ordination and protection of the electrical system generator--step-up transformer.« less

  15. The relationship between demand and need for orthodontic treatment in high school students in Bangkok.

    PubMed

    Atisook, Pitraporn; Chuacharoen, Rattiya

    2014-07-01

    Orthodontic service is limited in Thailand and cannot meet the demand of the population. (1) To assess the need for orthodontic treatment (OT) using the Index of Orthodontic Treatment Need (IOTN) to analyze the relationship between demand and need for OT and (2) to compare the demand and need for OT between genders. A cross-sectional study was conducted on 450 students aged 12- to 14-years-old in three government high schools in Bangkok. A constructed questionnaire was used to assess demand for OT Clinical examination was done by two orthodontists to determine the needfor OT using the IOTN RESULTS: Most of the students (74.0%) wished to have OT while only one-third (37.5%) had severe need, and one-third (34.4%) had moderate need for OT as judge by the DHC of the IOTN. The AC of the IOTN indicated that most students (55.8%) had mild or no need for OT Females (79%) demanded OT more than males (66% p-value = 0.033) but the need was similar in both sexes. Most functional factors had strong relationships with the demand for OTexcept lower teeth bite on palate, but none was found to be associated with need for OT All of the aesthetic factors had strong relationships with demand for OT There were significant relationships with needs in five categories, 1) crooked, crowded, or spacing teeth, 2) worried when speaking or smiling, 3) had suggestedfor OT 4) breath smell and halitosis, and 5) wanted to put on braces to be like other people or for fashionable reasons. Most of the students requested OT but females had significantly higher demand for OT than males. Most of the samples needed to have OT The aesthetic factors that had strong relationships with the need for OT were 1) crooked, crowded, or spacing teeth, 2) worried when speaking or smiling, 3) had suggested for T07 4) breath smell and halitosis, and 5) wanted to put on braces to be like otherpeople orfor fashionable reasons.

  16. Urgent Aeromedical Evacuation Network Capacity Planning

    DTIC Science & Technology

    2013-03-01

    What if AMC had one strategically positioned AC for the Urgent / Priority AE mission and the redistribution needs they encounter? This idea stems ...KtMI~rAFB _~...,_ Po~AFB ;------------~ Service Tirr~e Estimates I CO\\" CLl "SIO\\" • C-378 performs bestfrom a cost perspective • Contracted

  17. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section 405.440 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.440...

  18. Urgent Medical Assessment after Child Sexual Abuse

    ERIC Educational Resources Information Center

    Palusci, Vincent J.; Cox, Edward O.; Shatz, Eugene M.; Schultze, Joel M.

    2006-01-01

    Background: Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or…

  19. Improving Education and Training for Educational Administrators and Managers: Urgent Needs.

    ERIC Educational Resources Information Center

    Hughes, M. G.

    This paper advocates giving urgent attention to improving the education and training of educational administrators and managers, realizing the need to respond to rapid and far-reaching political and social change worldwide, and to consequent change within national educational systems. The improvement of administrative structures and the…

  20. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... means of transportation would endanger the beneficiary's health. (b) Emergency and urgently needed... temporarily absent from the MA plan's service (or, if applicable, continuation) area (or, under unusual and... organization's provider network is temporarily unavailable or inaccessible) when the services are medically...

  1. Health Needs of Urban Blacks.

    ERIC Educational Resources Information Center

    Blackwell, James E.; And Others

    Interviews were conducted with 237 adult blacks in the Boston area to determine their most urgent needs and the most urgent needs of blacks in general, to characterize the information flow from health services agencies, and to characterize access to and utilization of health services. The respondents ranked better economic conditions, family and…

  2. 3 CFR - Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 3 The President 1 2010-01-01 2010-01-01 false Unexpected Urgent Refugee and Migration Needs Related to the Continuing Conflict in Pakistan Presidential Documents Other Presidential Documents... to the Continuing Conflict in Pakistan Memorandum for the Secretary of State By the authority vested...

  3. 76 FR 35000 - Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-15

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Heartland Alliance, Chicago, IL AGENCY: Office of Refugee Resettlement, ACF, HHS. ACTION... technical assistance on incoming Lesbian, Gay, Bi- Sexual and Transgender (LGBT) refugee cases to Heartland...

  4. 78 FR 25455 - Announcement of the Award of Three Urgent Single-Source Grants To Support Shelter Care for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-01

    ... Unaccompanied Alien Children AGENCY: Office of Refugee Resettlement, Administration for Children and Families... of three urgent single-source grants from the Unaccompanied Alien Children's Program to KidsPeace in... capacity and supportive services to meet the number of unaccompanied alien children referrals from the...

  5. 29 CFR 570.52 - Occupations of motor-vehicle driver and outside helper (Order 2).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... urgent, time-sensitive deliveries means trips which, because of such factors as customer satisfaction... for the purpose of delivering goods of the minor's employer to a customer (except urgent, time... delivery of pizzas and prepared foods to the customer; the delivery of materials under a deadline (such as...

  6. Forum: Communication Activism Pedagogy. A Call for an Ethic of Transformation in Communication Activism Education

    ERIC Educational Resources Information Center

    Artz, Lee

    2017-01-01

    Lawrence Frey and David Palmer present a provocative call for communication education and research that is urgent and opportune in this forum's stimulus essay, "Communication Activism Pedagogy and Research: Communication Education Scholarship to Promote Social Justice." The call is urgent because the global human condition--including…

  7. 77 FR 21389 - Unexpected Urgent Refugee and Migration Needs

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-10

    ... April 3, 2012 Unexpected Urgent Refugee and Migration Needs Memorandum for the Secretary of State By the... 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C... United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting unexpected and...

  8. 76 FR 14271 - Unexpected Urgent Refugee and Migration Needs Related to Libya

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-16

    ... March 7, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya Memorandum for the... States, including section 2(c)(1) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as... million from the United States Emergency Refugee and Migration Assistance Fund, for the purpose of meeting...

  9. Prognostic impact of terminal T wave inversions on presentation in patients with ST-elevation myocardial infarction undergoing urgent percutaneous coronary intervention.

    PubMed

    Shimada, Yuichi J; Po, Jose Ricardo F; Kanei, Yumiko; Schweitzer, Paul

    2013-01-01

    Terminal T wave inversions (TTWI) indicate advanced stages of ST-elevation myocardial infarction (STEMI). The present study investigated whether TTWI predict unfavorable in-hospital outcomes in STEMI patients treated with urgent percutaneous coronary intervention (PCI). A retrospective cohort study was performed with consecutive 188 STEMI cases undergoing urgent PCI. The primary endpoint was in-hospital major adverse cardiac event (MACE), and the secondary endpoints were ST resolution (STR) after PCI and length of stay (LOS). TTWI on presentation were independently associated with higher incidence of in-hospital MACE (adjusted OR 2.8; 95% CI 1.1-7.0; p=0.03), inadequate STR (adjusted OR 5.5; 95% CI 2.1-14.3; p=0.01), and longer LOS (adjusted mean increase 4.1 days; 95% CI 0.3-7.9; p=0.03). TTWI predicted these outcomes better than patient-reported ischemic time or pathologic Q waves. TTWI on presentation are an independent risk factor for poor inpatient prognosis among patients presenting with STEMI undergoing urgent PCI. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Non-urgent accident and emergency department use as a socially shared custom: a qualitative study.

    PubMed

    Keizer Beache, Simone; Guell, Cornelia

    2016-01-01

    We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Analysis of the availability of the resources necessary for urgent and emergency healthcare in São Paulo between 2009-2013.

    PubMed

    Coimbra, Silvana Hebe; Camanho, Eliete Dominguez Lopez; Heringer, Lindolfo Carlos; Botelho, Ricardo Vieira; Vasconcellos, Cidia

    2017-06-01

    The Regulatory Complex is the structure that operationalizes actions for making resources available to meet the needs of urgent and emergency care in the municipality of São Paulo. In the case of urgent care, needs are immediate and associated with high morbidity and mortality. To identify the most frequently requested resources, the resolution capacity and the mortality rate associated with the unavailability of a certain resource. Our study was based on data from medical bulletins issued by the Urgent and Emergency Regulation Center (CRUE) in the city of São Paulo from 2009 to 2013. 91,823 requests were made over the five years of the study (2009 to 2013). Neurosurgery requests were the most frequent in all years (4,828, 5,159, 4,251, 5,008 and 4,394, respectively), followed by computed tomography (CT) scans, adult intensive care unit (ICU) beds, cardiac catheterization, and pediatric ICU beds. On average, requests for neurosurgery, adult ICU, pediatric ICU, CT scans, catheterization and vascular surgery were answered in 70%, 27%, 39%, 97%, 87% and 77% of cases. The total number of deaths relating to requests for neurosurgery, CT scans, adult ICU, pediatric ICU, catheterization and vascular surgeon assessment were 182, 9, 1,536, 1,536, 135, 49 and 24 cases, respectively. There is a lack of resources to meet urgent and emergency needs in the city of São Paulo.

  12. Alternative Destination Transport? The Role of Paramedics in Optimal Use of the Emergency Department

    PubMed Central

    Neeki, Michael M.; Dong, Fanglong; Avera, Leigh; Than, Tan; Borger, Rodney; Powell, Joe; Vaezazizi, Reza; Pitts, Richard

    2016-01-01

    Introduction Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient’s acuity level to determine the need to transport to an ED. Methods We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients’ acuity level in a large Level II trauma center between April 2015 and November 2015. Under-triage was defined as lower acuity assessed by paramedics but higher acuity by EPs. Over-triage was defined as higher acuity assessed by paramedics but lower acuity by EPs. The degree of agreement between the paramedics and EPs’ evaluations of patient’s acuity level was compared using Chi-square test. Results We included a total of 503 patients in the final analysis. For paramedics, 2 51 (49.9%) patients were assessed to be emergent, 178 (35.4%) assessed as urgent, and 74 (14.7%) assessed as non-emergent/non-urgent. In comparison, the EPs assessed 296 (58.9%) patients as emergent, 148 (29.4%) assessed as urgent, and 59 (11.7%) assessed as non-emergent/non-urgent. Paramedics agreed with EPs regarding the acuity level assessment on 71.8% of the cases. The overall under- and over-triage were 19.3% and 8.9%, respectively. A moderate Kappa=0.5174 indicated moderate inter-rater agreement between paramedics’ and EPs’ assessment on the same cohort of patients. Conclusion There is a significant difference in paramedic and physician assessment of patients into emergent, urgent, or non-emergent/non-urgent categories. The field triage of a patient to an alternative destination by paramedics under their current scope of practice and training cannot be supported. PMID:27833674

  13. [Non elective cesarean section: use of a color code to optimize management of obstetric emergencies].

    PubMed

    Rudigoz, René-Charles; Huissoud, Cyril; Delecour, Lisa; Thevenet, Simone; Dupont, Corinne

    2014-06-01

    The medical team of the Croix Rousse teaching hospital maternity unit has developed, over the last ten years, a set of procedures designed to respond to various emergency situations necessitating Caesarean section. Using the Lucas classification, we have defined as precisely as possible the degree of urgency of Caesarian sections. We have established specific protocols for the implementation of urgent and very urgent Caesarean section and have chosen a simple means to convey the degree of urgency to all team members, namely a color code system (red, orange and green). We have set time goals from decision to delivery: 15 minutes for the red code and 30 minutes for the orange code. The results seem very positive: The frequency of urgent and very urgent Caesareans has fallen over time, from 6.1 % to 1.6% in 2013. The average time from decision to delivery is 11 minutes for code red Caesareans and 21 minutes for code orange Caesareans. These time goals are now achieved in 95% of cases. Organizational and anesthetic difficulties are the main causes of delays. The indications for red and orange code Caesarians are appropriate more than two times out of three. Perinatal outcomes are generally favorable, code red Caesarians being life-saving in 15% of cases. No increase in maternal complications has been observed. In sum: Each obstetric department should have its own protocols for handling urgent and very urgent Caesarean sections. Continuous monitoring of their implementation, relevance and results should be conducted Management of extreme urgency must be integrated into the management of patients with identified risks (scarred uterus and twin pregnancies for example), and also in structures without medical facilities (birthing centers). Obstetric teams must keep in mind that implementation of these protocols in no way dispenses with close monitoring of labour.

  14. C-Reactive Protein and White Blood Cell Count as Triage Test Between Urgent and Nonurgent Conditions in 2961 Patients With Acute Abdominal Pain

    PubMed Central

    Gans, Sarah L.; Atema, Jasper J.; Stoker, Jaap; Toorenvliet, Boudewijn R.; Laurell, Helena; Boermeester, Marja A.

    2015-01-01

    Abstract The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging. Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. Parameters of diagnostic accuracy were calculated for clinically applicable cutoff values of CRP levels and WBC count, and for combinations. A total of 2961 patients were included of which 1352 patients (45.6%) had an urgent final diagnosis. The median WBC count and CRP levels were significantly higher in the urgent group than in the nonurgent group (12.8 ×109/L; interquartile range [IQR] 9.9–16) versus (9.3 ×109/L; IQR 7.2–12.1) and (46 mg/L; IQR 12–100 versus 10 mg/L; IQR 7–26) (P < 0.001). The highest positive predictive value (PPV) (85.5%) and lowest false positives (14.5%) were reached when cutoff values of CRP level >50 mg/L and WBC count >15 ×109/L were combined; however, 85.3% of urgent cases was missed. A high CRP level (>50 mg/L) combined with a high WBC count (>15 ×109/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48 hours). PMID:25738473

  15. An evaluation of the quality of Emergency Nurse Practitioner services for patients presenting with minor injuries to one rural urgent care centre in the UK: a descriptive study.

    PubMed

    McDevitt, Joe; Melby, Vidar

    2015-02-01

    To evaluate the quality of the emergency nurse practitioner service provided to people presenting to a rural urgent care centre with minor injuries. The three objectives that were focused were an evaluation of the safety and effectiveness of the emergency nurse practitioner service, an assessment of patients' satisfaction with the emergency nurse practitioner service and a determination of factors that may enhance the quality of the emergency nurse practitioner service. Urgent care centres have become increasingly prevalent across the UK. Emergency nurse practitioner services at these rural urgent care centres remain largely unevaluated. This study attempts to redress this deficit by evaluating the quality of an emergency nurse practitioner service in relation to the care of patients presenting with minor injuries to a rural urgent care centre. This descriptive study used a case-note review and a survey design with one open-ended exploratory question. Patient views were collected using a self-completed questionnaire and a data extraction tool to survey patients' case notes retrospectively. Despite comparatively low total length-of-stay times, most patients felt they had enough time to discuss things fully with the emergency nurse practitioner. Although emergency nurse practitioners routinely impart injury advice, feedback from some patients suggests a need for the provision of more in-depth information regarding their injury. The vast majority (97·3%) of patients felt that the quality of the emergency nurse practitioner service was of a high standard. Contrary to some other studies, the findings in this study indicate that patient satisfaction is not influenced by waiting times. Emergency nurse practitioners in rural urgent care centres have the potential to deliver a safe and effective quality service that is reflected in high levels of patient satisfaction. This study provides some evidence to support the continued expansion of the emergency nurse practitioner service in rural settings in the UK. © 2014 John Wiley & Sons Ltd.

  16. Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes.

    PubMed

    Jin, Haijiao; Fang, Wei; Zhu, Mingli; Yu, Zanzhe; Fang, Yan; Yan, Hao; Zhang, Minfang; Wang, Qin; Che, Xiajing; Xie, Yuanyuan; Huang, Jiaying; Hu, Chunhua; Zhang, Haifen; Mou, Shan; Ni, Zhaohui

    2016-01-01

    Several studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients. In this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups. Our study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate. In an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need for dialysis.

  17. Cumulative incidence for wait-list death in relation to length of queue for coronary-artery bypass grafting: a cohort study.

    PubMed

    Sobolev, Boris G; Kuramoto, Lisa; Levy, Adrian R; Hayden, Robert

    2006-08-24

    In deciding where to undergo coronary-artery bypass grafting, the length of surgical wait lists is often the only information available to cardiologists and their patients. Our objective was to compare the cumulative incidence for death on the wait list according to the length of wait lists at the time of registration for the operation. The study cohort included 8966 patients who registered to undergo isolated coronary-artery bypass grafting (82.4% men; 71.9% semi-urgent; 22.4% non-urgent). The patients were categorized according to wait-list clearance time at registration: either "1 month or less" or "more than 1 month". Cumulative incidence for wait-list death was compared between the groups, and the significance of difference was tested by means of regression models. Urgent patients never registered on a wait list with a clearance time of more than 1 month. Semi-urgent patients registered on shorter wait lists more often than non-urgent patients (79.1% vs. 44.7%). In semi-urgent and non-urgent patients, the observed proportion of wait-list deaths by 52 weeks was lower in category "1 month or less" than in category "more than 1 month" (0.8% [49 deaths] vs. 1.6% [39 deaths], P < 0.005). After adjustment, the odds of death before surgery were 64% higher in patients on longer lists, odds ratio [OR] = 1.64 (95% confidence interval [CI] 1.02-2.63). The observed death rate was higher in category "more than 1 month" than in category "1 month or less", 0.79 (95%CI 0.54-1.04) vs. 0.58 (95% CI 0.42-0.74) per 1000 patient-weeks, the adjusted OR = 1.60 (95%CI 1.01-2.53). Longer wait times (log-rank test = 266.4, P < 0.001) and higher death rates contributed to a higher cumulative incidence for death on the wait list with a clearance time of more than 1 month. Long wait lists for coronary-artery bypass grafting are associated with increased probability that a patient dies before surgery. Physicians who advise patients where to undergo cardiac revascularization should consider the risk of pre-surgical death that is associated with the length of a surgical wait list.

  18. Survivability on the Island of Spice: The Development of the UH-60 Blackhawk and Its Baptism of Fire in Operation Urgent Fury

    DTIC Science & Technology

    2015-06-12

    SURVIVABILITY ON THE ISLAND OF SPICE : THE DEVELOPMENT OF THE UH-60 BLACKHAWK AND ITS BAPTISM OF FIRE IN OPERATION URGENT FURY......THESIS APPROVAL PAGE Name of Candidate: Major Matthew G. Easley Thesis Title: Survivability on the Island of Spice : The Development of the UH

  19. Visions Lost and Dreams Forgotten: Environmental Education, Systems Thinking, and Possible Futures in American Public Schools

    ERIC Educational Resources Information Center

    Cassell, John A.; Nelson, Thomas

    2010-01-01

    This article discusses the contributions to this special issue of "Teacher Education Quarterly." At the core of all the contributions is the compellingly urgent realization that humanity is facing, and must deal with, enormous ecological and social problems and challenges. This situation has created an urgent and compelling need centered…

  20. 39 CFR 320.6 - Suspension for extremely urgent letters.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

  1. 39 CFR 320.6 - Suspension for extremely urgent letters.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

  2. 39 CFR 320.6 - Suspension for extremely urgent letters.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

  3. 39 CFR 320.6 - Suspension for extremely urgent letters.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

  4. 39 CFR 320.6 - Suspension for extremely urgent letters.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... qualify under the loss-of-value test set out in paragraph (b) of this section. Example (4). The same HMO's... would not qualify under the test set out in paragraph (b) of this section. Example (9). An organization... all post routes for extremely urgent letters if the conditions of either paragraph (b) or (c) of this...

  5. Breathing Life into New Speakers: Nsyilxcn and Tlingit Sequenced Curriculum, Direct Acquisition, and Assessments

    ERIC Educational Resources Information Center

    Johnson, S?ímla?w Michele K.

    2017-01-01

    Many Indigenous languages are critically endangered and faced with the urgent need to create parent-aged advanced speakers. This goal requires sequenced curriculum, effective teaching methods, students being supported to spend more than 2,000 hours on task, and regular assessments. In response to this urgent need the author followed a proven…

  6. 76 FR 53913 - Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Refugee Resettlement Award of an Urgent Single-Source Grant to Survivors of Torture International (SOTI) in San Diego, CA; Correction AGENCY: Office of... (SOTI), San Diego, CA. The document contained incorrect information in citing the statutory authority...

  7. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

  8. 42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

  9. Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

    PubMed Central

    Hunskaar, Steinar

    2011-01-01

    Background The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n=18, response rate 90%) as a test–retest assessment. Results Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage. PMID:21262792

  10. Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios.

    PubMed

    Hansen, Elisabeth Holm; Hunskaar, Steinar

    2011-05-01

    The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n = 18, response rate 90%) as a test-retest assessment. Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Correct classification of acute and non-urgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage.

  11. CLARIPED: a new tool for risk classification in pediatric emergencies.

    PubMed

    Magalhães-Barbosa, Maria Clara de; Prata-Barbosa, Arnaldo; Alves da Cunha, Antonio José Ledo; Lopes, Cláudia de Souza

    2016-09-01

    To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (Vipe score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system. Copyright © 2016 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  12. Low Caregiver Health Literacy is Associated with Higher Pediatric Emergency Department Use and Non-urgent Visits

    PubMed Central

    Morrison, Andrea K.; Schapira, Marilyn M.; Gorelick, Marc H.; Hoffmann, Raymond G.; Brousseau, David C.

    2014-01-01

    Objective We sought to determine the association between low caregiver health literacy and child emergency department (ED) use, both the number and urgency of ED visits. Methods This year long cross-sectional study utilized the Newest Vital Sign to measure the health literacy of caregivers accompanying children to a pediatric ED. Prior ED visits were extracted from a regional database. ED visit urgency was classified by resources utilized during the index ED visit. Regression analyses were used to model the outcomes: 1) prior ED visits and 2) ED visit urgency, stratified by chronic illness. Analyses were weighted by triage level. Results Overall, 503 caregivers completed the study; 55% demonstrated low health literacy. Children of caregivers with low health literacy had more prior ED visits (aIRR 1.5; 95% C.I.1.2, 1.8) and increased odds of a non-urgent index ED visit (AOR 2.4; 1.3, 4.4). Among children without chronic illness, low caregiver health literacy was associated with an increased proportion of non-urgent index ED visits (48% vs 22%; AOR 3.2; 1.8, 5.7). Conclusions Over half of caregivers presenting with their children to the ED have low health literacy. Low caregiver health literacy is an independent predictor of higher ED use and use of the ED for non-urgent conditions. In children without a chronic illness, low health literate caregivers had more than three times great odds of presenting for a non-urgent condition than those with adequate health literacy. PMID:24767784

  13. 76 FR 35719 - Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-20

    ... June 8, 2011 Unexpected Urgent Refugee and Migration Needs Related to Libya and C[ocirc]te d'Ivoire... laws of the United States, including section 2(c)(1) of the Migration and Refugee Assistance Act of... amount not to exceed $15 million from the United States Emergency Refugee and Migration Assistance Fund...

  14. 76 FR 53295 - Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-25

    ...-12 of August 8, 2011--Unexpected Urgent Refugee and Migration Needs Related to the Horn of Africa... Migration Needs Related to the Horn of Africa Memorandum for the Secretary of State By the authority vested...) of the Migration and Refugee Assistance Act of 1962 (the ``Act''), as amended, (22 U.S.C. 2601(c)(1...

  15. An audit of urgent referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service.

    PubMed

    White, T; Rutherford, H

    2005-10-01

    This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).

  16. A data management system to enable urgent natural disaster computing

    NASA Astrophysics Data System (ADS)

    Leong, Siew Hoon; Kranzlmüller, Dieter; Frank, Anton

    2014-05-01

    Civil protection, in particular natural disaster management, is very important to most nations and civilians in the world. When disasters like flash floods, earthquakes and tsunamis are expected or have taken place, it is of utmost importance to make timely decisions for managing the affected areas and reduce casualties. Computer simulations can generate information and provide predictions to facilitate this decision making process. Getting the data to the required resources is a critical requirement to enable the timely computation of the predictions. An urgent data management system to support natural disaster computing is thus necessary to effectively carry out data activities within a stipulated deadline. Since the trigger of a natural disaster is usually unpredictable, it is not always possible to prepare required resources well in advance. As such, an urgent data management system for natural disaster computing has to be able to work with any type of resources. Additional requirements include the need to manage deadlines and huge volume of data, fault tolerance, reliable, flexibility to changes, ease of usage, etc. The proposed data management platform includes a service manager to provide a uniform and extensible interface for the supported data protocols, a configuration manager to check and retrieve configurations of available resources, a scheduler manager to ensure that the deadlines can be met, a fault tolerance manager to increase the reliability of the platform and a data manager to initiate and perform the data activities. These managers will enable the selection of the most appropriate resource, transfer protocol, etc. such that the hard deadline of an urgent computation can be met for a particular urgent activity, e.g. data staging or computation. We associated 2 types of deadlines [2] with an urgent computing system. Soft-hard deadline: Missing a soft-firm deadline will render the computation less useful resulting in a cost that can have severe consequences Hard deadline: Missing a hard deadline renders the computation useless and results in full catastrophic consequences. A prototype of this system has a REST-based service manager. The REST-based implementation provides a uniform interface that is easy to use. New and upcoming file transfer protocols can easily be extended and accessed via the service manager. The service manager interacts with the other four managers to coordinate the data activities so that the fundamental natural disaster urgent computing requirement, i.e. deadline, can be fulfilled in a reliable manner. A data activity can include data storing, data archiving and data storing. Reliability is ensured by the choice of a network of managers organisation model[1] the configuration manager and the fault tolerance manager. With this proposed design, an easy to use, resource-independent data management system that can support and fulfill the computation of a natural disaster prediction within stipulated deadlines can thus be realised. References [1] H. G. Hegering, S. Abeck, and B. Neumair, Integrated management of networked systems - concepts, architectures, and their operational application, Morgan Kaufmann Publishers, 340 Pine Stret, Sixth Floor, San Francisco, CA 94104-3205, USA, 1999. [2] H. Kopetz, Real-time systems design principles for distributed embedded applications, second edition, Springer, LLC, 233 Spring Street, New York, NY 10013, USA, 2011. [3] S. H. Leong, A. Frank, and D. Kranzlmu¨ ller, Leveraging e-infrastructures for urgent computing, Procedia Computer Science 18 (2013), no. 0, 2177 - 2186, 2013 International Conference on Computational Science. [4] N. Trebon, Enabling urgent computing within the existing distributed computing infrastructure, Ph.D. thesis, University of Chicago, August 2011, http://people.cs.uchicago.edu/~ntrebon/docs/dissertation.pdf.

  17. Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy)

    PubMed Central

    2013-01-01

    Background The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother’s educational level in the relationship between citizenship and ER utilisation. Methods The cohort study included all healthy singleton live births in the years 2008–2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother’s citizenship. Other covariates were mother’s educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. Results There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59). The risk of ER visits is higher in the first two months of life (RR1stvs 3rd-12th 2.08; 95% CI 1.93-2.24 and RR 2ndvs 3rd-12th 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). Conclusions Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions. PMID:24176109

  18. Effects of immigrant status on Emergency Room (ER) utilisation by children under age one: a population-based study in the province of Reggio Emilia (Italy).

    PubMed

    Ballotari, Paola; D'Angelo, Stefania; Bonvicini, Laura; Broccoli, Serena; Caranci, Nicola; Candela, Silvia; Giorgi Rossi, Paolo

    2013-11-01

    The primary aim of this study was to assess the effect of immigrant status on Emergency Room (ER) utilisation by children under age one, considering all, non-urgent, very urgent, and followed by hospitalisation visits. The second aim was to investigate the role played by mother's educational level in the relationship between citizenship and ER utilisation. The cohort study included all healthy singleton live births in the years 2008-2009 and residing in the province of Reggio Emilia, followed for the first year of life in order to study their ER visits. The outcomes were the ER utilisation rate for all, non-urgent, very urgent, and followed by hospitalisation visits. The main explanatory variable was mother's citizenship. Other covariates were mother's educational level, maternal age, parity, and child gender. Multivariate analyses (negative binomial regression and zero inflated when appropriate) were performed. Adjusted utilisation Rate Ratios (RR) and their 95% Confidence Intervals (95% CI) were calculated. Trend for age in months by citizenship is depicted. There were 3,191 children (36.4%) with at least one ER visit in the first year of life. Adjusted RR show a significantly greater risk of ER visit for immigrants than for Italians: (RR 1.51; 95% CI 1.39-1.63). Immigrants also had a higher risk of non-urgent visits (RR 1.72; 95% CI 1.48-2.00) and for visits followed by hospitalizations (RR 1.58; 95% CI 1.33-1.89). For very urgent visits, the immigrants had a slightly higher risk compared to Italians (RR 1.25; 95% CI 0.98-1.59).The risk of ER visits is higher in the first two months of life (RR(1st vs 3rd-12th) 2.08; 95% CI 1.93-2.24 and RR(2nd vs 3rd-12th) 1.45; 95% CI 1.33-1.58, respectively). Considering all visits, the ER utilisation rate was inversely related with maternal education only for Italians (low educational level 44.0 and high educational level 73.9 for 100 children; p value for trend test < 0.001). Our study observed a higher use of ER services by immigrant children and, to a lesser extent, by children of less educated Italian mothers. In immigrants, the excess is mostly due to non-urgent visits and only slightly to high acute conditions.

  19. [Emergencies and urgent consultation in non-urban Swiss general practices].

    PubMed

    Meyer, R L; Marty, F

    2007-03-07

    The upcoming shortage of general practitioners in Switzerland will be a big challenge for medical out-of-hours services. Regionally ver different exists only few datas about organisational matters of and problems seen in "out-of-hours" care and "urgent consultations". Our Pilot present the prevalence of "out-of-hours care" in a general practitioner setting describes and classifies the problems seen using ICPC-2.

  20. Operation Urgent Fury - Grenada

    DTIC Science & Technology

    1983-11-01

    Urgent Fury : the planning and execution of joint operations in Grenada, 12 October-2 November 1983 / Ronald H. Cole. p . cm...meeting, Secretary of State George P . Shultz and the Chairman of the Joint Chiefs of Staff, General John W. Vessey, Jr., USA, warned the Special Situation...Group (RIG) of the National Security Council (NSC), on 12 October, Langhorne A. Motley, Assistant Secretary of State for Inter-American Affairs

  1. A cost-minimisation study of 1,001 NHS Direct users.

    PubMed

    Lambert, Rod; Fordham, Richard; Large, Shirley; Gaffney, Brian

    2013-08-08

    To determine financial and quality of life impact of patients calling the '0845' NHS Direct (NHS Direct) telephone helpline from the perspective of NHS service providers. Cost-minimisation of repeated cohort measures from a National Survey of NHS Direct's telephone service using telephone survey results. 1,001 people contacting NHS Direct's 0845 telephone service in 2009 who agreed to a 4-6 week follow-up. A cost comparison between NHS Direct recommendation and patient-stated first alternative had NHS Direct not been available. Analysis also considers impact on quality of life of NHS Direct recommendations using the Visual Analogue Scale of the EQ-5D. Significant referral pattern differences were observed between NHS Direct recommendation and patient-stated first alternatives (p < 0.001). Per patient cost savings resulted from NHS Direct's recommendation to attend A&E (£36.54); GP Practice (£19.41); Walk-In Centre (£49.85); Pharmacist (£25.80); Dentist (£2.35) and do nothing/treat at home (£19.77), while it was marginally more costly for 999 calls (£3.33). Overall an average per patient saving of £19.55 was found (a 36% saving compared with patient-stated first alternatives). For 5 million NHS Direct telephone calls per year, this represents an annual cost saving of £97,756,013. Significant quality of life differences were observed at baseline and follow-up between those who believed their problem was 'urgent' (p = 0.001) and those who said it was 'non-urgent' (p = 0.045). Whilst both groups improved, self-classified 'urgent' cases made greater health gains than those who said they were 'non-urgent' (urgent by 21.5 points; non-urgent by 16.1 points). The '0845' service of NHS Direct produced substantial cost savings in terms of referrals to the other parts of the NHS when compared with patients' own stated first alternative. Health-related quality of life also improved for users of this service demonstrating that these savings can be produced without perceived harm to patients.

  2. Factors associated with mode of colorectal cancer detection and time to diagnosis: a population level study.

    PubMed

    Sikdar, Khokan C; Dickinson, James; Winget, Marcy

    2017-01-05

    Although it is well-known that early detection of colorectal cancer (CRC) is important for optimal patient survival, the relationship of patient and health system factors with delayed diagnosis are unclear. The purpose of this study was to identify the demographic, clinical and healthcare factors related to mode of CRC detection and length of the diagnostic interval. All residents of Alberta, Canada diagnosed with first-ever incident CRC in years 2004-2010 were identified from the Alberta Cancer Registry. Population-based administrative health datasets, including hospital discharge abstract, ambulatory care classification system and physician billing data, were used to identify healthcare services related to CRC diagnosis. The time to diagnosis was defined as the time from the first CRC-related healthcare visit to the date of CRC diagnosis. Mode of CRC detection was classified into three groups: urgent, screen-detected and symptomatic. Quantile regression was performed to assess factors associated with time to diagnosis. 9626 patients were included in the study; 25% of patients presented as urgent, 32% were screen-detected and 43% were symptomatic. The median time to diagnosis for urgent, screen-detected and symptomatic patients were 6 days (interquartile range (IQR) 2-14 days), 74 days (IQR 36-183 days), 84 days (IQR 39-223 days), respectively. Time to diagnosis was greater than 6 months for 27% of non-urgent patients. Healthcare factors had the largest impact on time to diagnosis: 3 or more visits to a GP increased the median by 140 days whereas 2 or more visits to a GI-specialist increased it by 108 days compared to 0-1 visits to a GP or GI-specialist, respectively. A large proportion of CRC patients required urgent work-up or had to wait more than 6 months for diagnosis. Actions are needed to reduce the frequency of urgent presentation as well as improve the timeliness of diagnosis. Findings suggest a need to improve coordination of care across multiple providers.

  3. LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data

    PubMed Central

    van Walraven, Carl; Wong, Jenna; Forster, Alan J

    2012-01-01

    Background Death or urgent readmission after hospital discharge is a common adverse event that can be used to compare outcomes of care between institutions. To accurately adjust for risk and to allow for interhospital comparisons of readmission rates, we used administrative data to derive and internally validate an extension of the LACE index, a previously validated index for 30-day death or urgent readmission. Methods We randomly selected 500 000 medical and surgical patients discharged to the community from any Ontario hospital between 1 April 2003 and 31 March 2009. We derived a logistic regression model on 250 000 randomly selected patients from this group and modified the final model into an index scoring system, the LACE+ index. We internally validated the LACE+ index using data from the remaining 250 000 patients and compared its performance with that of the original LACE index. Results Within 30 days of discharge to the community, 33 825 (6.8%) of the patients had died or had been urgently readmitted. In addition to the variables included in the LACE index (length of stay in hospital [L], acuity of admission [A], comorbidity [C] and emergency department utilization in the 6 months before admission [E]), the LACE+ index incorporated patient age and sex, teaching status of the discharge hospital, acute diagnoses and procedures performed during the index admission, number of days on alternative level of care during the index admission, and number of elective and urgent admissions to hospital in the year before the index admission. The LACE+ index was highly discriminative (C statistic 0.771, 95% confidence interval 0.767–0.775), was well calibrated across most of its range of scores and had a model performance that exceeded that of the LACE index. Interpretation The LACE+ index can be used to predict the risk of postdischarge death or urgent readmission on the basis of administrative data for the Ontario population. Its performance exceeds that of the LACE index, and it allows analysts to accurately estimate the risk of important postdischarge outcomes. PMID:23696773

  4. Comparison of the efficacy of intravenous tranexamic acid with and without topical administration versus placebo in urgent endoscopy rate for acute gastrointestinal bleeding: A double-blind randomized controlled trial

    PubMed Central

    Tavakoli, Nader; Agah, Shahram; Azizi, Ali; Masoodi, Mohsen; Amiri, Hassan; Sheikhvatan, Mehrdad; Syedsalehi, Bahare; Behnam, Behdad; Arabahmadi, Mehran; Mehrazi, Maryam

    2017-01-01

    Background Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. Method This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. Results The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p < 0.001). A need for urgent endoscopy was seen in 14.49%, 10.52%, and 30.21% of patients in groups A, B, and C, respectively (p < 0.001). No significant statistical differences were seen between treatment groups regarding mortality, re-bleeding, blood transfusion, and endoscopic and/or surgical intervention rates. No thromboembolic event was documented during the 1-week follow up. Conclusions Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients. PMID:29435313

  5. Evacuation Priorities in Mass Casualty Terror-Related Events

    PubMed Central

    Einav, Sharon; Feigenberg, Zvi; Weissman, Charles; Zaichik, Daniel; Caspi, Guy; Kotler, Doron; Freund, Herbert R.

    2004-01-01

    Objective: To assess evacuation priorities during terror-related mass casualty incidents (MCIs) and their implications for hospital organization/contingency planning. Summary Background Data: Trauma guidelines recommend evacuation of critically injured patients to Level I trauma centers. The recent MCIs in Israel offered an opportunity to study the impositions placed on a prehospital emergency medical service (EMS) regarding evacuation priorities in these circumstances. Methods: A retrospective analysis of medical evacuations from MCIs (29.9.2000–31.9.2002) performed by the Israeli National EMS rescue teams. Results: Thirty-three MCIs yielded data on 1156 casualties. Only 57% (506) of the 1123 available and mobilized ambulances were needed to provide 612 evacuations. Rescue teams arrived on scene within <5 minutes and evacuated the last urgent casualty within 15–20 minutes. The majority of non-urgent and urgent patients were transported to medical centers close to the event. Less than half of the urgent casualties were evacuated to more distant trauma centers. Independent variables predicting evacuation to a trauma center were its being the hospital closest to the event (OR 249.2, P < 0.001), evacuation within <10 minutes of the event (OR 9.3, P = 0.003), and having an urgent patient on the ambulance (OR 5.6, P < 0.001). Conclusions: Hospitals nearby terror-induced MCIs play a major role in trauma patient care. Thus, all hospitals should be included in contingency plans for MCIs. Further research into the implications of evacuation of the most severely injured casualties to the nearest hospital while evacuating all other casualties to various hospitals in the area is needed. The challenges posed by terror-induced MCIs require consideration of a paradigm shift in trauma care. PMID:15075645

  6. [Scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit].

    PubMed

    Sumano-Ziga, Erika; Veloz-Martínez, María Guadalupe; Vázquez-Rodríguez, Juan Gustavo; Becerra-Alcántara, Geomar; Jimenez Vieyra, Carlos Ramón

    2015-01-01

    Patients with placenta accreta have a high frequency of complications and death risk. The aim of this study was to compare the results of scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit. An observational, comparative, cross-sectional study was conducted by reviewing patient records with confirmed diagnostic of placenta accreta, who attended in a one year period. They were divided into 2 groups based on the type of surgery, scheduled or urgent. Descriptive statistics were applied, with comparisons using Student t-test and chi squared tests. A value of P<.05 was considered significant. There were 4,592 births in the period of study, and 125 obstetric hysterectomies were performed, with 40 confirmed cases of accreta (8.7 per thousand births) with 20 in scheduled and 20 in urgent surgeries, with the most frequent type being placenta accreta. The mean maternal age was 32 years, with a mean of 5 hours operating time, total bleeding 3135 ml, and 3.5 units of packed cells transfused. There was no statistical difference when comparing these variables with re-interventions, hypovolaemic shock, and intensive care unit admission. Caesarean-hysterectomy with hypogastric artery ligation was the most frequent surgery performed. In this hospital, scheduled and urgent surgical treatment of patients with placenta accreta show similar results, probably because the constant availability of resources and the experience obtained by the multidisciplinary team in all shifts. Nevertheless, make absolutely sure to perform elective surgery while having all the necessary resources. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  7. Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients.

    PubMed

    Beynon, Christopher; Jakobs, Martin; Rizos, Timolaos; Unterberg, Andreas W; Sakowitz, Oliver W

    2014-01-01

    With the increased use of oral anticoagulation with vitamin K antagonists, emergency physicians encounter a growing number of patients requiring a rapid reversal of anticoagulant effects in order to perform urgent surgical procedures. Initiation of these procedures can be delayed because the coagulation status has to be assessed through examination of blood samples in central laboratories (CL). This delay may lead to negative effects, especially in potentially life-threatening conditions such as intracranial haemorrhage. Point-of-care (POC) devices for assessment of international normalized ratio (POC INR) have improved the management of anticoagulation therapy in the outpatient setting. The use of these devices may also have beneficial effects in the treatment of anticoagulated patients requiring urgent neurosurgical procedures. The primary aim of this study was to analyse the potential of POC-guided assessment of INR to reduce time to potentially life-saving neurosurgery in this setting. Feasibility and accuracy as well as the gain of time through the use of this device were analysed. The POC coagulometer CoaguChek XS(®) was used in 17 patients with a history of anticoagulant use and a condition requiring urgent anticoagulant reversal prior to neurosurgical procedures (burr-hole trepanation: n = 8, craniotomy: n = 7, laminectomy: n = 2). No technical difficulties occurred and rapid assessment of INR was achieved in all cases within 2 min. POC INR values correlated well with CL INR assessment with a mean INR deviation of 0.036 ± 0.12. The mean gain of time through the use of the POC INR device compared with CL assessment of INR was 47 ± 6 min (range: 37-61 min). Our initial experiences with a POC INR device in anticoagulated patients undergoing urgent neurosurgical procedures demonstrate that its use may contribute to an improved management of these patients.

  8. Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

    PubMed

    Roberts, Nasreen; Nesdole, Robert; Hu, Tina

    2018-01-01

    a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p < 0.01), a higher proportion in special educational placement (X2 (1) = 6.82, p < 0.01), a higher proportion with a family history of anxiety disorders (X2 (1) = 10.62, p = 0.01) and substance use disorder (X2 (1) = 18.99, p < 0.01). Conditional logistic regression results suggested that repeat-presentation group had higher odds of past hospital admission (OR: 3.50, p < 0.01) higher odds of family history of mood disorders (OR: 4.86, p < 0.01) and of antisocial disorders (OR: 4.97, p = 0.02), and lower odds of recommendation compliance (OR: 0.10, p < 0.01). Repeat-presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

  9. Patient Satisfaction With Care for Urgent Health Problems: A Survey of Family Practice Patients

    PubMed Central

    Howard, Michelle; Goertzen, James; Hutchison, Brian; Kaczorowski, Janusz; Morris, Kelly

    2007-01-01

    PURPOSE Patient satisfaction is an important health care outcome. This study compared patients’ satisfaction with care received for an urgent health problem from their family physician, at an after-hours clinic in which their physician participated, at a walk-in clinic, at the emergency department, from telephone health advisory services, or from more than 1 of those services. METHODS We mailed a questionnaire to a random sample of patients from 36 family practices in Thunder Bay, Ontario. We elicited satisfaction with care for the most recent urgent health problem in the past 6 months on a 7-point scale (very dissatisfied to very satisfied). RESULTS The response rate was 62.3% (5,884 of 9,397). Of the 5,722 eligible patients 1,342 (23.4%) reported an urgent health problem, and data were available for both services used and satisfaction for 1,227 patients. After adjusting for sociodemographic characteristics and self-reported health status, satisfaction with care received for most recent urgent health problem was significantly higher among patients who visited or spoke to their family physician (mean 6.1; 95% confidence interval [CI], 5.8–6.4) compared with all other services (all P <.004, adjusted for multiple comparisons), with the exception of patients who used the after-hours clinic affiliated with their physician, whose satisfaction was not significantly different (mean 5.6; 95% CI, 5.2–6.0). CONCLUSIONS Satisfaction was highest for patients receiving care from their own family physician or their physician’s after-hours clinic. These results are important for new primary care models that emphasize continuity and after-hours availability of family physicians. PMID:17893383

  10. Risk stratification of patients with severe heart failure awaiting heart transplantation-prospective national registry POLKARD HF.

    PubMed

    Zieliński, T; Browarek, A; Zembala, M; Sadowski, J; Zakliczyński, M; Przybylowski, P; Roguski, K; Kosakowska, A B; Korewicki, J

    2009-10-01

    Most methods used in the risk assessment of heart transplant candidates do not include new biomarkers. The aim of the study was to examine the value of NTproBNP and hsCRP and their combined use together with HFSS score in the risk assessment of patients with heart failure enlisted for heart transplantation. Data of 658 patients enlisted for heart transplantation in all active transplantation centers were stored in a prospective registry. The composite end point-death or urgent transplantation was recorded during the follow-up. Death or urgent transplantation was recorded in 161 (24%) of pts. 102 (15%) patients died and 59 (9%) were transplanted urgently. Kaplan-Meier curves for risk of death or urgent transplantation where highly significant when pts were stratified by the quartiles of NT proBNP (P < .000001) or quartiles according to the hsCRP level on admission (P < .002). In the multivariate Cox proportional hazard model, the significance was observed for NTproBNP (P < .01) and HFSS (P < .02), and borderline significance for hsCRP (P = .057). When ROC analyses of the area under the curve (AUC) values were considered, AUC area was for HFSS - 0.645, for NTproBNP - 0.653 and for hsCRP - 0.566. When all those variables were included together in the model, the AUC value rose to 0.6943. Based on those results a weighted risk model with all three parameters was proposed. HFSS, NTproBNP and hsCRP levels are independent stratification variables of survival or need for urgent heart transplantation. Their predictive value is moderately increased when they are analyzed together.

  11. Weekend Hospitalizations and Post-operative Complications following urgent surgery for Ulcerative Colitis and Crohn’s Disease

    PubMed Central

    Ananthakrishnan, Ashwin N; McGinley, Emily L

    2013-01-01

    Background There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease (IBD; Crohn’s disease (CD), ulcerative colitis (UC)) with frequent requirement for urgent surgery. Aim To determine whether a weekend effect exists for IBD care in the United States. Methods We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer hospitalization database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalization were identified using the appropriate ICD-9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders. Results Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post-operative complications were more common following weekend than weekday hospitalizations in UC (odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01–2.90). The most common post-operative complication was post-operative infections (Weekend 30% vs. weekday 20%, p=0.04). The most striking difference between weekend and weekday hospitalizations was for need for repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post-operative complication in CD was similar between weekday and weekend admissions. Conclusion Patients with UC hospitalized on a weekend undergoing urgent surgery within 2 days have an increased risk for post-operative complications, in particular mechanical wound complications, need for repeat laparotomy, and post-operative infections. PMID:23451882

  12. Mapping of courses on vector biology and vector-borne diseases systems: time for a worldwide effort.

    PubMed

    Casas, Jérôme; Lazzari, Claudio; Insausti, Teresita; Launois, Pascal; Fouque, Florence

    2016-11-01

    Major emergency efforts are being mounted for each vector-borne disease epidemiological crisis anew, while knowledge about the biology of arthropods vectors is dwindling slowly but continuously, as is the number of field entomologists. The discrepancy between the rates of production of knowledge and its use and need for solving crises is widening, in particular due to the highly differing time spans of the two concurrent processes. A worldwide web based search using multiple key words and search engines of onsite and online courses in English, Spanish, Portuguese, French, Italian and German concerned with the biology of vectors identified over 140 courses. They are geographically and thematically scattered, the vast majority of them are on-site, with very few courses using the latest massive open online course (MOOC) powerfulness. Over two third of them is given in English and Western Africa is particularity poorly represented. The taxonomic groups covered are highly unbalanced towards mosquitoes. A worldwide unique portal to guide students of all grades and levels of expertise, in particular those in remote locations, is badly needed. This is the objective a new activity supported by the Special Programme for Research and Training in Tropical Diseases (TDR).

  13. Study of behavior: science or pseudoscience (with comments of Bogdan Dreher, Giacomo Rizzolatti and Charles Gross).

    PubMed

    Konorski, Jerzy

    2013-01-01

    The manuscript printed below has been written by Professor Jerzy Konorski around 1970, a few years before his death in 1973. The manuscript has not been published before. It was recently discovered in Konorski's papers deposed in the Library of the Nencki Institute of Experimental Biology. In his critical review Konorski debates advantages and shortcomings of the physiological approach of Pavlov and purely behavioristic approaches advocated by Hull and Skinner. He supports close cooperation o behaviorists with neurophysiologists and neuroanatomists, with focus on the investigation of the neural mechanisms underlying behavior. Konorski's ideas concerning the integration of the study of behavior and neurophysiology anticipated contemporary path of neuroscience. Indeed, his approach, which at that time appeared somewhat controversial, is universally accepted by contemporary neuroscientists. By contrast, physiological theories of higher mental functions formulated by Pavlov as well as deliberately anti-physiological approaches of Skinner and Hull have all but disappeared from serious scientific discourse. However, the same problems such as strongly promoted self-importance of some branches of neuroscience, the lack of inter-communication between different branches and resulting lack of integrating ideas appear to emerge anew in each new generation of scientists. (Editors of Acta Neurobiologiae Experimentalis).

  14. Infrastructure for Rapid Development of Java GUI Programs

    NASA Technical Reports Server (NTRS)

    Jones, Jeremy; Hostetter, Carl F.; Wheeler, Philip

    2006-01-01

    The Java Application Shell (JAS) is a software framework that accelerates the development of Java graphical-user-interface (GUI) application programs by enabling the reuse of common, proven GUI elements, as distinguished from writing custom code for GUI elements. JAS is a software infrastructure upon which Java interactive application programs and graphical user interfaces (GUIs) for those programs can be built as sets of plug-ins. JAS provides an application- programming interface that is extensible by application-specific plugins that describe and encapsulate both specifications of a GUI and application-specific functionality tied to the specified GUI elements. The desired GUI elements are specified in Extensible Markup Language (XML) descriptions instead of in compiled code. JAS reads and interprets these descriptions, then creates and configures a corresponding GUI from a standard set of generic, reusable GUI elements. These elements are then attached (again, according to the XML descriptions) to application-specific compiled code and scripts. An application program constructed by use of JAS as its core can be extended by writing new plug-ins and replacing existing plug-ins. Thus, JAS solves many problems that Java programmers generally solve anew for each project, thereby reducing development and testing time.

  15. Transplant Ethics: Let's Begin the Conversation Anew : A Critical Look at One Institute's Experience with Transplant Related Ethical Issues.

    PubMed

    Shafran, David; Smith, Martin L; Daly, Barbara J; Goldfarb, David

    2016-06-01

    Standardizing consultation processes is increasingly important as clinical ethics consultation (CEC) becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all transplant related ethics consults performed at the Cleveland Clinic (CC) between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC.

  16. A recommendation module to help teachers build courses through the Moodle Learning Management System

    NASA Astrophysics Data System (ADS)

    Limongelli, Carla; Lombardi, Matteo; Marani, Alessandro; Sciarrone, Filippo; Temperini, Marco

    2016-01-01

    In traditional e-learning, teachers design sets of Learning Objects (LOs) and organize their sequencing; the material implementing the LOs could be either built anew or adopted from elsewhere (e.g. from standard-compliant repositories) and reused. This task is applicable also when the teacher works in a system for personalized e-learning. In this case, the burden actually increases: for instance, the LOs may need adaptation to the system, through additional metadata. This paper presents a module that gives some support to the operations of retrieving, analyzing, and importing LOs from a set of standard Learning Objects Repositories, acting as a recommending system. In particular, it is designed to support the teacher in the phases of (i) retrieval of LOs, through a keyword-based search mechanism applied to the selected repositories; (ii) analysis of the returned LOs, whose information is enriched by a concept of relevance metric, based on both the results of the searching operation and the data related to the previous use of the LOs in the courses managed by the Learning Management System; and (iii) LO importation into the course under construction.

  17. Precision electronic speed controller for an alternating-current

    DOEpatents

    Bolie, Victor W.

    1988-01-01

    A high precision controller for an alternating-current multi-phase electrical motor that is subject to a large inertial load. The controller was developed for and is particularly suitable for controlling, in a neutron chopper system, a heavy spinning rotor that must be rotated in phase-locked synchronism with a reference pulse train that is representative of an ac power supply signal having a meandering line frequency. The controller includes a shaft revolution sensor which provides a feedback pulse train representative of the actual speed of the motor. An internal digital timing signal generator provides a reference signal which is compared with the feedback signal in a computing unit to provide a motor control signal. In the preferred embodiment, the motor control signal is a weighted linear sum of a speed error voltage, a phase error voltage, and a drift error voltage, each of which is computed anew with each revolution of the motor shaft. The stator windings of the motor are driven by two amplifiers which are provided with input signals having the proper quadrature relationship by an exciter unit consisting of a voltage controlled oscillator, a binary counter, a pair of readonly memories, and a pair of digital-to-analog converters.

  18. Mapping of courses on vector biology and vector-borne diseases systems: time for a worldwide effort

    PubMed Central

    Casas, Jérôme; Lazzari, Claudio; Insausti, Teresita; Launois, Pascal; Fouque, Florence

    2016-01-01

    Major emergency efforts are being mounted for each vector-borne disease epidemiological crisis anew, while knowledge about the biology of arthropods vectors is dwindling slowly but continuously, as is the number of field entomologists. The discrepancy between the rates of production of knowledge and its use and need for solving crises is widening, in particular due to the highly differing time spans of the two concurrent processes. A worldwide web based search using multiple key words and search engines of onsite and online courses in English, Spanish, Portuguese, French, Italian and German concerned with the biology of vectors identified over 140 courses. They are geographically and thematically scattered, the vast majority of them are on-site, with very few courses using the latest massive open online course (MOOC) powerfulness. Over two third of them is given in English and Western Africa is particularity poorly represented. The taxonomic groups covered are highly unbalanced towards mosquitoes. A worldwide unique portal to guide students of all grades and levels of expertise, in particular those in remote locations, is badly needed. This is the objective a new activity supported by the Special Programme for Research and Training in Tropical Diseases (TDR). PMID:27759770

  19. The First Brown Dwarf Discovered by the Backyard Worlds: Planet 9 Citizen Science Project

    NASA Technical Reports Server (NTRS)

    Kuchner, Marc J.; Faherty, Jacqueline K.; Schneider, Adam C.; Meisner, Aaron M.; Filippazzo, Joseph C.; Gagne, Jonathan; Trouille, Laura; Silverberg, Steven M.; Castro, Rosa; Fletcher, Bob; hide

    2017-01-01

    The Wide-field Infrared Survey Explorer (WISE) is a powerful tool for finding nearby brown dwarfs and searching for new planets in the outer solar system, especially with the incorporation of NEOWISE and NEOWISE Reactivation data. However, so far, searches for brown dwarfs in WISE data have yet to take advantage of the full depth of the WISE images. To efficiently search this unexplored space via visual inspection, we have launched anew citizen science project, called "Backyard Worlds: Planet 9," which asks volunteers to examine short animations composed of difference images constructed from time-resolved WISE co adds. We report the first new substellar object discovered by this project, WISEA J110125.95+540052.8, a T5.5 brown dwarf located approximately 34 pc from the Sun with a total proper motion of approx.0. "7/ yr. WISEA J110125.95+540052.8 has a WISE W2 magnitude of W2 = 15.37+/- 0.09; our sensitivity to this source demonstrates the ability of citizen scientists to identify moving objects via visual inspection that are 0.9 mag fainter than the W2 single-exposure sensitivity, a threshold that has limited prior motion-based brown dwarf searches with WISE.

  20. Issues and challenges in the application of Husserlian phenomenology to the lived experience of hate crime and its legal aftermath: an enlightenment prejudice against prejudice?

    PubMed

    Salter, Michael; McGuire, Kim

    2015-06-01

    The field of hate crime research addresses the presence, sources, and impact of particular types of expressions of prejudice, often perceived as particularly damaging and hurtful forms of interpersonal abuse and violence. There is the reflexive question of the possibilities of researchers themselves ever being able to adopt a truly "unprejudiced" approach to the presence of such damaging prejudices. Can this goal be realized without a researcher necessarily losing an experientially grounded understanding of what these meanings, values and purposes have come to mean, and how they are themselves interpretively reconstituted anew, including within the lived experience of victims, witnesses, police, prosecutors, judges, and victim support workers? A possible philosophically informed approach to the dilemmas posed by this topic is offered by Husserl's phenomenology. This study critically explores the possibilities, reflective stages, and theoretical limitations of a sympathetically reconstructed Husserlian approach to hate crime. It argues that despite its manifest tensions, gaps, ambiguities, and internal contradictions, aspects of the Husserlian philosophical approach directed toward the different levels of experienced hate crime still retain the potential to both challenge and advance our understanding of this topic. © The Author(s) 2014.

  1. Development and Symbiosis Establishment in the Cnidarian Endosymbiosis Model Aiptasia sp.

    PubMed Central

    Bucher, Madeline; Wolfowicz, Iliona; Voss, Philipp A.; Hambleton, Elizabeth A.; Guse, Annika

    2016-01-01

    Symbiosis between photosynthetic algae and heterotrophic organisms is widespread. One prominent example of high ecological relevance is the endosymbiosis between dinoflagellate algae of the genus Symbiodinium and reef-building corals, which typically acquire symbionts anew each generation during larval stages. The tropical sea anemone Aiptasia sp. is a laboratory model system for this endosymbiosis and, similar to corals, produces non-symbiotic larvae that establish symbiosis by phagocytosing Symbiodinium from the environment into the endoderm. Here we generate the first overview of Aiptasia embryogenesis and larval development and establish in situ hybridization to analyze expression patterns of key early developmental regulators. Next, we quantify morphological changes in developing larvae and find a substantial enlargement of the gastric cavity over time. Symbiont acquisition starts soon after mouth formation and symbionts occupy a major portion of the host cell in which they reside. During the first 14 days of development, infection efficiency remains constant while in contrast, localization of phagocytosed symbionts changes, indicating that the occurrence of functional phagocytosing cells may be developmentally regulated. Taken together, here we provide the essential framework to further develop Aiptasia as a model system for the analysis of symbiosis establishment in cnidarian larvae at the molecular level. PMID:26804034

  2. Development and Symbiosis Establishment in the Cnidarian Endosymbiosis Model Aiptasia sp.

    PubMed

    Bucher, Madeline; Wolfowicz, Iliona; Voss, Philipp A; Hambleton, Elizabeth A; Guse, Annika

    2016-01-25

    Symbiosis between photosynthetic algae and heterotrophic organisms is widespread. One prominent example of high ecological relevance is the endosymbiosis between dinoflagellate algae of the genus Symbiodinium and reef-building corals, which typically acquire symbionts anew each generation during larval stages. The tropical sea anemone Aiptasia sp. is a laboratory model system for this endosymbiosis and, similar to corals, produces non-symbiotic larvae that establish symbiosis by phagocytosing Symbiodinium from the environment into the endoderm. Here we generate the first overview of Aiptasia embryogenesis and larval development and establish in situ hybridization to analyze expression patterns of key early developmental regulators. Next, we quantify morphological changes in developing larvae and find a substantial enlargement of the gastric cavity over time. Symbiont acquisition starts soon after mouth formation and symbionts occupy a major portion of the host cell in which they reside. During the first 14 days of development, infection efficiency remains constant while in contrast, localization of phagocytosed symbionts changes, indicating that the occurrence of functional phagocytosing cells may be developmentally regulated. Taken together, here we provide the essential framework to further develop Aiptasia as a model system for the analysis of symbiosis establishment in cnidarian larvae at the molecular level.

  3. Recent Efforts to Improve the Near Real Time Forest Disturbance Monitoring Capabilities of the ForWarn System

    NASA Technical Reports Server (NTRS)

    Spruce, Joseph; Hargrove, William; Gasser, Gerald

    2013-01-01

    This presentation discusses the development of anew method for computing NDVI temporal composites from near real time eMODIS data This research is being conducted to improve forest change products used in the ForWarn system for monitoring regional forest disturbances in the United States. ForWarn provides nation-wide NDVI-based forest disturbance detection products that are refreshed every 8 days. Current eMODIS and historical MOD13 24 day NDVI data are used to compute the disturbance detection products. The eMODIS 24 day NDVI data re-aggregated from 7 day NDVI products. The 24 day eMODIS NDVIs are generally cloud free, but do not necessarily use the freshest quality data. To shorten the disturbance detection time, a method has been developed that performs adaptive length/maximum value compositing of eMODIS NDVI, along with cloud and shadow "noise" mitigation. Tests indicate that this method can reduce detection rates by 8-16 days for known recent disturbance events, depending on the cloud frequencies and disturbance type. The noise mitigation in these tests, though imperfect, helped to improve quality of the resulting NDVI and forest change products.

  4. Tube thoracostomy; chest tube implantation and follow up

    PubMed Central

    Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Papaiwannou, Antonis; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos

    2014-01-01

    Pneumothorax is an urgent medical situation that requires urgent treatment. We can divide this entity based on the etiology to primary and secondary. Chest tube implantation can be performed either in the upper chest wall or lower. Both thoracic surgeons and pulmonary physicians can place a chest tube with minimal invasive techniques. In our current work, we will demonstrate chest tube implantation to locations, methodology and tools. PMID:25337405

  5. Defense Acquisition Research Journal. Volume 21, Number 2, Issue 69

    DTIC Science & Technology

    2014-04-01

    that quickly meets their needs, not a slow and lumbering bureau- cracy better suited to the last century. As important, our military men and women...resolution of urgent needs/ONS. Joint organizations and other military services, however, are not included in this table. As reflected in Table 2, multiple...urgent capability shortfall, the process endures. Materiel release is required for all nonexpendable materiel; high-density military expendables

  6. The Phonetics and Phonology of the Polish Calling Melodies.

    PubMed

    Arvaniti, Amalia; Żygis, Marzena; Jaskuła, Marek

    2016-01-01

    Two calling melodies of Polish were investigated, the routine call, used to call someone for an everyday reason, and the urgent call, which conveys disapproval of the addressee's actions. A Discourse Completion Task was used to elicit the two melodies from Polish speakers using twelve names from one to four syllables long; there were three names per syllable count, and speakers produced three tokens of each name with each melody. The results, based on eleven speakers, show that the routine calling melody consists of a low F0 stretch followed by a rise-fall-rise; the urgent calling melody, on the other hand, is a simple rise-fall. Systematic differences were found in the scaling and alignment of tonal targets: the routine call showed late alignment of the accentual pitch peak, and in most instances lower scaling of targets. The accented vowel was also affected, being overall louder in the urgent call. Based on the data and comparisons with other Polish melodies, we analyze the routine call as LH* !H-H% and the urgent call as H* L-L%. We discuss the results and our analysis in light of recent findings on calling melodies in other languages, and explore their repercussions for intonational phonology and the modeling of intonation. © 2017 S. Karger AG, Basel.

  7. The impact of unstable housing on emergency department use in a cohort of HIV-positive people in a Canadian setting

    PubMed Central

    Chan, Keith; Milan, David; Grafstein, Eric; Palmer, Alexis K.; Rhodes, Chelsey; Montaner, Julio S.G.; Hogg, Robert S.

    2014-01-01

    The social-structural challenges experienced by people living with HIV (PHA) have been shown to contribute to increased use of the Emergency Department (ED). This study identified factors associated with frequent and non-urgent ED use within a cohort of people accessing antiretroviral therapy (ART) in a Canadian setting. Interviewer-administered surveys collected socio-demographic information; clinical variables were obtained through linkages with the provincial drug treatment registry; and ED admission data were abstracted from the Department of Emergency Medicine database. Multivariate logistic regression was used to compute odds of frequent and non-urgent ED use. Unstable housing was independently associated with ED use (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.24–3.04]), having three or more ED visits within 6 months of interview date [AOR: 2.03 (95% CI: 1.07–3.83)] and being triaged as non-urgent (AOR=2.71, 95% CI: 1.19–6.17). Frequent and non-urgent use of the ED in this setting is associated with conditions requiring interventions at the social-structural level. Supportive housing may contribute to decreased healthcare costs and improved health outcomes amongst marginalized PHA. PMID:23656484

  8. Rural Ambulatory Access for Semi-Urgent Care and the Relationship of Distance to an Emergency Department

    PubMed Central

    Parks, Ashley; Hoegh, Andy; Kuehl, Damon

    2015-01-01

    Introduction Availability of timely access to ambulatory care for semi-urgent medical concerns in rural and suburban locales is unknown. Further distance to an emergency department (ED) may require rural clinics to serve as surrogate EDs in their region, and make it more likely for these clinics to offer timely appointments. We determined the availability of urgent (within 48 hours) access to ambulatory care for non-established visiting patients, and assessed the effect of insurance and ability to pay cash on a patient’s success in scheduling an appointment in rural and suburban Eastern United States. We also assessed how proximity to EDs and urgent care (UC) facilities influenced access to semi-urgent ambulatory appointments at primary care facilities. Methods The Appalachian Trail, which runs from Georgia to Maine, was used as a transect to select 190 rural and suburban primary care clinics located along its entire length. We calculated their location and distance to the nearest hospital-based ED or UC via Google Earth. A sham patient representing a non-established visiting patient called each clinic over a four-month period (2013), requesting an appointment in the next 48 hours for one of three scripted clinical vignettes representing common semi-urgent ambulatory concerns. We randomized the scenarios and insurance statuses (insured vs. uninsured). Each clinic was contacted twice, once with the caller representing an insured patient, once with the caller representing an uninsured patient. When the caller was representing an uninsured patient, any required upfront payment was requested from each clinic. One hundred dollars was used as a cutoff between the uninsured as a distinction between those able to afford substantial upfront sums and those who could not. To determine if proximity to other sources of care impacted a clinic’s ability to grant an appointment, distance to the nearest ED or UC was modeled as a dichotomous variable using 30 miles as the divider. Results Of 380 requests, 96 (25.3%) resulted in appointments within 48 hours. Insured patients and uninsured patients able to pay a substantial amount upfront (>$100) were more likely to book an appointment (p-value <0.001, OR 18, CI [5–154]). Of the 47 clinics that granted uninsured patients appointments 89.3% required some form of payment up front. Farther distances from an ED did not result in greater likelihood of an appointment (OR 1.7, CI [0.4–11.3]). Clinics located within 30 miles of an UC were more likely to grant an appointment (OR 2.45, CI [1.19–5.80]). Conclusion Almost 75% of rural clinics were unable to grant a new appointment for a semi-urgent health complaint. Lack of insurance and large upfront charges appear to be significant barriers to rural ambulatory care appointments. Greater distance from an ED does not improve a clinic’s ability to see semi-urgent appointments. Clinics located near an UC were more likely to grant an appointment than clinics without close alternative outpatient healthcare options. PMID:26265979

  9. SURGICAL TREATMENT AND COMPLICATIONS OF PENILE FRACTURES

    PubMed Central

    Kulovac, Benjamin; Aganović, Damir; Junuzović, Dželaludin; Prcić, Alden; Hadžiosmanović, Osman; BazardžAnović, Mustafa; Hodžić, Harun

    2007-01-01

    Paper goal is to determine complications after urgent surgical treatment of patient with penile fractures, by using circumferential-degloving technique (degloving penile skin to root of penis). In period between 1998-2006 year, 23 patients have been treated as urgent cases with clinically proven penis fracture, age between 18 and 35. Patients were treated in 3 medical centers in Bosnia and Herzegovina(Sarajevo, Tuzla and Zenica). All 23 (100%) patients were injured during sexual intercourse. In the case of 20 (86,9%) patients partial rupture of corpus cavernosum was verified. Two (8,6%) patients had a complete rupture of urethra and it was primary sutured. In 22 cases (95,6%) spontaneous erection appeared, and in the case of 2 (8,6%) patients penile curvature was verified. Urgent surgical treatment is the best therapy choice, which enables preservation of erection in great number of cases in patients with penile fracture. PMID:17489766

  10. [Towards universal nomenclature for urgent surgical care].

    PubMed

    Liakhovs'kyĭ, V I; Dem'ianiuk, D H; Kravtsiv, M I; Borkunov, A L; Sapun, L V

    2013-06-01

    In a modern professional literature the diseases, which undoubtedly threaten the patient's health and life, are called an urgent, special, emergent, fixed-date, etc. Not rare these terms are used simultaneously. Such a plurality of names of a quite dangerous state causes sometimes in these conditions uncertainty to seek help of a specialists and loss of a time. Modern dictionaries of a foreign languages words, of a foreign languages words in Ukrainian language, medical, big explanatory dictionary of a modern Ukrainian language definitely explains, that these terms are synonyms. All of them mean unconditional, timing. And every expression may be used in this context. The above mentioned suggestions and thoughts do not promote a secure fixing in the citizens consciousness the undoubtedness, the disease consequences danger, a threat to health and life. To deposit this in their awareness it is possible not by amorphous depiction, but using a singular, brief, firm term - an urgent.

  11. [Combined use of killed vaccines and immunomodulator ridostin for urgent prevention of epidemic stomatitis, Aujeszky disease and carnivore plague in experiment].

    PubMed

    Barinskiĭ, I F; Ulasov, V I; Kravchenko, V M; Toloknov, A S; Lycheva, I A; Alimbarova, L M; Kosiakova, N P

    2002-01-01

    Results of experimental studies of mice and pigs infected with foot-and-mouth disease virus, minks infected with Aujeszky's disease virus, and dogs infected with canine distemper virus are described. In animals with foot-and-mouth disease and Aujeszky's disease, combined treatment with killed vaccine and immunomodulator Ridostin by the scheme of urgent prophylaxis (3 days before infection) caused 75% (foot-and-mouth disease) and 100% (Aujeszky's disease) prevention of animal death and development of generalized infection. The use of Ridostin by the scheme of urgent prophylaxis in a canine distemper infection focus arrested clinical symptoms of the disease in 50% of animals received immunomodulator. Clinical symptoms of canine distemper in the other dogs treated with immunomodulator were manifested in a mild form, and their appearance was delayed to 23-25 days after contact with infected animal.

  12. Tranexamic acid for reducing mortality in emergency and urgent surgery.

    PubMed

    Perel, Pablo; Ker, Katharine; Morales Uribe, Carlos Hernando; Roberts, Ian

    2013-01-31

    Emergency or urgent surgery, which can be defined as surgery which must be done promptly to save life, limb, or functional capacity, is associated with a high risk of bleeding and death. Antifibrinolytic agents, such as tranexamic acid, inhibit blood clot breakdown (fibrinolysis) and can reduce perioperative bleeding. Tranexamic acid has been shown to reduce the need for a blood transfusion in adult patients undergoing elective surgery but its effects in patients undergoing emergency or urgent surgery is unclear.   To assess the effects of tranexamic acid on mortality, blood transfusion and thromboembolic events in adults undergoing emergency or urgent surgery. We searched the following electronic databases: the Cochrane Injuries Group's Specialised Register (22 August 2012); Cochrane Central Register of Controlled Trials (2012, issue 8 of 12); MEDLINE (Ovid SP) 1950 to August Week 2, 2012; PubMed 1 June 2012 to 22 August 2012; EMBASE (Ovid SP) 1980 to 2012 Week 33; ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) 1990 to 22 August 2012; ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) 1970 to 22 August 2012. We also searched online trial registers on 22 August 2012 to identify unpublished studies. Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in adults undergoing emergency or urgent surgery. Two authors examined titles, abstracts and keywords of citations from the electronic databases for eligibility and extracted data for analysis and risk of bias assessment. Outcome measures of interest were mortality, receipt of a blood transfusion, units of blood transfused, reoperation, seizures and thromboembolic events (myocardial infarction, stroke, deep vein thrombosis and pulmonary embolism). We identified five trials involving 372 people that met the inclusion criteria. Three trials (260 patients) contributed data to the analyses. The effect of tranexamic acid on mortality (RR 1.01; 95% CI 0.14 to 7.3) is uncertain. However, tranexamic acid reduces the probability of receiving a blood transfusion by 30% although the estimate is imprecise (RR 0.70; 95% CI 0.52 to 0.94). The effect on deep venous thrombosis (RR 2.29; 95% CI 0.68 to 7.66), and stroke (RR 2.79; 95% CI 0.12 to 67.10) is uncertain. There were no events of pulmonary embolism or myocardial infarction. None of the trials reported units of blood transfused, reoperation, or seizure outcomes. There is evidence that tranexamic acid reduces blood transfusion in patients undergoing emergency or urgent surgery. There is a need for a large pragmatic clinical trial to assess the effects of routine use of tranexamic acid on mortality in a heterogeneous group of urgent and emergency surgical patients.

  13. Do emergency medical services dispatch nature and severity codes agree with paramedic field findings?

    PubMed

    Neely, K W; Eldurkar, J A; Drake, M E

    2000-02-01

    Emergency medical services (EMS) systems increasingly seek to triage patients to alternative EMS resources. Emergency medical services dispatchers may be asked to perform this triage. New protocols may be necessary. Alternatively, existing protocols may be sufficient for this task. For an existing dispatch protocol to be sufficient, it at least must accurately categorize patient condition and severity based on an external standard. To examine the extent to which nature codes (NCs), or patient condition codes, and severity codes (SCs) currently assigned in one urban 911 center agree with paramedic field findings. The null hypothesis was that there is no routine agreement (75%) between dispatcher-assigned NC or SC and paramedic-assigned NC or SC for the same patient using the same protocol. Emergency medical services dispatch nature and severity code data and matching out-of-hospital data were prospectively gathered over six months. Dispatch data included the NC: caller-identified problem, and the SC: dispatcher-assessed severity. Each NC is modified by one of three SCs (1, 3, or 9): 1 is emergent, 3 is urgent, and 9 is neither. Paramedics verified and/or corrected dispatcher-assigned NCs and SCs using the same dispatch protocol. One thousand forty usable cases fell into 33 unique NC/SC combinations. The designation of SC 1 was assigned 275 times, SC 3 was assigned 736 times, and SC 9 was assigned 24 times. The SC was missing five times. The overall NC agreement was 0.70 (95% CI = 0.697 to 0.703). The overall SC agreement was 0.65 (95% CI = 0.645 to 0.655). The NC agreement exceeded 75% for ten (59%) NC/SC combinations. The SC agreement exceeded 75% for five (29%) NC/SC combinations. There was both NC and SC agreement for four (24%) combinations: urgent breathing problems, urgent diabetic problems, urgent falls, and urgent overdoses. The greatest NC/SC disagreement occurred within emergent and urgent traffic crashes. Paramedics adjusted SC toward lower severity 29% of the time and toward higher severity 5.4% of the time. There was no upward SC adjustment for eight (47%) combinations. Certain dispatcher-assigned NC and SC codes and NC/SC combinations achieved the study threshold. Overall agreement failed to achieve the threshold. The lowest SC level was rarely assigned, preventing a meaningful analysis of all severity levels.

  14. Urgent Reform Required: Army Expeditionary Contracting. Report of the Commission on Army Acquisition and Program Management in Expeditionary Operations

    DTIC Science & Technology

    2007-10-01

    Division Dave Mabee , Senior Procurement Analyst, Office of the Deputy Assistant Secretary of the Army, Policy and Procurement Jill Stiglich, Lieutenant...U.S. Army, Commanding General, U.S. Army Materiel Command Grazioplene, James , Vice President, KBR Grover, Jeffrey, Lieutenant Colonel, U.S. Army...Management and Chief Acquisition Officer, FEMA Loehrl, James , Director of the Acquisition Center and PARC, U.S. Army Sustainment Command Urgent Reform

  15. Experience in Organization of Urgent Medical Care in Large-Scale Accident Conditions at Nuclear Power Stations

    DTIC Science & Technology

    2001-05-01

    approximately 340 Gwt) which is 17% of the worldwide electricity production level. The Chernobyl Nuclear Disaster with its long-term medico-biological...population to avoid or minimize the risk of their exposure. In October 1986, after the Chernobyl Nuclear Disaster the Federal Center of Radiation...period of their cooperation the Urgent Medical Care Department and the Rapid Response Teams visited the following sites of accidents: "* Chernobyl (a fire

  16. A hybrid online scheduling mechanism with revision and progressive techniques for autonomous Earth observation satellite

    NASA Astrophysics Data System (ADS)

    Li, Guoliang; Xing, Lining; Chen, Yingwu

    2017-11-01

    The autonomicity of self-scheduling on Earth observation satellite and the increasing scale of satellite network attract much attention from researchers in the last decades. In reality, the limited onboard computational resource presents challenge for the online scheduling algorithm. This study considered online scheduling problem for a single autonomous Earth observation satellite within satellite network environment. It especially addressed that the urgent tasks arrive stochastically during the scheduling horizon. We described the problem and proposed a hybrid online scheduling mechanism with revision and progressive techniques to solve this problem. The mechanism includes two decision policies, a when-to-schedule policy combining periodic scheduling and critical cumulative number-based event-driven rescheduling, and a how-to-schedule policy combining progressive and revision approaches to accommodate two categories of task: normal tasks and urgent tasks. Thus, we developed two heuristic (re)scheduling algorithms and compared them with other generally used techniques. Computational experiments indicated that the into-scheduling percentage of urgent tasks in the proposed mechanism is much higher than that in periodic scheduling mechanism, and the specific performance is highly dependent on some mechanism-relevant and task-relevant factors. For the online scheduling, the modified weighted shortest imaging time first and dynamic profit system benefit heuristics outperformed the others on total profit and the percentage of successfully scheduled urgent tasks.

  17. Paediatric emergency department utilisation: is it necessary an educational intervention?

    PubMed

    De Tina, Annalisa; Quattrin, Rosanna; Montina, Laura; Brusaferro, Silvio

    2014-01-01

    Over the past ten years there has been a progressive increase in accesses to services for paediatric emergency room, documented in Italy and abroad. The aim of the study is describe the sociodemographic, cultural, subjective and objective factors for non-urgent access to paediatric emergency service in an Italian region. It was adopted a descriptive survey of a sample of non-urgent accesses to two paediatric emergency room services in an Italian region during the period from February-March 2009, through the administration of questionnaires and the consultation of facilities databases. Half of the accesses to the paediatric emergency room are not urgent and are to be referred to the paediatric primary care. 80% of the users do not call for advice before coming to the emergency room. The convenience of the service, which accounts for more than 50% of the case, and the proximity from home are reasons to go to the emergency room. Approximately half of the accesses to the paediatric emergency department could be managed by primary care services. The convenience of the service, the self-referred and the proximity to home are emerging as the only influential factors reported by literature. In the future it should become crucial providing strategies for education/health information focused on non-urgent paediatric problems and offering people a call center phone service in order to filter and prevent the inappropriate accesses.

  18. Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure.

    PubMed

    Sachdeva, Amit; Horwich, Tamara B; Fonarow, Gregg C

    2010-09-15

    B-type natriuretic peptide (BNP), peak oxygen consumption (VO(2)), blood urea nitrogen (BUN), systolic blood pressure (SBP), and pulmonary capillary wedge pressure are all established predictors of mortality or urgent transplantation in patients with advanced heart failure (HF). However, their comparative predictive ability in estimating prognosis has not been well studied. We analyzed 1,215 patients with advanced systolic HF referred to a university center from 1999 to 2009. BUN, BNP, VO(2), SBP, and pulmonary capillary wedge pressure were measured as a part of the initial evaluation. The patients were divided into groups according to the best cutoffs for predicting both 1- and 2-year mortality from the analysis of the receiver operating characteristic curves (BNP > or =579 pg/ml, peak VO(2) <14 ml/kg/min, BUN > or =53 mg/dl, SBP <118 mm Hg, and pulmonary capillary wedge pressure > or =21 mm Hg). During a 2-year follow-up, 234 patients (19%) died, and 208 (17%) required urgent transplantation. BNP (odds ratio 4.3, 95% confidence interval 3.3 to 5.5) and peak VO(2) (odds ratio 4.5, 95% confidence interval 2.6 to 7.8) were the strongest predictors for death or urgent transplantation. On multivariate analyses, BNP and peak VO(2) were the strongest predictors for both death or urgent transplantation and all-cause mortality. The c-statistic was 0.756 for BNP, 0.701 for VO(2), 0.659 for BUN, 0.638 for SBP, and 0.650 for pulmonary capillary wedge pressure. In conclusion, of the 5 established predictors of outcomes in advanced HF, BNP was the most robust discriminator of risk and thus could be useful, along with other more traditional prognostic variables, in patient counseling regarding prognosis and determining the timing for heart transplantation. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Effects of income and dental insurance coverage on need for dental care in Canada.

    PubMed

    Duncan, Laura; Bonner, Ashley

    2014-01-01

    To estimate the strength of the associations among income, dental insurance coverage and need for dental care (both urgent and nonurgent) in Canada. Multinomial logistic models were fit to data from the 2009 Canadian Health Measures Survey to test unadjusted associations among household income, dental insurance coverage and the need for urgent and nonurgent dental care. Adjusted associations, controlling for socio-demographic variables (age, sex, immigration status, education and province of residence) and oral health habits (brushing, flossing and visits to the dentist) were also evaluated. In the unadjusted model, need for treatment was lower among people with dental insurance than among those without insurance coverage (for urgent treatment: odds ratio [OR] 0.76, 95% confidence interval [CI] 0.66-0.89; for nonurgent treatment: OR 0.59, 95% CI 0.50-0.70). In addition, there was an income gradient, whereby people with higher income had less need for dental treatment (for urgent treatment: OR 0.99, 95% CI 0.99-1.00; for nonurgent treatment: OR 0.99, 95% CI 0.98-0.99). Controlling for socio-demographic and oral health variables decreased the magnitude of the association between dental insurance coverage and need for treatment (for urgent treatment: OR 0.80, 95% CI 0.68-0.95; for nonurgent treatment: OR 0.76, 95% CI 0.63-0.92). An interaction term between dental coverage and income was significant in relation to the need for nonurgent treatment: among lower-income individuals, having insurance slightly decreased the odds of needing nonurgent treatment, with this decrease in odds becoming greater for middle-income earners and even greater for high-income earners. Income-related inequality in need for dental care exists even in the presence of dental insurance coverage and good dental hygiene habits. These findings highlight the need for increased access to dental care for low-income populations and families living in poverty.

  20. Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency department.

    PubMed

    Sharma, Anurag; Inder, Brett

    2011-08-01

    To empirically model the determinants of duration of wait of emergency (triage category 2) patients in an emergency department (ED) focusing on two questions: (i) What is the effect of enhancing the degree of choice for non-urgent (triage category 5) patients on duration of wait for emergency (category 2) patients in EDs; and (ii) What is the effect of co-located GP clinics on duration of wait for emergency patients in EDs? The answers to these questions will help in understanding the effectiveness of demand management strategies, which are identified as one of the solutions to ED crowding. The duration of wait for each patient (difference between arrival time and time first seen by treating doctor) was modelled as a function of input factors (degree of choice, patient characteristics, weekend admission, metro/regional hospital, concentration of emergency (category 2) patients in hospital service area), throughput factors (availability of doctors and nurses) and output factor (hospital bed capacity). The unit of analysis was a patient episode and the model was estimated using a survival regression technique. The degree of choice for non-urgent (category 5) patients has a non-linear effect: more choice for non-urgent patients is associated with longer waits for emergency patients at lower values and shorter waits at higher values of degree of choice. Thus more choice of EDs for non-urgent patients is related to a longer wait for emergency (category 2) patients in EDs. The waiting time for emergency patients in hospital campuses with co-located GP clinics was 19% lower (1.5 min less) on average than for those waiting in campuses without co-located GP clinics. These findings suggest that diverting non-urgent (category 5) patients to an alternative model of care (co-located GP clinics) is a more effective demand management strategy and will reduce ED crowding.

  1. WARFIGHTER SUPPORT: Improvements to DOD’s Urgent Needs Processes Would Enhance Oversight and Expedite Efforts to Meet Critical Warfighter Needs

    DTIC Science & Technology

    2010-04-01

    life and/or prevent the successful completion of a near -term military mission. The memo defines immediate warfighter needs as urgent operational...successful completion of a near -term military mission. An executive director leads JRAC and reports to the Director, Rapid Fielding, within DDR&E and...performance assessment of the experimental HMDS prior to them making a decision to purchase it in large numbers. Testing for the HMDS officially began in

  2. Transforming Armed Forces to National Guard Units in Latin America

    DTIC Science & Technology

    2007-03-30

    Kliksberg, El crecimiento de la criminalidad en América Latina: un tema urgente, http://www.iadb.org/Etica/SP4321/DocHit.cfm?DocIndex=327, , Internet...html ; Internet accessed Friday, Jan 12, 2007. 4 Ibid. Bernardo Kliksberg, El crecimiento de la criminalidad en América Latina: un tema urgente...Latin American and the Caribbean, page 2, http://www.iadb.org/sds/doc/1073eng.pdf, 6 Ibid. Bernardo Kliksberg, El crecimiento de la criminalidad en

  3. Providing sustainable catalytic solutions for a rapidly changing world: a summary and recommendations for urgent future action.

    PubMed

    Thomas, John Meurig

    2018-01-13

    In addition to summarizing the main thrusts of each paper presented at this Discussion, other urgent issues involving the role (and characterization) of new catalysts for eliminating oxides of nitrogen, for using CO 2 liberated from steel mills, for fuel cells and the need for rapid decarbonization of fossil fuels are outlined.This article is part of a discussion meeting issue 'Providing sustainable catalytic solutions for a rapidly changing world'. © 2017 The Author(s).

  4. [Migration, climate and health].

    PubMed

    Tellier, Siri; Carballo, Manuel; Calballo, Manuel

    2009-10-26

    Many tentative connections have been postulated between migration and climate. This article points to rural-urban migration, particularly into low elevation urban slums prone to flooding as an issue needing urgent attention by health professionals. It also notes the no-man's land in which environmental refugees find themselves and the consequences this may have. Finally, it points to the urgent need to reform health systems in both developing and developed countries to adapt to rapidly changing disease patterns and to become more responsive to them.

  5. A QoS Management Technique of Urgent Information Provision in ITS Services Using DSRC for Autonomous Base Stations

    NASA Astrophysics Data System (ADS)

    Shimura, Akitoshi; Aizono, Takeiki; Hiraiwa, Masashi; Sugano, Shigeki

    A QoS management technique based on an autonomous decentralized mobility system, which is an autonomous decentralized system enhanced to provide mobile stations with information about urgent roadway situations, is proposed in this paper. This technique enables urgent messages to be flexibly and quickly transmitted to mobile stations by multiple decentralized base stations using dedicated short range communication. It also supports the easy addition of additional base stations. Each station autonomously creates information-delivery communities based on the urgency of the messages it receives through the roadside network and the distances between the senders and receivers. Each station dynamically determines the urgency of messages according to the message content and the speed of the mobile stations. Evaluation of this technique applied to the Smart Gateway system, which provides driving-assistance services to mobile stations through dedicated short-range communication, demonstrated its effectiveness and that it is suitable for actual systems.

  6. Effects of inter-stimulus interval and intensity on the perceived urgency of tactile patterns.

    PubMed

    White, Timothy L; Krausman, Andrea S

    2015-05-01

    This research examines the feasibility of coding urgency into tactile patterns. Four tactile patterns were presented at either, 12 or 23.5 dB above mean threshold, with an ISI of either 0 (no interval) or 500 msec. Measures included pattern identification and urgency rating on a scale of 1 (least urgent) to 10 (most urgent). Two studies were conducted, a laboratory study and a field study. In the laboratory study, participants received the tactile patterns while seated in front of a computer. For the field study, participants performed dismounted Soldier maneuvers while receiving the tactile patterns. Higher identification rates were found for the 23.5 dB intensity. Patterns presented at the 23.5 dB intensity and no ISI were rated most urgent. No differences in urgency ratings were found for 12 dB based on ISI. Findings support the notion of coding urgency into tactile patterns as a way of augmenting tactile communication. Published by Elsevier Ltd.

  7. A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.

    PubMed

    Bicki, Alexandra; Silva, Adam; Joseph, Valerie; Handoko, Ryan; Rico, Sheryl-vi; Burns, Jacqueline; Simonelli, Anna; Harrop, Jordan; Nedow, Jennifer; De Groot, Anne S

    2013-12-01

    Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

  8. Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

    PubMed

    Barbash, Israel M; Gaglia, Michael A; Torguson, Rebecca; Minha, Sa'ar; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2013-10-01

    Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI. Clinical observational analysis of consecutive patients undergoing elective or urgent PCI from 1993 to 2011 was performed. Patients were stratified by marital status, comparing married to unmarried patients. Clinical outcome up to 12 months was obtained by telephone contact or office visit. A total of 11,216 patients were included in the present analysis; 55% were married and 45% unmarried. Significant differences in baseline characteristics were noted, including a lower prevalence of hypertension (86% vs 88%), diabetes (34% vs 38%), and smoking (19% vs 25%) among married vs unmarried patients, respectively (P < .001). However, married patients had a higher prevalence of hypercholesterolemia and family history of coronary artery disease. Early and late major adverse cardiac event rates were significantly lower for married vs unmarried patients up to 1 year (13.3% vs 8.2%, P < .001). Married status was independently associated with improved outcome in multivariable analysis (hazard ratio 0.7, 95% CI 0.6-0.9). Married patients who undergo urgent or elective PCI have superior short- and long-term outcomes up to 1 year when compared with unmarried patients. These benefits persist after adjustment for multiple traditional cardiovascular risk factors. © 2013.

  9. [DIAGNOSTIC AND TREATMENT STRATEGY IN FOLLICULAR TUMOR OF THYROID GLAND].

    PubMed

    Mikhaĭlova, M V; Zubarovskiĭ, I N; Osipenko, S K

    2015-01-01

    The article is based on the treatment results of 44 patients with follicular tunor of thyroid gland. A staged morphological assessment of thyroid nodes was performed for all patients: in case of preoperative fine-needle biopsy, urgent intraoperative study and according to results of final histological research. The urgent histological study of surgical material was conducted for 44 patients with diagnosis "follicular tumor" according to fine-needle biopsy. The data of final histological study were matched with findings of intraoperative research. A micro-follicular adenoma was detected in 22 patients (50%) and 6 (13,6%) patients had this diagnosis combined with autoimmune thyroiditis. The general part of patients didn't changed in final study, but the rate of diagnosis "micro-follicular adenoma against the background of autoimmune thyroiditis" increased. Papillary carcinoma was revealed in 5 (11,4%) patients and follicular cancer had 4 (9,1%) patients detected in intraoperative study and 3 (6,8%) more patients according to data of final research. The histopathologic feature of colloid goiter was observed in 7 (15,9%) cases and a part of such patients reduced to 6,8% during final study. One of the patients (2,3%) had final diagnosis "oncocytoma". In case of thyroid nodules detection the needle biopsy should be carried out regardless to the size of nodule. The authors recommended performing the surgery with the urgent histological study in case of undetermined histological report. The following surgical strategy was specified by the results of the urgent histological report.

  10. Audit of radiology communication systems for critical, urgent, and unexpected significant findings.

    PubMed

    Duncan, K A; Drinkwater, K J; Dugar, N; Howlett, D C

    2016-03-01

    To determine the compliance of UK radiology departments and trusts/healthcare organisations with National Patient Safety Agency and Royal College of Radiologist's published guidance on the communication of critical, urgent, and unexpected significant radiological findings. A questionnaire was sent to all UK radiology department audit leads asking for details of their current departmental policy regarding the issuing of alerts; use of automated electronic alert systems; methods of notification of clinicians of critical, urgent, and unexpected significant radiological findings; monitoring of results receipt; and examples of the more common types of serious pathologies for which alerts were issued. One hundred and fifty-four of 229 departments (67%) responded. Eighty-eight percent indicated that they had a policy in place for the communication of critical, urgent, and unexpected significant radiological findings. Only 34% had an automated electronic alert system in place and only 17% had a facility for service-wide electronic tracking of radiology reports. In only 11 departments with an electronic acknowledgement system was someone regularly monitoring the read rate. There is wide variation in practice across the UK with regard to the communication and monitoring of reports with many departments/trusts not fully compliant with published UK guidance. Despite the widespread use of electronic systems, only a minority of departments/trusts have and use electronic tracking to ensure reports have been read and acted upon. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Deprivation in relation to urgent suspicion of head and neck cancer referrals in Glasgow.

    PubMed

    Zeitler, M; Fingland, P; Tikka, T; Douglas, C M; Montgomery, J

    2018-06-01

    To examine deprivation measured by the Scottish index of multiple deprivation (SIMD) and its relation to urgent suspicion of head and neck cancer referrals. A secondary aim was to examine the symptomatology generating urgent suspicion of cancer (USOC) referrals by SIMD category. All "urgent suspicion of cancer" referrals to the GGC ENT department over a one-year period, between 2015 and 2016, were reviewed. Information was recorded anonymously and included demographics and red flag referral symptoms. A total of 1998 patients were assessed, 43.4% (n = 867) were male. A total of 171 (8.6%) patients had primary head and neck cancer. A total of 61 patients had other types of cancer, giving an all cause cancer rate of 11.6%. About 71.3% of primary patients with head and neck cancer (HNC) were male. The most common SIMD category observed was SIMD1, the most common SIMD category yielding a primary head and neck cancer diagnosis was SIMD1. Neck lump was the commonest symptom amongst all SIMD categories. A link between deprivation and USOC referrals has been established. A difference in gender distribution between referrals and HNC was observed, more females are referred but a significantly higher number of patients with HNC are males. Neck lump is a very strong referral indicator for HNC and intermittent hoarseness is not. The findings from this analysis could be used to refine local referral patterns and priority of referral. © 2018 John Wiley & Sons Ltd.

  12. THE SCHULHOF FAMILY: SOLVING THE AGE PUZZLE

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

    Vokrouhlický, David; Ďurech, Josef; Pravec, Petr

    The Schulhof family, a tight cluster of small asteroids around the central main belt body (2384) Schulhof, belongs to a so far rare class of very young families (estimated ages less than 1 Myr). Characterization of these asteroid clusters may provide important insights into the physics of the catastrophic disruption of their parent body. The case of the Schulhof family has been up to now complicated by the existence of two proposed epochs of its origin. In this paper, we first use our own photometric observations, as well as archival data, to determine the rotation rate and spin axis orientation ofmore » the largest fragment (2384) Schulhof. Our data also allow us to better constrain the absolute magnitude of this asteroid, and thus also improve the determination of its geometric albedo. Next, using the up-to-date catalog of asteroid orbits, we perform a new search of smaller members in the Schulhof family, increasing their number by 50%. Finally, the available data are used to access Schulhof's family age anew. We now find that the younger of the previously proposed two ages of this family is not correct, resulting from a large orbital uncertainty of single-opposition members. Our new runs reveal a single age solution of about 800 kyr with a realistic uncertainty of 200 kyr.« less

  13. What top-down task sets do for us: an ERP study on the benefits of advance preparation in visual search.

    PubMed

    Eimer, Martin; Kiss, Monika; Nicholas, Susan

    2011-12-01

    When target-defining features are specified in advance, attentional target selection in visual search is controlled by preparatory top-down task sets. We used ERP measures to study voluntary target selection in the absence of such feature-specific task sets, and to compare it to selection that is guided by advance knowledge about target features. Visual search arrays contained two different color singleton digits, and participants had to select one of these as target and report its parity. Target color was either known in advance (fixed color task) or had to be selected anew on each trial (free color-choice task). ERP correlates of spatially selective attentional target selection (N2pc) and working memory processing (SPCN) demonstrated rapid target selection and efficient exclusion of color singleton distractors from focal attention and working memory in the fixed color task. In the free color-choice task, spatially selective processing also emerged rapidly, but selection efficiency was reduced, with nontarget singleton digits capturing attention and gaining access to working memory. Results demonstrate the benefits of top-down task sets: Feature-specific advance preparation accelerates target selection, rapidly resolves attentional competition, and prevents irrelevant events from attracting attention and entering working memory.

  14. Behavior Analysis and Ecological Psychology: Past, Present, and Future. A Review of Harry Heft's Ecological Psychology in Context

    PubMed Central

    Morris, Edward K

    2009-01-01

    Relations between behavior analysis and ecological psychology have been strained for years, notwithstanding the occasional comment on their affinities. Harry Heft's (2001) Ecological Psychology in Context provides an occasion for reviewing anew those relations and affinities. It describes the genesis of ecological psychology in James's radical empiricism; addresses Holt's neorealism and Gestalt psychology; and synthesizes Gibson's ecological psychology and Barker's ecobehavioral science as a means for understanding everyday human behavior. Although behavior analysis is excluded from this account, Heft's book warrants a review nonetheless: It describes ecological psychology in ways that are congruent and complementary with behavior analysis (e.g., nonmediational theorizing; the provinces of natural history and natural science). After introducing modern ecological psychology, I comment on (a) Heft's admirable, albeit selective, historiography; (b) his ecological psychology—past and present—as it relates to Skinner's science and system (e.g., affordances, molar behavior); (c) his misunderstandings of Skinner's behaviorism (e.g., reductionistic, mechanistic, molecular); and (d) the theoretical status of Heft's cognitive terms and talk (i.e., in ontology, epistemology, syntax). I conclude by considering the alliance and integration of ecological psychology and behavior analysis, and their implications for unifying and transforming psychology as a life science, albeit more for the future than at present. PMID:20354604

  15. Surveillance of human influenza A(H3N2) virus from 1999 to 2009 in southern Italy.

    PubMed

    DE Donno, A; Idolo, A; Quattrocchi, M; Zizza, A; Gabutti, G; Romano, A; Grima, P; Donatelli, I; Guido, M

    2014-05-01

    The aim of this study was to evaluate the presence of influenza virus co-infections in humans and changes in the genetic variability of A(H3N2) virus strains in southern Italy from 1999 to 2009. A partial sequence of the haemagglutinin (HA) gene by human influenza H3N2 strains identified in oropharyngeal swabs from patients with influenza-like illness was analysed by DNA sequencing and a phylogenetic analysis was performed. During the seasons 1999-2000, 2002-2003, 2004-2005 and 2008-2009, the influenza viruses circulating belonged to subtype H3N2. However, A(H1N1) subtype virus and B type were respectively prevalent during the 2000-2001, 2006-2007, 2007-2008 and 2001-2002, 2003-2004, 2005-2006 seasons. The HA sequences appeared to be closely related to the sequence of the influenza A vaccine strain. Only the 2002-2003 season was characterized by co-circulation of two viral lineages: A/New York/55/01(H3N2)-like virus of the previous season and A/Fujian/411/02(H3N2)-like virus, a new H3 variant. In this study, over the decade analysed, no significant change was seen in the sequences of the HA gene of H3 viruses isolated.

  16. Monitoring of small lymphatics function under different impact on animal model by integrated optical imaging

    NASA Astrophysics Data System (ADS)

    Galanzha, Ekaterina I.; Tuchin, Valery V.; Chowdhury, Parimal; Zharov, Vladimir P.

    2004-08-01

    The digital transmission microscopy is very informative, noninvasive for vessels, simple and available method for studying and measuring lymph microvessels function in vivo. Rat mesentery can use as promising animal model of lymph microvessels in vivo. Such imaging system allowed visualizing the entire lymphangion (with input and output valves), its wall, lymphatic valves, lymph flow as well as single cells in flow; obtaining anew basic information on lymph microcirculation and quantitative data on lymphatic function including indexes of phasic contractions and valve function, the quantitative parameters of lymph-flow velocity. Rat mesentery is good model to create different types of lymphedemas in acute and chronic experiments. The obtained data revealed that significant edema started immediately after lymph node dissection in one-half of cases and was accompanied by lymphatic disturbances. The greatest degree of edema was found after 1 week. After 4 weeks, the degree of edema sometimes decreased, but functional lymphatic disturbances progressed. Nicotine had significant direct dose-dependent effect on microlymphatic function at the acute local application, but the same dose of this drug was not effect on microcirculation in chronic intoxication. Despite yielding interesting data, transmittance microscopy had some limitations when applied to microcirculation studies. The problems could be solved at the application of integrated measuring technique.

  17. Does perceived risk influence the effects of message framing? Revisiting the link between prospect theory and message framing.

    PubMed

    Van 't Riet, Jonathan; Cox, Anthony D; Cox, Dena; Zimet, Gregory D; De Bruijn, Gert-Jan; Van den Putte, Bas; De Vries, Hein; Werrij, Marieke Q; Ruiter, Robert A C

    2016-12-01

    Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', which was derived from prospect theory, has been central to health message-framing research for the better part of two decades and has enduring appeal to researchers and practitioners. It has found its way into several health communication handbooks and is communicated to the general public. The present article examines the validity of the risk-framing hypothesis anew by providing a review of the health message-framing literature. In spite of its ongoing appeal, we conclude that the hypothesis has severe theoretical flaws. In addition, we find that the empirical evidence in favour of the hypothesis is weak and inconsistent. It seems that, in applying prospect theory's tenets to a health-promotion context, some of the theory's key aspects have been lost in translation. At the close of the article, we offer a research agenda for the future, arguing that, above all, new methodology is needed to bring the message-framing literature further.

  18. The Schulhof Family: Solving the Age Puzzle

    NASA Astrophysics Data System (ADS)

    Vokrouhlický, David; Ďurech, Josef; Pravec, Petr; Kušnirák, Peter; Hornoch, Kamil; Vraštil, Jan; Krugly, Yurij N.; Inasaridze, Raguli Ya.; Ayvasian, Vova; Zhuzhunadze, Vasili; Molotov, Igor E.; Pray, Donald; Husárik, Marek; Pollock, Joseph T.; Nesvorný, David

    2016-03-01

    The Schulhof family, a tight cluster of small asteroids around the central main belt body (2384) Schulhof, belongs to a so far rare class of very young families (estimated ages less than 1 Myr). Characterization of these asteroid clusters may provide important insights into the physics of the catastrophic disruption of their parent body. The case of the Schulhof family has been up to now complicated by the existence of two proposed epochs of its origin. In this paper, we first use our own photometric observations, as well as archival data, to determine the rotation rate and spin axis orientation of the largest fragment (2384) Schulhof. Our data also allow us to better constrain the absolute magnitude of this asteroid, and thus also improve the determination of its geometric albedo. Next, using the up-to-date catalog of asteroid orbits, we perform a new search of smaller members in the Schulhof family, increasing their number by 50%. Finally, the available data are used to access Schulhof's family age anew. We now find that the younger of the previously proposed two ages of this family is not correct, resulting from a large orbital uncertainty of single-opposition members. Our new runs reveal a single age solution of about 800 kyr with a realistic uncertainty of 200 kyr.

  19. Mature osteoblasts dedifferentiate in response to traumatic bone injury in the zebrafish fin and skull.

    PubMed

    Geurtzen, Karina; Knopf, Franziska; Wehner, Daniel; Huitema, Leonie F A; Schulte-Merker, Stefan; Weidinger, Gilbert

    2014-06-01

    Zebrafish have an unlimited capacity to regenerate bone after fin amputation. In this process, mature osteoblasts dedifferentiate to osteogenic precursor cells and thus represent an important source of newly forming bone. By contrast, differentiated osteoblasts do not appear to contribute to repair of bone injuries in mammals; rather, osteoblasts form anew from mesenchymal stem cells. This raises the question whether osteoblast dedifferentiation is specific to appendage regeneration, a special feature of the lepidotrichia bone of the fish fin, or a process found more generally in fish bone. Here, we show that dedifferentiation of mature osteoblasts is not restricted to fin regeneration after amputation, but also occurs during repair of zebrafish fin fractures and skull injuries. In both models, mature osteoblasts surrounding the injury downregulate the expression of differentiation markers, upregulate markers of the pre-osteoblast state and become proliferative. Making use of photoconvertible Kaede protein as well as Cre-driven genetic fate mapping, we show that osteoblasts migrate to the site of injury to replace damaged tissue. Our findings suggest a fundamental role for osteoblast dedifferentiation in reparative bone formation in fish and indicate that adult fish osteoblasts display elevated cellular plasticity compared with mammalian bone-forming cells. © 2014. Published by The Company of Biologists Ltd.

  20. Turbulence effects on volatilization rates of liquids and solutes

    USGS Publications Warehouse

    Lee, J.-F.; Chao, H.-P.; Chiou, C.T.; Manes, M.

    2004-01-01

    Volatilization rates of neat liquids (benzene, toluene, fluorobenzene, bromobenzene, ethylbenzene, m-xylene, o-xylene, o-dichlorobenzene, and 1-methylnaphthalene) and of solutes (phenol, m-cresol, benzene, toluene, ethylbenzene, o-xylene, and ethylene dibromide) from dilute water solutions have been measured in the laboratory over a wide range of air speeds and water-stirring rates. The overall transfer coefficients (KL) for individual solutes are independent of whether they are in single- or multi-solute solutions. The gas-film transfer coefficients (kG) for solutes in the two-film model, which have hitherto been estimated by extrapolation from reference coefficients, can now be determined directly from the volatilization rates of neatliquids through anew algorithm. The associated liquid-film transfer coefficients (KL) can then be obtained from measured KL and kG values and solute Henry law constants (H). This approach provides a novel means for checking the precision of any kL and kG estimation methods for ultimate prediction of KL. The improved kG estimation enables accurate K L predictions for low-volatility (i.e., low-H) solutes where K L and kGH are essentially equal. In addition, the prediction of KL values for high-volatility (i.e., high-H) solutes, where KL ??? kL, is also improved by using appropriate reference kL values.

  1. Biogeography as critical nursing pedagogy: Breathing life into nurse education.

    PubMed

    Kyle, Richard G; Atherton, Iain M

    2016-09-01

    Insights from the social sciences, including geography, sociology, and anthropology, have long been incorporated into pre-registration nursing programmes. However, scholars have suggested that their inclusion has been sporadic and lacks clear theoretical rationale. In this paper we argue anew that the social sciences - and particularly, human geography - could be central to nurse education. Specifically, we recast the concept of 'biogeography' drawn from human geography that emphasises the interplay between life (bio) and place (geo) to propose pedagogy that theoretically justifies and practically enables the inclusion of the social sciences in nurse education. Biogeography can breathe new life into nursing curricula by animating our students through the cultivation of three 'spirits of nursing'. First, a 'spirit of empathy' that can shatter patient-professional dualisms by facilitating person-centred and place-sensitive care. Second, a 'spirit of engagement' that situates practice in social structures awakening a desire to effect change by fomenting an acute sense of social justice. Third, a 'spirit of enquiry' that holds in critical tension the theory-practice gap by fostering continual questioning and pursuit of evidence. In so doing, biogeographical pedagogy releases the latent potential of the social sciences to revitalise nurse education, reinvigorate our students, and renew ourselves as nurse educators. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

    PubMed

    Agrawal, Harsh; Martinez, Anna; Volkmann, Elizabeth R; Melamed, Oleg; Wali, Soma

    2017-05-01

    Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this series was to educate and assist residents in the primary care setting to comfortably manage subspecialty conditions, help reduce the already-overwhelmed county subspecialty referral system, and promote learning. The Olive View-UCLA Medical Center internal medicine residency program has a total of 74 residents, which includes postgraduate year-1 (PGY-1) to PGY-4, with PGY-4 being combined internal medicine-pediatrics or emergency medicine-internal medicine residents. We used core curriculum topics as provided by the Accreditation Council for Graduate Medical Education to design the curriculum. We sent e-mails to the stakeholders whom we identified as the residents and the attending physicians working in urgent care, inquiring after topics they wanted to discuss during the rotation. Using these responses we compiled a list of all of the topics that could be discussed and reviewed during the rotation. These topics were broken down into short 10- to 15-minute-long lectures. During the lectures, we provided a retrospective post- then prequestionnaire to the residents for evaluation of the program and the lectures. A benefit of the post-then-pre design is that participants answer the postquestions and the prequestions together after the lecture, thereby reducing the possibility of response shift bias. Of the 74 residents in the program, 25 responded; the response rate was approximately 33%. Regarding content, 92% (23) said it was appropriate, 4% (1) said it was too low a level, and 4% (1) did not respond. Overall, 36% (9) said the lecture was excellent, 52% (13) said it was very good, 8% (2) said it was good, and 4% (1) did not respond. We also looked at the number of referrals made pre- and postcurriculum implementation and found that the overall referral percentage was down, from 34% to 31%. We designed an urgent care curriculum and lecture series for the primary urgent care clinics to promote learning and education in a structured, succinct, and systematic manner. This will help triage and manage subspecialty conditions in the scope of primary care settings and thus initiate appropriate and timely referrals to subspecialists.

  3. Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions.

    PubMed

    Bin Jabr, Adel; Lindblad, Bengt; Kristmundsson, Thorarinn; Dias, Nuno; Resch, Timothy; Malina, Martin

    2016-03-01

    Endovascular abdominal aortic repair requires an adequate sealing zone. The chimney graft (CG) technique may be the only option for urgent high-risk patients who are unfit for open repair and have no adequate sealing zone. This single-center experience provides long-term results of CGs with endovascular repair for urgent and complex aortic lesions. Between July 2006 and October 2012, 51 patients (16 women) with a median age of 77 years (interquartile range, 72-81 years), were treated urgently (within 24 hours [61%]) or semiurgently (within 3 days [39%]) with endovascular aortic repair and visceral CGs (n = 73). Median follow-up was 2.3 years (interquartile range, 0.8-5.0 years) for the whole cohort, 3 years for 30-day survivors, and 4.8 years for patients who are still alive. Five patients (10%) died within 30 days. All of them had a sacrificed kidney. All-cause mortality was 57% (n = 29), but the chimney- and procedure-related mortality was 6% (n = 3) and 16% (n = 8), respectively. Chimney-related death was due to bleeding, infection, renal failure, and multiple organ failure. There were two postoperative ruptures; both were fatal although not related to the treated disease. The primary and secondary long-term CG patencies were 89% (65 of 73) and 93% (68 of 73), respectively. Primary type I endoleak (EL-I) occurred in 10% (5 of 51) of the patients, and only one patient had recurrent EL-I (2%; 1 of 51). No secondary endoleak was observed. Chimney-related reintervention was required in 16% (8 of 51) of the patients because of EL-I (n = 3), visceral ischemia (n = 4), and bleeding (n = 2). The reinterventions included stenting (n = 5), embolization (n = 3), and laparotomy (n = 2). Thirty-one visceral branches were sacrificed (9 celiac trunks, 9 right, and 13 left renal arteries). Among the 30-day survivors, 8 of 17 patients (47%) with a sacrificed kidney required permanent dialysis; of these, seven underwent an urgent index operation. The aneurysm sac shrank in 63% (29 of 46) of cases. The 6% chimney-related mortality and 93% long-term patency seem promising in urgent, complex aortic lesions of a high-risk population and may justify a continued yet restrictive applicability of this technique. Most endoleaks could be sealed endovascularly. However, sacrifice of a kidney in this elderly cohort was associated with permanent dialysis in 47% of patients. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  4. Urgent liver transplantation for acute liver failure due to parvovirus B19 infection complicated by primary Epstein-Barr virus and cytomegalovirus infections and aplastic anaemia.

    PubMed

    So, K; Macquillan, G; Garas, G; Delriviere, L; Mitchell, A; Speers, D; Mews, C; Augustson, B; de Boer, W B; Baker, D; Jeffrey, G P

    2007-03-01

    An 11-year-old boy presented with hepatic failure secondary to parvovirus B19 infection, requiring urgent liver transplantation. His recovery was complicated by primary Epstein-Barr virus and cytomegalovirus infections. He subsequently developed aplastic anaemia that has been refractory to antithymocyte globulin and cyclosporine therapy and may now require bone marrow transplantation. We present this case to emphasize parvovirus as a rare cause of hepatic failure and of aplastic anaemia as a complication of the virus.

  5. A diagnostic dilemma of right lower lobe collapse caused by pulmonary bilharsiasis.

    PubMed

    Sersar, Sameh Ibrahim; Abulmaaty, Reda Ahmed; Elnahas, Hala Ahmed; Moussa, Sherif Abdou; Shiha, Usama A; Ghafar, Wael A Abdel; Elmotawaly, Raed A

    2006-02-01

    A 32-year-old male was presented with massive haemoptysis. An urgent chest X-ray (Fig. 1a) and CT chest (Fig. 1b-e) was done revealing a right lower lobe consolidation collapse. An urgent rigid bronchoscopy was performed to localize the source of bleeding and try to control it. A right lower lobectomy was done using a double-lumen endotracheal tube. Preoperative and intraoperative impressions of non-specific inflammation were accused to be the aetiology. Histopathology revealed pulmonary venous congestion with bilharsial ova.

  6. Using systems thinking to identify workforce enablers for a whole systems approach to urgent and emergency care delivery: a multiple case study.

    PubMed

    Manley, Kim; Martin, Anne; Jackson, Carolyn; Wright, Toni

    2016-08-09

    Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust. Data sources included 14 clinical settings where upstream or downstream pinch points are likely to occur including discharge planning and rapid response teams; ten regional stakeholder events (n = 102); a qualitative survey (n = 48); and a review of literature and analysis of policy documents including care pathways and protocols. The key workforce enablers for whole systems urgent and emergency care delivery identified were: clinical systems leadership, a single integrated career and competence framework and skilled facilitation of work based learning. In this study, participants agreed that whole systems urgent and emergency care allows for the design and implementation of care delivery models that meet complexity of population healthcare needs, reduce duplication and waste and improve healthcare outcomes and patients' experiences. For this to be achieved emphasis needs to be placed on holistic changes in structures, processes and patterns of the urgent and emergency care system. Often overlooked, patterns that drive the thinking and behavior in the workplace directly impact on staff recruitment and retention and the overall effectiveness of the organization. These also need to be attended to for transformational change to be achieved and sustained. Research to refine and validate a single integrated career and competence framework and to develop standards for an integrated approach to workplace facilitation to grow the capacity of facilitators that can use the workplace as a resource for learning is needed.

  7. Timely access to specialist medical oncology services closer to home for rural patients: experience from the Townsville Teleoncology Model.

    PubMed

    Sabesan, Sabe; Roberts, Lynden J; Aiken, Peter; Joshi, Abhishek; Larkins, Sarah

    2014-08-01

    Prior to 2009, the teleoncology model of the Townsville Cancer Centre (TCC) did not achieve its aims of equal waiting times for rural and urban patients and the provision of reliable, local acute cancer care. From 2007-2009, 60 new patients from Mt Isa travelled to TCC for their first consultation and their first dose of chemotherapy. Six of these patients required inter-hospital transfers and eight required urgent flights to attend outpatient clinics. Only 50% these rural patients (n = 30) were reviewed within one week of their referral, compared with 90% of Townsville patients. A descriptive study. TCC provides teleoncology services to 21 rural towns; the largest is Mt Isa, Qld. Specialist review of 90% of urgent cases within 24 hours, and 90% of non-urgent cases within one week of referral via videoconferencing. A 50% reduction in inpatient inter-hospital transfers from Mt Isa to Townsville. Employment of a half-time medical officer and a half-time cancer care coordinator, and implementation of new policies. Between 2009 and 2011, TCC provided cancer care to 70 new patients from Mt Isa. Of these new patients, 93% (65/70) were seen within one week of referral. All 17 patients requiring urgent reviews were seen within 24 hours of referral and managed locally thus eliminating the need for inpatient inter-hospital transfers. Provision of timely acute cancer care closer to home requires an increase in the rural case complexity and human resources. © 2014 National Rural Health Alliance Inc.

  8. Improving the transport of urgent specimens to an off-site laboratory using a novel sticker-tracker.

    PubMed

    Sepahzad, Afsoon; Ejiofor, Florence; Giles, Susan; Klaber, Robert

    2013-01-01

    Obtaining results for urgent microbiology specimens in an efficient manner is imperative to ensure that patients receive appropriate antibiotic therapy. A previous audit carried out in the Paediatric department of a central teaching hospital and a number of clinical incidents, highlighted a delay in transport of specimens (exceeding eight hours) and 'missing' specimens. This results in empirical antibiotic treatment of infection, with delay in confirming microbiology result and unnecessary, distressing repeat investigation. As an initial step we sought staff opinion to further explore the problem. A sticker was designed for the microbiology specimen bag to assign accountability, track each step in the transport process and to raise awareness of the problem. The sticker required the member of staff responsible at each stage of the process to time, date and sign it, to allow tracking of potential delays. The new sticker tracking system was promoted and launched in the Paediatric department. Initial challenges included lack of awareness of the protocol and lack of pods for sending urgent specimens. The team met regularly and completed stickers were analysed weekly to identify on-going issues and to devise solutions. Consequently total transport time was reduced to an average of 69 minutes by September (within four hr target). Our intervention improved the efficiency and reliability of urgent specimen transport. This is likely to result in safer antibiotic use and avoid the need for repeat investigation. The system is now also used in the Neonatal department and has lead to the development of a new 'Central Specimens Reception'.

  9. Do case-generic measures of queue performance for bypass surgery accurately reflect the waiting-list experiences of those most urgent?

    PubMed

    Burstein, Jason; Lee, Douglas S; Alter, David A

    2006-02-01

    Queue performance is typically assessed using generic measures, which capture the queue in aggregate. The objective of this study was to examine whether case-generic measures of queue performance appropriately reflected the waiting-list experiences of those patients with greatest disease severity. We examined the queue for isolated coronary artery bypass grafting (CABG) in Ontario between April 1993 and March 2000 using data obtained from the Cardiac Care Network. Our primary measure of queue performance was the proportion of patients who received their bypass surgery within their recommended maximum waiting times (%RMWTs) in any given month. We compared case-generic measures of queue performance to case-specific measures of queue performance stratified by urgency level. The queue was largely comprised of elective cases ranging from 73% (1993) to 57%(1999). Urgent patients comprised the minority of the queue ranging from 14% (1993) to 20% (1999). Case-generic month-to-month variations in the percentage of cases completed within RMWTs (an aggregated waiting list measure encompassing the characteristics of all patients in the queue) closely resembled the experiences of elective patients (R2 = 0.81), but conversely, bore little relationship to the waiting-list experiences of those most urgent (R2 = 0.15). Case-generic measures of queue performance for bypass surgery in Ontario were not reflective of the waiting-list experiences of those most urgent. Our results reinforce the concept that urgency-specific waiting list monitoring systems are required to best evaluate and appropriately respond to fluctuations in queue performance.

  10. Referring patients to specialists: A structured vignette survey of Australian and British GPs

    PubMed Central

    Jiwa, Moyez; Gordon, Michael; Arnet, Hayley; Ee, Hooi; Bulsara, Max; Colwell, Brigitte

    2008-01-01

    Background In Australia and in the United Kingdom (UK) access to specialists is sanctioned by General Practitioners (GPs). It is important to understand how practitioners determine which patients warrant referral. Methods A self-administered structured vignette postal survey of General Practitioners in Western Australia and the United Kingdom. Sixty-four vignettes describing patients with colorectal symptoms were constructed encompassing six clinical details. Nine vignettes, chosen at random, were presented to each individual. Respondents were asked if they would refer the patient to a specialist and how urgently. Logistic regression and parametric tests were used to analyse the data Results We received 260 completed questionnaires. 58% of 'cancer vignettes' were selected for 'urgent' referral. 1632/2367 or 69% of all vignettes were selected for referral. After adjusting for clustering the model suggests that 38.4% of the variability is explained by all the clinical variables as well as the age and experience of the respondents. 1012 or 42.8 % of vignettes were referred 'urgently'. After adjusting for clustering the data suggests that 31.3 % of the variability is explained by the model. The age of the respondents, the location of the practice and all the clinical variables were significant in the decision to refer urgently. Conclusion GPs' referral decisions for patients with lower bowel symptoms are similar in the two countries. We question the wisdom of streaming referrals from primary care without a strong evidence base and an effective intervention for implementing guidelines. We conclude that implementation must take into account the profile of patients but also the characteristics of GPs and referral policies. PMID:18194578

  11. Urgent tracheostomy: four-year experience in a tertiary hospital.

    PubMed

    Costa, Liliana; Matos, Ricardo; Júlio, Sara; Vales, Fernando; Santos, Margarida

    2016-01-01

    Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely important. We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were reviewed. The study included 56 patients (44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two (3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal (51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated (average time: 4 months), and none of them were cancer patients. Complications occurred in 5 (12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the procedure. Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with difficult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.

  12. "Why Is This Patient Being Sent Here?": Communication from Urgent Care to the Emergency Department.

    PubMed

    Gardner, Rebekah; Choo, Esther K; Gravenstein, Stefan; Baier, Rosa R

    2016-03-01

    Despite patients' increasing use of urgent care centers (UCC), little is known about how urgent care clinicians communicate with the emergency department (ED). To assess ED clinicians' perceptions of the quality and consistency of communication when patients are referred from UCCs to EDs. Emergency medicine department chairs distributed a brief, electronic survey to a statewide sample of ED clinicians via e-mail. The survey included multiple-choice and free-text questions focused on types of communication desired and received from UCCs, types of test results available on transfer, and suggestions for improvement. Of 199 ED clinicians, 102 (51.3%) responded. More than four out of five respondents "somewhat" or "strongly agreed" that each of the following would be helpful: a telephone call, the reason for referral, specific concern, a copy of the chart, and UCC contact information. However, ED clinicians reported not consistently receiving these: only a fifth (21.6%) of clinicians reported receiving the specific concern for their last 5 patients transferred from a UCC, and 34.3% recalled receiving a copy of the chart. Overall, 54.9% reported receiving laboratory test results "often or almost always," 49.0% electrocardiograms, and 44.1% imaging reports. Qualitative analysis revealed several themes: incomplete data when patients are referred; barriers to discussion between ED and urgent care clinicians; and possible solutions to improve communication. Our findings highlight variation in communication from UCCs to EDs, indicating a need to improve communication standards and practices. We identify several potential ways to improve this clinical information hand-off. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Yield and accuracy of urgent combined carotid/transcranial ultrasound testing in acute cerebral ischemia.

    PubMed

    Chernyshev, Oleg Y; Garami, Zsolt; Calleja, Sergio; Song, Joon; Campbell, Morgan S; Noser, Elizabeth A; Shaltoni, Hashem; Chen, Chin-I; Iguchi, Yasuyuki; Grotta, James C; Alexandrov, Andrei V

    2005-01-01

    We routinely perform an urgent bedside neurovascular ultrasound examination (NVUE) with carotid/vertebral duplex and transcranial Doppler (TCD) in patients with acute cerebral ischemia. We aimed to determine the yield and accuracy of NVUE to identify lesions amenable for interventional treatment (LAITs). NVUE was performed with portable carotid duplex and TCD using standardized fast-track (<15 minutes) insonation protocols. Digital subtraction angiography (DSA) was the gold standard for identifying LAIT. These lesions were defined as proximal intra- or extracranial occlusions, near-occlusions, > or =50% stenoses or thrombus in the symptomatic artery. One hundred and fifty patients (70 women, mean age 66+/-15 years) underwent NVUE at median 128 minutes after symptom onset. Fifty-four patients (36%) received intravenous or intra-arterial thrombolysis (median National Institutes of Health Stroke Scale (NIHSS) score 14, range 4 to 29; 81% had NIHSS > or =10 points). NVUE demonstrated LAITs in 98% of patients eligible for thrombolysis, 76% of acute stroke patients ineligible for thrombolysis (n=63), and 42% in patients with transient ischemic attack (n=33), P<0.001. Urgent DSA was performed in 30 patients on average 230 minutes after NVUE. Compared with DSA, NVUE predicted LAIT presence with 100% sensitivity and 100% specificity, although individual accuracy parameters for TCD and carotid duplex specific to occlusion location ranged 75% to 96% because of the presence of tandem lesions and 10% rate of no temporal windows. Bedside neurovascular ultrasound examination, combining carotid/vertebral duplex with TCD yields a substantial proportion of LAITs in excellent agreement with urgent DSA.

  14. Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures.

    PubMed

    Kothari, Anai N; Zapf, Matthew A C; Blackwell, Robert H; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N; Kuo, Paul C

    2015-10-01

    We hypothesized that perioperative hospital resources could overcome the "weekend effect" (WE) in patients undergoing emergent/urgent surgeries. The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P < 0.001). Specific hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

  15. Urine Culture Follow-up and Antimicrobial Stewardship in a Pediatric Urgent Care Network.

    PubMed

    Saha, Dipanwita; Patel, Jimisha; Buckingham, Don; Thornton, David; Barber, Terry; Watson, Joshua R

    2017-04-01

    Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record. Monthly antibiotic discontinuation rates were tracked in empirically treated patients with negative urine culture results from July 2013 through December 2015. Statistical process control methods were used to track improvement over time. Fourteen-day return visits for UTIs were monitored as a balancing measure. During the study period, 910 patients received empiric antibiotic therapy for UTIs but had a negative urine culture result. The antibiotic discontinuation rate increased from 4% to 84%, avoiding 3429 (40%) of 8648 antibiotic days prescribed. Among patients with discontinued antibiotics, none was diagnosed with a UTI within 14 days of the initial urgent care encounter. Implementation of a standard protocol for urine culture follow-up and discontinuation of unnecessary antibiotics was both effective and safe in a high-volume pediatric urgent care network. Urine culture follow-up management is an essential opportunity for improved antimicrobial stewardship in the outpatient setting that will affect many patients by avoiding a substantial number of antibiotic days. Copyright © 2017 by the American Academy of Pediatrics.

  16. Value of subjective visual reduction in patients with acute-onset floaters and/or flashes.

    PubMed

    Hurst, Jonathan; Johnson, Davin; Law, Christine; Schweitzer, Kelly; Sharma, Sanjay

    2015-08-01

    To quantify the association between subjective visual reduction (SVR) and retinal pathology in patients with acute-onset monocular floaters or flashes, or both. Prospective cohorts study involving all new patients referred for acute-onset floaters or flashes, or both, to a tertiary care emergency eye clinic in Kingston, Ontario, between July 1, 2011, and June 29, 2012 (n = 333). All patients were evaluated for the presence of SVR in a standardized fashion, as well as other known risk factors for retina pathology including a family history of retinal tear or retinal detachment, a personal history of retinal tear or detachment, high myopia, and ocular trauma. Our major outcome was urgent retinal pathology, defined as retina pathology requiring a same-day referral to a retina specialist for evaluation, management, or both. SVR was strongly associated with retinal pathology (likelihood ratio 7.9, 95% CI 5.2-12.1). Patients with SVR are at increased risk for urgent retinal pathology and should be triaged for urgent ophthalmologic examination. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  17. [Urgent laparoscopic adrenalectomy in acute crisis caused by pheochromocytoma].

    PubMed

    Bereczky, Bíborka; Madách, Krisztina; Gál, János; István, Gábor; Sugár, István; Ondrejka, Pál; Vörös, Attila

    2014-06-01

    Authors present the case of a 30-year-old female patient, who was admitted to the ICU because of hypertensive crisis accompanied by chest complains, cardiac decompensation, progrediating short of breath and unconsciousness. Despite the quick examinations and the prompt treatment multi-organ failure developed 3 days after admission. Investigations revealed the underlying cause, which was a left-sided suprarenal neoplasm. Hence, multidisciplinary decision was made to carry out a laparoscopic adrenalectomy urgently. The histology examination of the removed neoplasm was pheochromocytoma. In the postoperative period the condition of the patient gradually improved, her symptoms and complains settled, and finally she was discharged in a healthy condition. The diagnosis of a pheochromocytoma is a difficult task, the symptoms and complains caused by it can simulate many other illnesses. The acute crisis caused by pheochromocytoma usually can be treated conservatively, but in more severe cases with impending multi-organ failure an urgent operative treatment can be unavoidable. Though the operative risk is relatively high, the correct intra- and postoperative treatment with a quick laparoscopic procedure can be effective.

  18. Urgent Optic Nerve Decompression via an Endoscopic Endonasal Transsphenoidal Approach for Craniopharyngioma in a 12-Month-Old Infant: A Case Report.

    PubMed

    Shibata, Teishiki; Tanikawa, Motoki; Sakata, Tomohiro; Mase, Mitsuhito

    2018-01-01

    Craniopharyngiomas are benign tumors and account for approximately 5.6-13% of all intracranial tumors in children. Diagnosis of pediatric craniopharyngioma is often delayed until the tumor becomes relatively large and manifests severe visual and/or endocrine disturbance. Endoscopic endonasal approaches have recently been introduced to surgery for craniopharyngioma. These techniques, however, have rarely been utilized in patients affected with craniopharyngioma as young as 1 year old. This report documents a 12-month-old male infant with sellar craniopharyngioma who presented with acute total vision loss. To increase the chances of visual recovery, an endoscopic endonasal optic nerve decompression was performed as an urgent procedure. After decompression, which resulted in improvement of his visual disturbance, gross total resection of the tumor was undertaken through an anterior interhemispheric approach at a later date. Tumor mass reduction through an endoscopic endonasal transsphenoidal approach followed by secondary radical total resection under craniotomy was considered to be useful in cases such as this when urgent optic nerve decompression is required. © 2018 S. Karger AG, Basel.

  19. [Emergencies and continuous care: overload of the current on-call system and search for new models].

    PubMed

    Enríquez-Navascués, Jose M

    2008-04-01

    Emergency surgical care is still provided by means of an 24 hours physical presence "on-call" model (encompassing a normal day followed by "on call"), and is obligatory for all staff. This defective organisation of work has become unsustainable with the acceptance of the European 48 hours Directive, and is gruelling due to the excessive night work and feeling of being locked in that it entails. Emergency general and digestive system surgery care cannot be provided by a single organisational model, but has to be adapted to local circumstances. It is important to separate scheduled activity from urgent, and whereas increasingly more resources are dedicated to scheduled care, sufficient resources are also required for urgent activities, that cannot be considered as simply an "on call" or a fleeting stop in scheduled activity. Core subjects in residency, creating different levels of provision and activities, the analysis of urgent activity per work period and the identification of foreseeable activity, to maintain a pro-active mentality, and the disappearance of the "overtime" concept, should help provide another care model and method of remuneration.

  20. Event-based surveillance of food- and waterborne diseases in Europe: urgent inquiries (outbreak alerts) during 2008 to 2013.

    PubMed

    Gossner, C M; de Jong, B; Hoebe, C J; Coulombier, D

    2015-06-25

    During 2008 to 2013, 215 outbreak alerts, also known as 'urgent inquiries' (UI), for food- and waterborne diseases were launched in Europe, the majority of them (135; 63%) being related to salmonellosis. For 110 (51%) UI, a potential food vehicle of infection was identified, with vegetables being the most reported category (34;31%). A total of 28% (n = 60) of the outbreaks reported had an international dimension, involving at least two countries (mean: 4; standard deviation: 2; range:2–14). Participating countries posted 2,343 messages(initial posts and replies, excluding updates), with a median of 11 messages per urgent inquiry (range:1–28). Of 60 multicountry UI, 50 involved between two and four countries. The UI allowed early detection of multicountry outbreaks, facilitated the identification of the suspected vehicles and consequently contributed to the timely implementation of control measures. The introduction of an epidemic intelligence information system platform in 2010 has strengthened the role of the Food- and Waterborne Diseases and Zoonoses network in facilitating timely exchange of information between public health authorities of the participating countries.

  1. [Biosafety provision on handling pathogenic biological agents on the concept of biorisk assessment and management].

    PubMed

    Dobrokhotskiĭ, O N; Kolombet, L V

    2010-01-01

    The paper shows it urgent to realize the concept of biological risk assessment and management on handling pathogenic biological agents (PBA). It gives a number of objective reasons that impede development of a methodology to assess laboratory biological risks. A concept of continuous improvement (a process approach) is proposed for use as a biorisk management tool for biosafety assurance when handling PBA. It is demonstrated that development of international cooperation urgently requires that national concepts and standards be harmonized with international regulatory documents on biosafety assurance on handling PBA.

  2. Urgent Call for Nursing Big Data.

    PubMed

    Delaney, Connie W

    2016-01-01

    The purpose of this panel is to expand internationally a National Action Plan for sharable and comparable nursing data for quality improvement and big data science. There is an urgent need to assure that nursing has sharable and comparable data for quality improvement and big data science. A national collaborative - Nursing Knowledge and Big Data Science includes multi-stakeholder groups focused on a National Action Plan toward implementing and using sharable and comparable nursing big data. Panelists will share accomplishments and future plans with an eye toward international collaboration. This presentation is suitable for any audience attending the NI2016 conference.

  3. Fungal exposure, atopy, and asthma exacerbations in Puerto Rican children.

    PubMed

    Blatter, Joshua; Forno, Erick; Brehm, John; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Thorne, Peter S; Metwali, Nervana; Canino, Glorisa; Celedón, Juan C

    2014-07-01

    Glucan is a component of the fungal cell wall that is used as a marker of fungal exposure. Little is known about indoor glucan, atopy, and asthma exacerbations among children living in tropical environments such as Puerto Rico. Our objective was to examine whether glucan exposure is associated with degree of atopy or visits to the emergency department (ED)/urgent care for asthma in Puerto Rican children. This was a cross-sectional study of 317 children aged 6 to 14 years with (cases, n = 160) and without (control subjects, n = 157) asthma in San Juan, Puerto Rico. Our primary outcomes were the number of positive skin tests to allergens (range, 0-15) and (in cases only) having had at least one visit to the ED/urgent care for asthma in the prior year. Levels of glucan, endotoxin, peptidoglycan, and five allergens (Der p 1, Bla g 2, Fel d 1, Can f 1, and Mus m 1) were measured in samples of house dust. Linear or logistic regression was used for the multivariate analysis. In a multivariate analysis adjusting for case-control status, mouse allergen, and other covariates, children exposed to glucan levels in the second and third quartiles had approximately two more positive skin tests than those in the lowest quartile (P < 0.01 in both instances). Among children with asthma, exposure to the highest quartile of glucan was associated with nearly ninefold greater odds of one or more visits to the ED/urgent care for asthma (95% confidence interval for adjusted odds ratio, 2.7-28.4; P < 0.001). Our results suggest that indoor fungal exposure leads to an increased degree of atopy and visits to the ED/urgent care for asthma in Puerto Rican children.

  4. Fungal Exposure, Atopy, and Asthma Exacerbations in Puerto Rican Children

    PubMed Central

    Blatter, Joshua; Forno, Erick; Brehm, John; Acosta-Pérez, Edna; Alvarez, María; Colón-Semidey, Angel; Thorne, Peter S.; Metwali, Nervana; Canino, Glorisa

    2014-01-01

    Background: Glucan is a component of the fungal cell wall that is used as a marker of fungal exposure. Little is known about indoor glucan, atopy, and asthma exacerbations among children living in tropical environments such as Puerto Rico. Our objective was to examine whether glucan exposure is associated with degree of atopy or visits to the emergency department (ED)/urgent care for asthma in Puerto Rican children. Methods: This was a cross-sectional study of 317 children aged 6 to 14 years with (cases, n = 160) and without (control subjects, n = 157) asthma in San Juan, Puerto Rico. Our primary outcomes were the number of positive skin tests to allergens (range, 0–15) and (in cases only) having had at least one visit to the ED/urgent care for asthma in the prior year. Levels of glucan, endotoxin, peptidoglycan, and five allergens (Der p 1, Bla g 2, Fel d 1, Can f 1, and Mus m 1) were measured in samples of house dust. Linear or logistic regression was used for the multivariate analysis. Measurements and Main Results: In a multivariate analysis adjusting for case-control status, mouse allergen, and other covariates, children exposed to glucan levels in the second and third quartiles had approximately two more positive skin tests than those in the lowest quartile (P < 0.01 in both instances). Among children with asthma, exposure to the highest quartile of glucan was associated with nearly ninefold greater odds of one or more visits to the ED/urgent care for asthma (95% confidence interval for adjusted odds ratio, 2.7–28.4; P < 0.001). Conclusions: Our results suggest that indoor fungal exposure leads to an increased degree of atopy and visits to the ED/urgent care for asthma in Puerto Rican children. PMID:24915164

  5. Comparing emergency department presentations among children with cerebral palsy with general childhood presentations: a data linkage study.

    PubMed

    Meehan, Elaine; Williams, Katrina; Reid, Susan M; Freed, Gary L; Babl, Franz E; Sewell, Jillian R; Vidmar, Suzanna; Donath, Susan; Reddihough, Dinah S

    2017-11-01

    The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children. This was a retrospective cohort study. The Victorian Cerebral Palsy Register was linked to the Victorian Emergency Minimum Dataset. Data on emergency department presentations for the CP cohort occurring between 2007 and 2014 and population control data were obtained. The CP cohort (n=1748) had 7015 emergency department presentations during the 7-year period, accounting for 0.4% of the 1.69 million age-specific presentations during that time. The number of annual presentations per 1000 children rose with increasing CP severity. Compared with presentations among the general population, higher proportions of presentations among the CP cohort were preceded by ambulance arrivals (27% vs 8%), triaged as urgent (66% vs 32%), and required hospital admission (38% vs 12%). The marked differences in presentations between the CP cohort and the general population in the proportions that were urgent and required ambulance arrivals and hospital admissions was an important finding. Strategies to ensure appropriate use of services, including encouragement to seek earlier assistance from primary care providers, may prevent problems escalating to the need for urgent care. Children with cerebral palsy (CP) account for 0.4% of childhood emergency department presentations. More emergency department presentations among children with CP require ambulance arrival. More CP emergency department presentations are urgent and require hospital admission. Traditional emergency department triage scales seem less accurate for this group. © 2017 Mac Keith Press.

  6. Prognostic Value of Serum Lactate Levels in Patients Undergoing Urgent Heart Transplant: A Subanalysis of the ASIS-TC Spanish Multicenter Study.

    PubMed

    Couto-Mallón, David; González-Vílchez, Francisco; Almenar-Bonet, Luis; Díaz-Molina, Beatriz; Segovia-Cubero, Javier; González-Costello, José; Delgado-Jiménez, Juan; Castel-Lavilla, María A; Crespo-Leiro, María G; Rangel-Sousa, Diego; Martínez-Sellés, Manuel; Rábago-Juan-Aracil, Gregorio; De-la-Fuente-Galán, Luis; Blasco-Peiró, Teresa; Hervás-Sotomayor, Daniela; Garrido-Bravo, Iris P; Mirabet-Pérez, Sonia; Muñiz, Javier; Barge-Caballero, Eduardo

    2018-05-30

    To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant. We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels. The main study outcome was 1-year survival after transplant. A total of 177 heart transplant recipients were studied; preoperatively, 90 were supported on venoarterial extracorporeal membrane oxygenation, 51 on temporary left ventricular assist devices, and 36 on temporary biventricular assist devices. Preoperative hyperlactatemia (≥ 2 mmol/L) was present in 44 (25%) patients. On multivariable analysis, pretransplant serum lactate was identified as an independent predictor of 1-year posttransplant survival (adjusted HR per 0.1 mmol/L, 1.02; 95%CI, 1.01-1.03; P = .007). One-year posttransplant survival was 53.1% (95%CI, 45.3-60.9) in patients with preoperative hyperlactatemia and 75.6% (95%CI, 71.8-79.4) in those without preoperative hyperlactatemia (adjusted HR, 1.94; 95%CI, 1.04-3.63; P = .039). Preoperative hyperlactatemia correlated with adverse outcomes in patients supported with extracorporeal membrane oxygenation, but not in patients supported on ventricular assist devices. Preoperative serum lactate is a strong independent predictor of worse outcomes in patients undergoing urgent heart transplant on short-term mechanical circulatory support. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis.

    PubMed

    Lee, Hee Seung; Chung, Moon Jae; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock

    2018-01-01

    Acute pancreatitis is a common diagnosis worldwide, with gallstone disease being the most prevalent cause (50%). The American College of Gastroenterology recommends urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 h) for patients with biliary pancreatitis accompanied by cholangitis. Most international guidelines recommend that ERCP be performed within 72 h in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, but the optimal timing for endoscopy is controversial. We investigated the optimal timing for ERCP in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, and whether performing endoscopy within 24 h is superior to performing it after 24 h. We analyzed the clinical data of 505 patients with newly diagnosed acute pancreatitis, from January 1, 2005 to December 31, 2014. We divided the patients into two groups according to the timing of ERCP: < 24 h (urgent) and 24-72 h (early).Among the 505 patients, 73 were diagnosed with biliary pancreatitis and a bile duct obstruction without cholangitis. The mean age of the patients was 55 years (range: 26-90 years). Bile duct stones and biliary sludge were identified on endoscopy in 45 (61.6%) and 11 (15.0%) patients, respectively. The timing of ERCP within 72 h was not associated with ERCP-related complications (P = 0.113), and the total length of hospital stay was not different between urgent and early ERCP (5.9 vs. 5.7 days, P = 0.174). No significant differences were found in total length of hospitalization or procedural-related complications, in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, according to the timing of ERCP (< 24 h vs. 24-72 h).

  8. The use of technology for urgent clinician to clinician communications: a systematic review of the literature.

    PubMed

    Nguyen, Cristina; McElroy, Lisa M; Abecassis, Michael M; Holl, Jane L; Ladner, Daniela P

    2015-02-01

    Urgent clinician-clinician communications require routes of contact that are fast and dependable, and allow for the exchange of complex information. Despite the increasing focus on improving healthcare delivery systems over the past decade, few studies have examined the role of technology in clinician-clinician communication. The aim of this study was to review the literature examining the role of devices and technology in facilitating urgent clinician-clinician communication to identify critical areas for future research. A search of Pub Med was performed using the terms (((("Critical Care"[Mesh] OR "urgent")))) AND (((hospital communication systems[MeSH Terms]) OR health communication[MeSH Terms]) OR interdisciplinary communication[MeSH Terms]). Commentaries and editorials were excluded. The initial search returned 272 articles, which were reviewed to identify articles describing: (1) the role of technological support or devices in clinician-clinician communication, (2) technology-based interventions that improved clinician-to-clinician communication in hospitals or acute care facilities related to critically ill patients, or (3) critical information exchange. A total of 16 articles were included in the final review. These were grouped into three categories: alphanumeric pagers, cellular and smart telephones, and novel uses of technology. Breakdowns in clinician-clinician communication are complex and cannot be solved through the implementation of devices or technologically advanced systems alone. It is essential to understand the correlation between emerging technologies, a demanding workload, and clinician-clinician interaction. Enhanced communication of clinical ideas, opportunities for team discussion, and a sense of partnership and support require not just increased information, but enhanced delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Ultrasonography-guided central venous catheterisation in haematological patients with severe thrombocytopenia

    PubMed Central

    Napolitano, Mariasanta; Malato, Alessandra; Raffaele, Francesco; Palazzolo, Manuela; Iacono, Giorgio Lo; Pinna, Roberto; Geraci, Girolamo; Modica, Giuseppe; Saccullo, Giorgia; Siragusa, Sergio; Cajozzo, Massimo

    2013-01-01

    Background Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia. Materials and methods We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×109/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded. Results All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group. Discussion US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion. PMID:23399356

  10. Preventive induction of labor for non-urgent indications at term and maternal and neonatal outcomes.

    PubMed

    Zhang, Lin; Zhang, Hao; Zhang, Jun; Zhang, Jin Wen; Ye, Jiang Feng; Branch, D Ware

    2016-04-21

    Induction of labor (IOL) is a common practice in many parts of the world. However, the benefits and risks of preventive IOL for the mother and baby have yet to be critically assessed. This study is to investigate the effects of preventive IOL for non-urgent indications at term on maternal and neonatal outcomes. In this study, we applied a propensity score model to mimic a randomized clinical trial. Maternal and neonatal outcomes were compared between women with preventive IOL at 37-39 weeks of gestation and women with ongoing pregnancy (expectant management). The subjects were from the Consortium on Safe Labor, a study of over 200,000 births from 19 hospitals across the US from 2002 to 2008. Both nulliparous and multiparous women induced preventively for non-urgent indications at 37-38 weeks' gestation had lower rates of cesarean delivery compared to those delivered at later gestational weeks. However, preventive IOL was associated with increased risks of adverse neonatal outcomes (adjusted odds ratio [aOR] = 1.68, 95% confidence interval [CI], 0.97-2.92 for nulliparas; aOR = 2.22, 1.32-3.74 for multiparas) and admission to NICU (aOR = 1.48, 0.99-2.20 for nulliparas; aOR = 2.08, 1.47-2.96 for multiparas) at 37 weeks' gestation. A longer maternal hospital stay was found among all women with preventive IOL. Preventive IOL for non-urgent indications may be associated with a decreased risk of cesarean delivery at early term but increased risks of adverse neonatal outcomes at 37 weeks. It also results in a longer hospital stay than expectant management.

  11. Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population

    NASA Astrophysics Data System (ADS)

    Palmisano, Pietro; Accogli, Michele; Zaccaria, Maria; Vergari, Alessandra; De Luca De Masi, Gabriele; Negro, Luca; De Blasi, Sergio

    2014-09-01

    There is little information on any seasonal variations or meteorological factors associated with symptomatic bradyarrhythmias requiring cardiac pacing. The aim of this single-center study was to investigate the seasonal distribution of the incidence of severe, life-threatening bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population. Consecutive patients who underwent urgent temporary transvenous cardiac pacing between 2007 and 2012 were enrolled. The baseline characteristics of the patients and some meteorological parameters, including the calculation the daily heat index (HI), were recorded. During the study period, 79 consecutive patients (mean age 82 ± 8 years, 41 % male) underwent urgent temporary transvenous cardiac pacing, mainly for third-degree atrioventricular block (79 %). The incidence of bradyarrhythmias was significantly higher in summer than in the other seasons ( P < 0.001). Moreover, the highest incidence was observed in months with HI > 90 °F for >3 h per day for at least 10 days ( P < 0.001). A direct correlation was found between the average monthly temperature and the monthly number of patients undergoing temporary cardiac pacing (r = 0.54, P < 0.001). Compared with other patients, those observed during the hottest months were significantly older and more frequently affected by chronic disabling neurological diseases (all P < 0.05). In addition, they more frequently showed biochemical indices of dehydration, renal function impairment and hyperkalemia (all P < 0.05). This study showed an increased incidence of severe bradyarrhythmias in an elderly population during the hottest months of the year. In these months, in subjects characterized by increased susceptibility to dehydration, the risk of developing bradyarrhythmias was increased significantly.

  12. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa.

    PubMed

    Levitt, Naomi S; Puoane, Thandi; Denman, Catalina A; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A

    2015-01-01

    We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

  13. Urgent Chemotherapy for Life-Threatening Complications Related to Solid Neoplasms.

    PubMed

    Zerbib, Yoann; Rabbat, Antoine; Fartoukh, Muriel; Bigé, Naïke; Andréjak, Claire; Mayaux, Julien; De Prost, Nicolas; Misset, Benoît; Lemiale, Virginie; Bruneel, Fabrice; Maizel, Julien; Ricome, Sylvie; Jacobs, Frédéric; Bornstain, Caroline; Dupont, Hervé; Baudin, François; Azoulay, Elie; Pène, Frédéric

    2017-07-01

    Solid neoplasms can be directly responsible for organ failures at the time of diagnosis or relapse. The management of such specific complications relies on urgent chemotherapy and eventual instrumental or surgical procedures, combined with advanced life support. We conducted a multicenter study to address the prognosis of this condition. A multicenter retrospective (2001-2015) chart review. Medical and respiratory ICUs. Adult patients who received urgent chemotherapy in the ICU for organ failure related to solid neoplasms were included. The modalities of chemotherapy, requirements of adjuvant instrumental or surgical procedures, and organ supports were collected. Endpoints were short- and long-term survival rates. None. One hundred thirty-six patients were included. Lung cancer was the most common malignancy distributed into small cell lung cancer (n = 57) and non-small cell lung cancer (n = 33). The main reason for ICU admission was acute respiratory failure in 111 patients (81.6%), of whom 89 required invasive mechanical ventilation. Compression and tissue infiltration by tumor cells were the leading mechanisms resulting in organ involvement in 78 (57.4%) and 47 (34.6%) patients. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 37%, 58%, 74%, and 88%, respectively. Small cell lung cancer was identified as an independent predictor of hospital survival. However, this gain in survival was not sustained since the 1-year survival rates of small cell lung cancer, non-small cell lung cancer, and non-lung cancer patients all dropped below 20%. Urgent chemotherapy along with aggressive management of organ failures in the ICU can be lifesaving in very selected cancer patients, most especially with small cell lung cancer, although the long-term survival is hardly sustainable.

  14. Role of enhanced multi-detector-row computed tomography before urgent endoscopy in acute upper gastrointestinal bleeding.

    PubMed

    Miyaoka, Youichi; Amano, Yuji; Ueno, Sayaka; Izumi, Daisuke; Mikami, Hironobu; Yazaki, Tomotaka; Okimoto, Eiko; Sonoyama, Takayuki; Ito, Satoko; Fujishiro, Hirofumi; Kohge, Naruaki; Imaoka, Tomonori

    2014-04-01

    Multi-detector-row computed tomography (MDCT) has been reported to be a potentially useful modality for detection of the bleeding origin in patients with acute upper massive gastrointestinal (GI) bleeding. The purpose of this study is to investigate the efficacy of MDCT as a routine method for detecting the origin of acute upper GI bleeding prior to urgent endoscopy. Five hundred seventy-seven patients with acute upper GI bleeding (514 nonvariceal patients, 63 variceal patients) who underwent urgent upper GI endoscopy were retrospectively analyzed. Patients were divided into three groups: enhanced MDCT, unenhanced MDCT, and no MDCT before endoscopy. The diagnostic accuracy of MDCT for detection of the bleeding origin was evaluated, and the average procedure times needed to endoscopically identify the bleeding origin were compared between groups. Diagnostic accuracy among endoscopists was 55.3% and 14.7% for the enhanced MDCT and unenhanced MDCT groups, respectively. Among nonvariceal patients, accuracy was 50.2% in the enhanced MDCT group, which was significantly better than that in the unenhanced MDCT group (16.5%). In variceal patients, accuracy was significantly better in the enhanced MDCT group (96.4%) than in the unenhanced MDCT group (0.0%). These accuracies were similar to those achieved by expert radiologists. The average procedure time to endoscopic detection of the bleeding origin in the enhanced MDCT group was significantly faster than that in the unenhanced MDCT and no-MDCT groups. Enhanced MDCT preceding urgent endoscopy may be an effective modality for the detection of bleeding origin in patients with acute upper GI bleeding. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  15. Predictors for identification of stigmata of recent hemorrhage on colonic diverticula in lower gastrointestinal bleeding.

    PubMed

    Niikura, Ryota; Nagata, Naoyoshi; Aoki, Tomonori; Shimbo, Takuro; Tanaka, Shohei; Sekine, Katsunori; Kishida, Yoshihiro; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Yanase, Mikio; Akiyama, Junichi; Mizokami, Masashi; Uemura, Naomi

    2015-03-01

    The aim of this study was to identify predictors for the identification of stigmata of recent hemorrhage (SRH) on colonic diverticula. Several factors influence the identification of SRH in the diagnosis of colonic diverticular bleeding. A total of 396 patients hospitalized for lower gastrointestinal bleeding were analyzed. Comorbidities, medications, timing of colonoscopy [<24 h (h); urgent, 24 to 48 h, >48 h], preparation, expert colonoscopist, use of a cap, use of a water-jet scope, total colonoscopy, and procedure time (over 60 min) were assessed. A multivariable logistic regression model was used to estimate odds ratio (OR) and 95% confidence interval (CI). Two hundred fifteen patients were diagnosed with colonic diverticular bleeding and 37 (17%) were identified with SRH. Urgent colonoscopy (OR, 8.4; 95% CI, 2.3-30; P<0.01), expert colonoscopist (OR, 3.0; 95% CI, 1.2-7.3; P=0.02), use of a cap (OR, 3.4; 95% CI, 1.4-8.0; P=0.01), and use of water-jet scope (OR, 5.8; 95% CI, 2.3-15; P<0.01) were found to be independent predictive factors for SRH. The accuracy of these factors in combination was 0.90 (95% CI, 0.85-0.96) as measured by area under the receiver operating characteristic curve (ROC-AUC). SRH identification rate was higher in the urgent (22%) than in the 24 to 48 hours (2.9%, P<0.01) and >48 hours groups (1.0%, P<0.01), showing a tendency to decrease with time (P<0.01 for trend). Factors of urgent colonoscopy, expert colonoscopist, use of a cap, and use of water-jet scope are useful for identifying SRH diverticula.

  16. The diagnostic test accuracy of rectal examination for prostate cancer diagnosis in symptomatic patients: a systematic review.

    PubMed

    Jones, Daniel; Friend, Charlotte; Dreher, Andreas; Allgar, Victoria; Macleod, Una

    2018-06-02

    Prostate cancer is the most common cancer in men in the UK. NICE guidelines on recognition and referral of suspected cancer, recommend performing digital rectal examination (DRE) on patients with urinary symptoms and urgently referring if the prostate feels malignant. However, this is based on the results of one case control study, so it is not known if DRE performed in primary care is an accurate method of detecting prostate cancer. The aim of this review is to ascertain the sensitivity, specificity, positive and negative predictive value of DRE for the detection of prostate cancer in symptomatic patients in primary care. CENTRAL, MEDLINE, EMBASE and CINAHL databases were searched in august 2015 for studies in which a DRE was performed in primary care on symptomatic patients and compared against a reference diagnostic procedure. Four studies were included with a total of 3225 patients. The sensitivity and specificity for DRE as a predictor of prostate cancer in symptomatic patients was 28.6 and 90.7%, respectively. The positive and negative predictive values were 42.3 and 84.2%, respectively. This review found that DRE performed in general practice is accurate, and supports the UK NICE guidelines that patients with a malignant prostate on examination are referred urgently for suspected prostate cancer. Abnormal DRE carried a 42.3% chance of malignancy, above the 3% risk threshold which NICE guidance suggests warrants an urgent referral. However this review questions the benefit of performing a DRE in primary care in the first instance, suggesting that a patient's risk of prostate cancer based on symptoms alone would warrant urgent referral even if the DRE feels normal.

  17. Early Postoperative Perils of Intraventricular Tumors: An Observational Comparative Study.

    PubMed

    Schär, Ralph T; Schwarz, Christa; Söll, Nicole; Raabe, Andreas; Z'Graggen, Werner J; Beck, Jürgen

    2018-05-01

    Early postoperative patient surveillance after removal of intraventricular tumors is often hindered by delayed awakening and prolonged somnolence. The objective of this study was to analyze the incidence of early critical postoperative events after elective craniotomy for intraventricular tumors in adults compared with extraventricular lesions. An observational comparative study was conducted on adult patients who had undergone first-time elective craniotomy between November 2011 and August 2016. Patients were stratified into extraventricular lesions (group 1) and intraventricular tumors (group 2). The rates of late extubation, early postoperative seizures, emergency head computed tomography (CT) scans, and urgent surgical intervention within 48 hours and mortality within 30 days of surgery were analyzed from a prospective database. A total of 977 elective craniotomies were analyzed, including 951 (97.3%) in group 1 and 26 (2.7%) in group 2. Emergency CT scans were ordered significantly more frequently in group 2 (34.6% vs. 8.4%; odds ratio, 5.76; 95% confidence interval [CI], 2.49-13.35; P = 0.0002), and the incidence of urgent surgical intervention was significantly higher in group 2 (11.5% vs. 0.8%; odds ratio, 15.38; 95% CI, 3.83-61.72; P = 0.002). The main reason for urgent surgical intervention in group 2 was acute obstructive hydrocephalus. Overall surgical mortality after 30 days was 0.3% (3 cases in group 1, no cases in group 2). Intraventricular tumors are at significantly higher risk for early emergency head CT and urgent surgical intervention. This patient cohort might benefit from routine intraoperative and early postoperative imaging, as well as intraoperative extraventricular drain placement. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection.

    PubMed

    Lipworth, Adam D; Park, Jong Min; Trefrey, Brie L; Rubin, Krista M; Geller, Alan C; Sober, Arthur J; Tsao, Hensin

    2011-06-01

    As melanoma rates increase, and the supply of dermatologists remains suboptimal to meet demand for services, detection of early melanoma has become an increasingly difficult challenge. Some authors advocate for shifting dermatologic resources from routine appointments to urgent visits for those with lesions concerning for melanoma. We sought to investigate the potential of an urgent access track (UAT) embedded within a pigmented lesion clinic to improve early melanoma detection. We conducted a retrospective review of patient records from a tertiary care hospital's pigmented lesion clinic and the associated UAT. Results of procedures for all 4495 patient visits to the routine track and all 316 visits to the UAT during the 21-month study period were included, as were detailed chart reviews of all UAT patient visits. UAT visits were more than 4 times as likely (4.1% vs 1.0%) to yield a diagnosis of melanoma as routine track visits (odds ratio 4.24; 95% confidence interval 2.28-7.88; P < .0001), and almost 25 times as likely (2.2% vs 0.1%) to yield a diagnosis of metastatic melanoma (odds ratio 25.4; 95% confidence interval 7.4-87.4; P < .0001). This was a preliminary analysis with only limited data extracted from the routine track pigmented lesion clinic patient visits. This initial analysis of UAT strategy suggests that UATs have potential to detect patients with earlier melanomas; further research is needed to specifically delineate how resources should be best allocated between routine surveillance and urgent care to maximize melanoma early detection and survival. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  19. Donor recruitment and selection for adult-to-adult living donor liver transplantation in urgent and elective circumstances.

    PubMed

    Ben-Haim, Menahem; Carmiel, Michal; Lubezky, Nir; Keidar, Rivka; Katz, Paulina; Blachar, Arye; Nimrod, Adi; Sorkine, Patrick; Oren, Ran; Klausner, Joseph M; Nakache, Richard

    2005-03-01

    Adult-to-adult living donor liver transplantation is becoming an alternative to cadaveric transplantation in urgent and elective settings. Donor selection crucially affects donor safety and recipient outcome. To present our algorithm of urgent and elective donor selection. Urgent selection is expeditious and protocol-based. Elective selection permits a comprehensive process. Both include medical, psychosocial and surgical-anatomic evaluations. Liver volumes and vascular anatomy are evaluated with computerized tomographic angiography. Informed consent is obtained after painstaking explanations. Independent institutional committees review and approve all cases. Between July 2003 and June 2004 we evaluated 43 potential live donors for 12 potential recipients (fulminant hepatic failure, n = 5; chronic end-stage liver disease, n = 6; primary graft non-function, n = 1). Thirty-three candidates (76%) were excluded due to blood type incompatibility (n = 14, 42%), incompatible anatomy (n = 8, 24%)--including problematic volume distribution (n = 2) or vascular anatomy (n = 6)--psychosocial issues (n = 4, 12%), or medical co-morbidity (n = 7, 22%). Five recipients (FHF, n = 4; chronic ESLD, n = 1) were successfully transplanted from living donors. In the acute setting, two patients (FHF, PGNF) died in the absence of an appropriate donor (cadaveric or living donor). In the elective group, one patient died of unexpected variceal bleeding and one received a cadaveric graft just before the planned living donor transplantation was performed. One candidate was transplanted overseas and two cases are scheduled. The ratio of compatibility for donation was 34% (10/29) for blood type-compatible candidates. Donor selection for living donor liver transplantation is a complex, labor-intensive multidisciplinary process. Most exclusions are due to blood type incompatibility or anatomic details. Psychosocial aspects of these donations warrant special attention.

  20. Memory and learning with rapid audiovisual sequences

    PubMed Central

    Keller, Arielle S.; Sekuler, Robert

    2015-01-01

    We examined short-term memory for sequences of visual stimuli embedded in varying multisensory contexts. In two experiments, subjects judged the structure of the visual sequences while disregarding concurrent, but task-irrelevant auditory sequences. Stimuli were eight-item sequences in which varying luminances and frequencies were presented concurrently and rapidly (at 8 Hz). Subjects judged whether the final four items in a visual sequence identically replicated the first four items. Luminances and frequencies in each sequence were either perceptually correlated (Congruent) or were unrelated to one another (Incongruent). Experiment 1 showed that, despite encouragement to ignore the auditory stream, subjects' categorization of visual sequences was strongly influenced by the accompanying auditory sequences. Moreover, this influence tracked the similarity between a stimulus's separate audio and visual sequences, demonstrating that task-irrelevant auditory sequences underwent a considerable degree of processing. Using a variant of Hebb's repetition design, Experiment 2 compared musically trained subjects and subjects who had little or no musical training on the same task as used in Experiment 1. Test sequences included some that intermittently and randomly recurred, which produced better performance than sequences that were generated anew for each trial. The auditory component of a recurring audiovisual sequence influenced musically trained subjects more than it did other subjects. This result demonstrates that stimulus-selective, task-irrelevant learning of sequences can occur even when such learning is an incidental by-product of the task being performed. PMID:26575193

  1. Memory and learning with rapid audiovisual sequences.

    PubMed

    Keller, Arielle S; Sekuler, Robert

    2015-01-01

    We examined short-term memory for sequences of visual stimuli embedded in varying multisensory contexts. In two experiments, subjects judged the structure of the visual sequences while disregarding concurrent, but task-irrelevant auditory sequences. Stimuli were eight-item sequences in which varying luminances and frequencies were presented concurrently and rapidly (at 8 Hz). Subjects judged whether the final four items in a visual sequence identically replicated the first four items. Luminances and frequencies in each sequence were either perceptually correlated (Congruent) or were unrelated to one another (Incongruent). Experiment 1 showed that, despite encouragement to ignore the auditory stream, subjects' categorization of visual sequences was strongly influenced by the accompanying auditory sequences. Moreover, this influence tracked the similarity between a stimulus's separate audio and visual sequences, demonstrating that task-irrelevant auditory sequences underwent a considerable degree of processing. Using a variant of Hebb's repetition design, Experiment 2 compared musically trained subjects and subjects who had little or no musical training on the same task as used in Experiment 1. Test sequences included some that intermittently and randomly recurred, which produced better performance than sequences that were generated anew for each trial. The auditory component of a recurring audiovisual sequence influenced musically trained subjects more than it did other subjects. This result demonstrates that stimulus-selective, task-irrelevant learning of sequences can occur even when such learning is an incidental by-product of the task being performed.

  2. Demonstration of solar echoes using the Air Force OTH-B radar

    NASA Technical Reports Server (NTRS)

    Pizzo, V. J.; Hildner, E.; Georges, T.; Fraser-Smith, A.; Kelly, F.

    1995-01-01

    From the late 50s to early 70s, attempts were made by at least two different groups to obtain information on physical conditions in the corona by means of active radar soundings. While echoes from the Sun were unquestionably detected. difficulties in their interpretation led to inconclusive results. A major hindrance to these efforts was the limited understanding of the day-to-day structure of the corona then available (e.g., pioneering work in solar wind studies were just underway. and coronal holes had not yet been discovered). With the end of the Cold War, the very large over-the-horizon (OTH) radars operated by the Air Force have been opened up to basic science research through the end of the fiscal year. In light of advances made in coronal physics and in signal processing technology since these early experiments were undertaken. access to the state-of-the art OTH-B radar offers a rare opportunity to gauge anew the scientific potential for radar sounding of the Sun. In principle, it should be possible to obtain useful data on plasma densities and motions over a range of heights in the corona near 0.5R(solar mass) above the solar surface We report here the preliminary findings from a sequence of observations taken over the course of a solar rotation.

  3. Combustion Characterization and Model Fuel Development for Micro-tubular Flame-assisted Fuel Cells.

    PubMed

    Milcarek, Ryan J; Garrett, Michael J; Baskaran, Amrish; Ahn, Jeongmin

    2016-10-02

    Combustion based power generation has been accomplished for many years through a number of heat engine systems. Recently, a move towards small scale power generation and micro combustion as well as development in fuel cell research has created new means of power generation that combine solid oxide fuel cells with open flames and combustion exhaust. Instead of relying upon the heat of combustion, these solid oxide fuel cell systems rely on reforming of the fuel via combustion to generate syngas for electrochemical power generation. Procedures were developed to assess the combustion by-products under a wide range of conditions. While theoretical and computational procedures have been developed for assessing fuel-rich combustion exhaust in these applications, experimental techniques have also emerged. The experimental procedures often rely upon a gas chromatograph or mass spectrometer analysis of the flame and exhaust to assess the combustion process as a fuel reformer and means of heat generation. The experimental techniques developed in these areas have been applied anew for the development of the micro-tubular flame-assisted fuel cell. The protocol discussed in this work builds on past techniques to specify a procedure for characterizing fuel-rich combustion exhaust and developing a model fuel-rich combustion exhaust for use in flame-assisted fuel cell testing. The development of the procedure and its applications and limitations are discussed.

  4. Accord near for offshore California oil shipments

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

    Not Available

    There are faint glimmers of hope again for offshore California operators. After more than a decade of often bitter strife over offshore oil and gas development and transportation issues, state officials and oil producers may be moving toward compromise solutions. One such solution may be forthcoming on offshore development. But the real change came with the turnabout of the California Coastal Commission (CCC), which last month approved a permit for interim tankering of crude from Point Arguello oil field in the Santa Barbara Channel to Los Angeles. The dispute over how to ship offshore California crude to market has draggedmore » on since before Point Arguelo development plans were unveiled. The project's status has become a flashpoint in the U.S. debate over resource use and environmental concerns. The controversy flared anew in the wake of the 1989 Exxon Valdez tanker spill off Alaska, when CCC voided a Santa Barbara County permit for interim tankering, a move project operator Chevron Corp. linked to the Exxon Valdez accident. Faced with litigation, the state's economic devastation, and acrimonious debate over transporting California crude, Gov. Pete Wilson and other agencies approved the CCC permit. But there's a catch: A permanent pipeline must be built to handle full production within 3 years. The paper discusses permit concerns, the turnaround decision, the anger of environmental groups, and pipeline proposals.« less

  5. Neutron scattering on solitons in quasi-one-dimensional systems

    NASA Astrophysics Data System (ADS)

    Fedyanin, V. K.

    1983-05-01

    In the framework of the model of an ideal lattice gas of solitons, we obtain the following general formula for the dynamic neutron scattering form factor: S(q, w) = N¯S 1(q, w) , S(q, w) = {p‧(ν 0)δ 22}/{2πqZ 1h }f 2(qδ(ν 0 Here q = k‧ - k and w = E‧ - E are the neutron momentum and energy transfer, respectively, ν0 = wq-1, δ(ν) is the soliton width of velocity ν, p‧( ν0) = d p/d ν| ν0 , p(ν) is the soliton momentum, E(p(ν)) is the soliton energy, N¯ is the average number of solitons at θ = kδT = β-1 and is constructed from the soliton non-linear differential equations. The derivation of the formula is essentially based on (i) specific dependence of these solutions on ξ = x - vt, and (ii) generalization of the averaging over the soliton ensemble, proposed in ref. [1]. The specifi properties of the scattering spectra of polypeptides, DNA molecules and magnetics as functions of the temperature and interaction parameters and of external fields are discussed on the basis of this formula. The contribution to S(q, w) for “slow” solitons in magnetics has been calculated in [2, 3]. (For each concrete model the authors were forced to formulate anew the way of calculation, to assume the small size of ν, etc.)

  6. The Colorado River region and John Wesley Powell

    USGS Publications Warehouse

    Rabbitt, Mary C.; McKee, Edwin D.; Hunt, Charles B.; Leopold, Luna Bergere

    1969-01-01

    A century ago John Wesley Powell-teacher, scientist, and veteran of the Civil War-set out to explore the unknown reaches of the Colorado River. He emerged from the forbidding canyons with a compelling interest in the nature of the western lands and how they could be developed for the greatest benefit to the Nation. A man gifted with imagination, yet always tempered by the scientist's appreciation for facts, Powell became one of the country's most vigorous proponents for the orderly development of the public domain and the wise use of its natural resources. Throughout his lifetime, Powell stood firm in his belief that science, as a sound basis for human progress, should serve all the people, and he played an important role in organizing and directing scientific activities of the U.S. Government. His zeal led to the establishment of the Geological Survey in the U.S. Department of the Interior and the Bureau of Ethnology in the Smithsonian Institution. On this 100th Anniversary of the Powell Colorado River Expedition, the U.S. Department of the Interior, Smithsonian Institution, and National Geographic Society (which Powell helped to found) have joined many organizations and individuals to recall the works of this man ;and to examine anew the imprints of his mind. His prescient concepts for the Nation's programs concerning people and their environment have been enhanced through a century of national development.

  7. Lack of association between digit ratio (2D:4D) and assertiveness: replication in a large sample.

    PubMed

    Voracek, Martin

    2009-12-01

    Findings regarding within-sex associations of digit ratio (2D:4D), a putative pointer to long-lasting effects of prenatal androgen action, and sexually differentiated personality traits have generally been inconsistent or unreplicable, suggesting that effects in this domain, if any, are likely small. In contrast to evidence from Wilson's important 1983 study, a forerunner of modern 2D:4D research, two recent studies in 2005 and 2008 by Freeman, et al. and Hampson, et al. showed assertiveness, a presumably male-typed personality trait, was not associated with 2D:4D; however, these studies were clearly statistically underpowered. Hence this study examined this question anew, based on a large sample of 491 men and 627 women. Assertiveness was only modestly sexually differentiated, favoring men, and a positive correlate of age and education and a negative correlate of weight and Body Mass Index among women, but not men. Replicating the two prior studies, 2D:4D was throughout unrelated to assertiveness scores. This null finding was preserved with controls for correlates of assertiveness, also in nonparametric analysis and with tests for curvilinear relations. Discussed are implications of this specific null finding, now replicated in a large sample, for studies of 2D:4D and personality in general and novel research approaches to proceed in this field.

  8. The Réunion Fody and Sonnerat's Shrew and the validity of scientifically naming animals described without physical types.

    PubMed

    Cheke, Anthony S; Hume, Julian P

    2018-02-21

    An essential requirement of the current edition of the International Code of Zoological Nomenclature (ICZN 1999) is to designate a holotype or syntypes for a species or subspecies newly described after 1999. Where specimens exist this makes sense (and is indeed essential), but is meaningless when describing a species-group taxon from an old illustration or written account in which specimens were not preserved or even necessarily taken at all. The naming of two species which one or both of us described post-1999 from old accounts without designating types has been singled out as invalid on this basis. As the revisers of the ICZN apparently did not anticipate further naming of taxa from old accounts, and thus allowed a logical paradox to arise, we strongly recommend that, in respect of descriptions from old accounts with no specimens, this rule be waived by a retrospective amendment, as it is likely that other similar cases exist, and it serves no-ones' interest to strike down otherwise properly described names on a pointless technicality. Prior to our proposed change in the Code, in this note Foudia delloni Cheke Hume sp. nov. (Aves: Passeriformes: Ploceidae), from Réunion Island, and Diplomesodon sonnerati Cheke sp. nov. (Mammalia: Soricomorpha: Soricidae), from southern India, are named anew using the same names and the original diagnoses.

  9. Quarrelsome behavior in borderline personality disorder: influence of behavioral and affective reactivity to perceptions of others.

    PubMed

    Sadikaj, Gentiana; Moskowitz, D S; Russell, Jennifer J; Zuroff, David C; Paris, Joel

    2013-02-01

    We examined how the amplification of 3 within-person processes (behavioral reactivity to interpersonal perceptions, affect reactivity to interpersonal perceptions, and behavioral reactivity to a person's own affect) accounts for greater quarrelsome behavior among individuals with borderline personality disorder (BPD). Using an event-contingent recording (ECR) methodology, individuals with BPD (N = 38) and community controls (N = 31) reported on their negative affect, quarrelsome behavior, and perceptions of the interaction partner's agreeable-quarrelsome behavior in interpersonal events during a 20-day period. Behavioral reactivity to negative affect was similar in both groups. However, behavioral reactivity and affect reactivity to interpersonal perceptions were elevated in individuals with BPD relative to community controls; specifically, individuals with BPD reported more quarrelsome behavior and more negative affect during interactions in which they perceived others as more cold-quarrelsome. Greater negative affect reactivity to perceptions of other's cold-quarrelsome behavior partly accounted for the increased quarrelsome behavior reported by individuals with BPD during these interactions. This pattern of results suggests a cycle in which the perception of cold-quarrelsome behavior in others triggers elevated negative affect and quarrelsome behavior in individuals with BPD, which subsequently led to more quarrelsome behavior from their interaction partners, which leads to perceptions of others as cold-quarrelsomeness, which begins the cycle anew. 2013 APA, all rights reserved

  10. The promiscuous larvae: flexibility in the establishment of symbiosis in corals

    NASA Astrophysics Data System (ADS)

    Cumbo, V. R.; Baird, A. H.; van Oppen, M. J. H.

    2013-03-01

    Coral reefs thrive in part because of the symbiotic partnership between corals and Symbiodinium. While this partnership is one of the keys to the success of coral reef ecosystems, surprisingly little is known about many aspects of coral symbiosis, in particular the establishment and development of symbiosis in host species that acquire symbionts anew in each generation. More specifically, the point at which symbiosis is established (i.e., larva vs. juvenile) remains uncertain, as does the source of free-living Symbiodinium in the environment. In addition, the capacity of host and symbiont to form novel combinations is unknown. To explore patterns of initial association between host and symbiont, larvae of two species of Acropora were exposed to sediment collected from three locations on the Great Barrier Reef. A high proportion of larvae established symbiosis shortly after contact with sediments, and Acropora larvae were promiscuous, taking up multiple types of Symbiodinium. The Symbiodinium types acquired from the sediments reflected the symbiont assemblage within a wide range of cnidarian hosts at each of the three sites, suggesting potential regional differences in the free-living Symbiodinium assemblage. Coral larvae clearly have the capacity to take up Symbiodinium prior to settlement, and sediment is a likely source. Promiscuous larvae allow species to associate with Symbiodinium appropriate for potentially novel environments that may be experienced following dispersal.

  11. A lemma science of mind: the potential of the Kegon (Flower Ornament) Sutra.

    PubMed

    Nakazawa, Shin'ichi

    2017-02-01

    The paper argues for a new perspective on the relationship between Buddhism and European psychology, or sciences of the mind, based in the Kegon Sutra, a text that emerged in the early stages of Mahayana Buddhism (3 rd - 5 th century CE). The basis of European science is logos intellection, formalized by Aristotle as following three laws: the law of identity, the law of contradiction and the law of the excluded middle. Logic in the Buddhist tradition, by contrast, is based in lemma (meaning to understand as a whole not with language, but with intuition). Lemma-based science born in the Buddhist tradition shows that rational perception is possible even without the three laws of logos. The Kegon Sutra, which explains what Buddha preached only a week after he attained enlightenment, is unified under the logic of lemma and can be seen as an effort to create a 'lemma science of the mind'. The fundamental teaching of the Kegon Sutra is explored, and its principles are compared with primary process thinking and the unconscious as outlined by Freud and Jung. Jung's research of Eastern texts led him to create a science of the mind that went further than Freud: his concept of synchronicity is given by way of example and can be seen anew within the idea of a lemma-based science. © 2017, The Society of Analytical Psychology.

  12. Functional Constructivism: In Search of Formal Descriptors.

    PubMed

    Trofimova, Irina

    2017-10-01

    The Functional Constructivism (FC) paradigm is an alternative to behaviorism and considers behavior as being generated every time anew, based on an individual's capacities, environmental resources and demands. Walter Freeman's work provided us with evidence supporting the FC principles. In this paper we make parallels between gradual construction processes leading to the formation of individual behavior and habits, and evolutionary processes leading to the establishment of biological systems. Referencing evolutionary theory, several formal descriptors of such processes are proposed. These FC descriptors refer to the most universal aspects for constructing consistent structures: expansion of degrees of freedom, integration processes based on internal and external compatibility between systems and maintenance processes, all given in four different classes of systems: (a) Zone of Proximate Development (poorly defined) systems; (b) peer systems with emerging reproduction of multiple siblings; (c) systems with internalized integration of behavioral elements ('cruise controls'); and (d) systems capable of handling low-probability, not yet present events. The recursive dynamics within this set of descriptors acting on (traditional) downward, upward and horizontal directions of evolution, is conceptualized as diagonal evolution, or di-evolution. Two examples applying these FC descriptors to taxonomy are given: classification of the functionality of neuro-transmitters and temperament traits; classification of mental disorders. The paper is an early step towards finding a formal language describing universal tendencies in highly diverse, complex and multi-level transient systems known in ecology and biology as 'contingency cycles.'

  13. "Making strange": a role for the humanities in medical education.

    PubMed

    Kumagai, Arno K; Wear, Delese

    2014-07-01

    Stories, film, drama, and art have been used in medical education to enhance empathy, perspective-taking, and openness to "otherness," and to stimulate reflection on self, others, and the world. Yet another, equally important function of the humanities and arts in the education of physicians is that of "making strange"-that is, portraying daily events, habits, practices, and people through literature and the arts in a way that disturbs and disrupts one's assumptions, perspectives, and ways of acting so that one sees the self, others, and the world anew. Tracing the development of this concept from Viktor Shklovsky's "enstrangement" (ostranenie) through Bertolt Brecht's "alienation effect," this essay describes the use of this technique to disrupt the "automaticity of thinking" in order to discover new ways of perceiving and being in the world.Enstrangement may be used in medical education in order to stimulate critical reflection and dialogue on assumptions, biases, and taken-for-granted societal conditions that may hinder the realization of a truly humanistic clinical practice. In addition to its ability to enhance one's critical understanding of medicine, the technique of "making strange" does something else: By disrupting fixed beliefs, this approach may allow a reexamination of patient-physician relationships in terms of human interactions and provide health care professionals an opportunity-an "open space"-to bear witness and engage with other individuals during challenging times.

  14. Professional development of medical students: problems and promises.

    PubMed

    Wear, D

    1997-12-01

    Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.

  15. [Are urgent imaging tests indicated in the management of acute pancreatitis?].

    PubMed

    Fornell Pérez, R; Lozano Rodríguez, A

    2016-01-01

    Acute pancreatitis is a common emergency within abdominal disease. It is accepted that two of three conditions must be fulfilled for its diagnosis: characteristic clinical presentation, characteristic laboratory findings, and/or characteristic diagnostic imaging findings. The first two conditions are the most often used, probably for reasons of efficiency and frequency. Nevertheless, the need for imaging studies is sometimes a source of conflict. For this reason, we decided to review the current evidence regarding the indication of urgent imaging tests in the management of acute pancreatitis. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  16. Neurobiology of food addiction and adolescent obesity prevention in low- and middle-income countries.

    PubMed

    Lee, Albert; Gibbs, Susannah E

    2013-02-01

    Adolescent obesity has become an increasingly urgent issue in low- and middle-income countries. Recent relevant advances include the application of the neurobiology of addiction to food addiction and obesity. The biochemistry of the etiology of obesity indicates the need for multilevel interventions that go beyond simple behavioral approaches. Additional research on the neurobiology of food addiction and adolescent obesity in low- and middle-income countries, as well as program evaluations that examine the biochemical effects of complex interventions, is urgently needed. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

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

    D’Oria, Mario, E-mail: mario.doria88@outlook.com; Sgorlon, Giada; Calvagna, Cristiano

    We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

  18. Red, orange and green Caesarean sections: a new communication tool for on-call obstetricians.

    PubMed

    Dupuis, Olivier; Sayegh, Isabelle; Decullier, Evelyne; Dupont, Corinne; Clément, Henri-Jacques; Berland, Michel; Rudigoz, René-Charles

    2008-10-01

    To evaluate the effect of a novel communication tool, related to the degree of urgency for Caesarean sections (CSs), on the decision-to-delivery interval for emergency CS. Red CS are very urgent cases corresponding to life-threatening maternal or foetal situations, orange CS are urgent cases and green CS are non-urgent intrapartum CS. We carried out this cohort study in a French maternity hospital. The study included all emergency Caesarean sections during two 6-month periods, before and after introduction of the code. We compared the decision-to-delivery interval of the two study periods. Our study included 174 emergency CS. The mean decision-to-delivery interval after introduction of the code was 31.7 min, significantly shorter (p=0.02) than the 39.6 min interval before introduction of the colour code. Except for the preparation time, each time interval decreased. This included transporting the patient into the operating theatre, and the incision-to-delivery time interval. This study suggests that the use of the three-colour code could significantly shorten the decision-to-delivery interval in emergency CS. Further prospective studies are needed to confirm this result.

  19. Outcomes from peptic ulcer surgery have not benefited from advances in medical therapy.

    PubMed

    Towfigh, Shirin; Chandler, Charles; Hines, Oscar J; McFadden, David W

    2002-04-01

    Given the advancements in medical treatment of peptic ulcer disease such as Helicobacter pylori eradication and proton-pump inhibitors, we sought to assess their impact on the need for surgical intervention. Patients who underwent peptic ulcer surgery between 1981 and 1998 were evaluated in a retrospective chart review from a tertiary-care hospital (n = 222). The number of operations performed for peptic ulcers decreased annually (24 vs 11.3). Seventy-seven per cent of all cases were done urgently; most were performed for acute perforated ulcers. The overall 30-day mortality rate was 13 per cent, which remained unchanged over the past two decades. The highest mortality rate (82%) was in the transplanted population (n = 11). Our institutional experience demonstrates that despite the lower volume of patients requiring operative management a greater percentage of these patients are presenting with urgent need for surgery. Also despite the aggressive endoscopic management of acutely bleeding ulcers there was no change in the percentage of patients taken to the operating room for uncontrollable hemorrhage. Improvements in medical management of peptic ulcer disease have decreased the surgical volume; nevertheless we show a rising proportion of urgent operations performed annually, and mortality remains high.

  20. [Triage: a key tool in emergency care].

    PubMed

    Soler, Wifredo; Gómez Muñoz, M; Bragulat, E; Alvarez, A

    2010-01-01

    "Triage" is a process that enables us to manage clinical risk in order to safely and suitably handle patient flows when demand and clinical needs exceed resources. At present, triage systems that are employed are structured according to five levels of priority. Levels are allocated according to the concept that what is urgent is not always serious and that what is serious is not always urgent. This makes it possible to classify patients according to "degree of urgency", so that the more urgent patients will be attended to first and the rest will be re-evaluated until they are seen by the doctor. The Spanish triage system (SET) and the Manchester triage system (MTS) are the two standardised systems most implemented in our country. We also discuss the system of triage devised in Navarre--integrated in the computerised clinical history--and used in the hospital network of Navarre. All are multidisciplinary systems based on the reasons and urgency of consultation, but not on diagnoses, and are carried out by nursing staff with medical support when required. In addition, they all include monitoring of the quality of the accident and emergency service itself, and can be applied in the outpatient field.

  1. Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy.

    PubMed

    Felli, Emanuele; Brunetti, Francesco; Disabato, Mara; Salloum, Chady; Azoulay, Daniel; De'angelis, Nicola

    2014-01-01

    Right colon cancer rarely presents as an emergency, in which bowel occlusion and massive bleeding are the most common clinical presentations. Although there are no definite guidelines, the first line treatment for massive right colon cancer bleeding should ideally stop the bleeding using endoscopy or interventional radiology, subsequently allowing proper tumor staging and planning of a definite treatment strategy. Minimally invasive approaches for right and left colectomy have progressively increased and are widely performed in elective settings, with laparoscopy chosen in the majority of cases. Conversely, in emergent and urgent surgeries, minimally invasive techniques are rarely performed. We report a case of an 86-year-old woman who was successfully treated for massive rectal bleeding in an urgent setting by robotic surgery (da Vinci Intuitive Surgical System®). At admission, the patient had severe anemia (Hb 6 g/dL) and hemodynamic stability. A computer tomography scanner with contrast enhancement showed a right colon cancer with active bleeding; no distant metastases were found. A colonoscopy did not show any other bowel lesion, while a constant bleeding from the right pre-stenotic colon mass was temporarily arrested by endoscopic argon coagulation. A robotic right colectomy in urgent setting (within 24 hours from admission) was indicated. A three-armed robot was used with docking in the right side of the patient and a fourth trocar for the assistant surgeon. Because of the patient's poor nutritional status, a double-barreled ileocolostomy was performed. The post-operative period was uneventful. As the neoplasia was a pT3N0 adenocarcinoma, surveillance was decided after a multidisciplinary meeting, and restoration of the intestinal continuity was performed 3 months later, once good nutritional status was achieved. In addition, we reviewed the current literature on minimally invasive colectomy performed for colon carcinoma in emergent or urgent setting. No study on robotic approach was found. Seven studies evaluating the role of laparoscopic colectomy concluded that this technique is a safe and feasible option associated with lower blood loss and shorter hospital stay. It may require longer operative time, but morbidity and mortality rates appeared comparable to open colectomy. However, the surgeon's experience and the right selection of candidate patients cannot be understated.

  2. Bladder Diseases

    MedlinePlus

    ... frequent, urgent urination Bladder cancer Doctors diagnose bladder diseases using different tests. These include urine tests, x- ... National Institute of Diabetes and Digestive and Kidney Diseases

  3. Surveillance of pertussis: methods and implementation.

    PubMed

    Guiso, Nicole; Wirsing von König, Carl Heinz

    2016-07-01

    Pertussis or whooping cough is a respiratory disease caused by Bordetella pertussis or, to a lesser extent, by B. parapertussis. Vaccines against pertussis have been widely used for more than 50 years and have led to a significant reduction of morbidity and mortality. However, even in countries with a high vaccine coverage, the disease is still not well controlled. Surveillance is urgently needed. This review summarizes surveillance methods and gives examples that may be used when setting up a surveillance program or analyzing an outbreak. Expert commentary: Pertussis surveillance is urgently required in order to define the burden of disease, to adapt vaccine strategies according to the type of pertussis vaccine used and to follow the evolution of the bacteria.

  4. Are you good enough for your patients? The European certification model in laparoscopic surgery

    PubMed Central

    Campo, R.; Molinas, C.R.; De Wilde, R.L.; Brolmann, H.; Brucker, S.; Mencaglia, L.; Odonovan, P.; Wallwiener, D.; Wattiez, A.

    2012-01-01

    Quality control, training and education in gynaecological surgery are challenged and urgent measures are emerging. The implementation of a structured and validated program for training and quality control seems the most urgent measurement to be taken. The European Academy of Gynaecological Surgery has made a first attempt to do so. Through a practical and theoretical tests system, the skills of an individual surgeon is measured and the conditions to enter the different level of expertise are clearly defined. This certification system based on the best possible level of scientific evidence provides a first practical tool, universally implementable for a decent quality control and structured training program in Gynaecological laparoscopic surgery. PMID:24753896

  5. Priority and Negotiation Based Dynamic Spectrum Allocation Scheme for Multiple Radio Access Network Operators

    NASA Astrophysics Data System (ADS)

    Kim, Hoon; Hyon, Taein; Lee, Yeonwoo

    Most of previous works have presented the dynamic spectrum allocation (DSA) gain achieved by utilizing the time or regional variations in traffic demand between multi-network operators (NOs). In this paper, we introduce the functionalities required for the entities related with the spectrum sharing and allocation and propose a spectrum allocation algorithm while considering the long-term priority between NOs, the priority between multiple class services, and the urgent bandwidth request. To take into account the priorities among the NOs and the priorities of multiple class services, a spectrum sharing metric (SSM) is proposed, while a negotiation procedure is proposed to treat the urgent bandwidth request.

  6. Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality.

    PubMed

    Alavi, Nazanin; Roberts, Nasreen; Sutton, Chloe; Axas, Nicholas; Repetti, Leanne

    2015-10-01

    To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen's University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.

  7. Convenience, quality and choice: Patient and service-provider perspectives for treating primary care complaints in urgent care settings.

    PubMed

    Sturgeon, David

    2017-11-01

    To investigate why patients chose to attend two, nurse-led, minor injury units (MIUs) to access primary healthcare services rather than attend their GP practice. Since the 1980's, healthcare organisations in the UK and elsewhere have implemented an increasingly consumer-orientated model of healthcare provision. As a result, patients with non-urgent presentations are attending Emergency Departments (EDs) and other urgent care facilities in growing numbers. A comparative case study approach was adopted and between October 2014 and May 2015 the researcher was embedded as a participant observer as part of the emergency nurse practitioner team at two, nurse-led, MIUs (site A and B). During this time, 40 patients, 17 service-providers and 1 senior manager were interviewed. Patients and service-providers at both sites identified convenience and quality of care as the principle reasons patients presented for primary healthcare services at MIUs rather than their GP practice. Service-providers were aware that by providing treatment, they established a precedent and a sense of expectation for future care. Patients are acting rationally and predictably in response to healthcare policy promises regarding choice, expectation created by service-providers, and local demographic factors. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial

    PubMed Central

    Neal, Richard D; Barham, Allan; Bongard, Emily; Edwards, Rhiannon Tudor; Fitzgibbon, Jim; Griffiths, Gareth; Hamilton, Willie; Hood, Kerenza; Nelson, Annmarie; Parker, David; Porter, Cath; Prout, Hayley; Roberts, Kirsty; Rogers, Trevor; Thomas-Jones, Emma; Tod, Angela; Yeo, Seow Tien; Hurt, Chris N

    2017-01-01

    Background: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. Methods: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care. Results: The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer. Conclusions: We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care. PMID:28072761

  9. Is urgent coronary artery bypass grafting a safe option in octogenarians? A developing country perspective.

    PubMed

    Luqman, Zubair; Ansari, Junaid; Siddiqui, Fahad Javaid; Sami, Shahid Ahmed

    2009-09-01

    Life expectancy has increased during recent decades leading to a growing number of older population. The objective of this study was to evaluate the outcomes of coronary artery bypass grafting (CABG) in octogenarians and to compare the outcomes of the emergent CABG with elective surgery. Prospectively collected data from 31 consecutive octogenarian patients who underwent CABG between 1 January 2006 and 31 December 2008 were analyzed. Main outcomes of interest included mortality, length of ICU stay, length of hospital stay, priority of surgery, postoperative complications and functional status on follow-up. Fifteen patients were operated on an urgent basis. Patients operated on an urgent basis were in NYHA class III or IV preoperatively (P=0.0016). There were no significant differences in operative and postoperative variables. There were three in-hospital deaths and 23 patients (82%) were alive on follow-up and 19 were in functional class I or II. Quality of life assessment was performed using Seattle Angina Questionnaire and patients reported remarkable improvement in quality of life. Overall, 90% patients were not or slightly disabled in their daily activity. Satisfaction with their current quality of life was reported by 95% of patients. CABG may be performed in octogenarians with remarkable outcomes and improvement in quality of life.

  10. Residents' numeric inputting error in computerized physician order entry prescription.

    PubMed

    Wu, Xue; Wu, Changxu; Zhang, Kan; Wei, Dong

    2016-04-01

    Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors. Thirty residents participated in four prescribing tasks in which two factors were manipulated: numeric inputting methods (numeric row in the main keyboard vs. numeric keypad) and urgency levels (urgent situation vs. non-urgent situation). Multiple aspects of participants' prescribing behavior were measured in sober prescribing situations. The results revealed that in urgent situations, participants were prone to make mistakes when using the numeric row in the main keyboard. With control of performance in the sober prescribing situation, the effects of the input methods disappeared, and urgency was found to play a significant role in the generalized linear model. Most errors were either omission or substitution types, but the proportion of transposition and intrusion error types were significantly higher than that of the previous research. Among numbers 3, 8, and 9, which were the less common digits used in prescription, the error rate was higher, which was a great risk to patient safety. Urgency played a more important role in CPOE numeric typing error-making than typing skills and typing habits. It was recommended that inputting with the numeric keypad had lower error rates in urgent situation. An alternative design could consider increasing the sensitivity of the keys with lower frequency of occurrence and decimals. To improve the usability of CPOE, numeric keyboard design and error detection could benefit from spatial incidence of errors found in this study. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Mechanical Thrombectomy for Minor and Mild Stroke Patients Harboring Large Vessel Occlusion in the Anterior Circulation: A Multicenter Cohort Study.

    PubMed

    Dargazanli, Cyril; Arquizan, Caroline; Gory, Benjamin; Consoli, Arturo; Labreuche, Julien; Redjem, Hocine; Eker, Omer; Decroix, Jean-Pierre; Corlobé, Astrid; Mourand, Isabelle; Gaillard, Nicolas; Ayrignac, Xavier; Charif, Mahmoud; Duhamel, Alain; Labeyrie, Paul-Emile; Riquelme, Carlos; Ciccio, Gabriele; Smajda, Stanislas; Desilles, Jean-Philippe; Gascou, Grégory; Lefèvre, Pierre-Henri; Mantilla-García, Daniel; Cagnazzo, Federico; Coskun, Oguzhan; Mazighi, Mikael; Riva, Roberto; Bourdain, Frédéric; Labauge, Pierre; Rodesch, Georges; Obadia, Michael; Bonafé, Alain; Turjman, Francis; Costalat, Vincent; Piotin, Michel; Blanc, Raphaël; Lapergue, Bertrand

    2017-12-01

    Proximal large vessel occlusion (LVO) is present in up to 30% of minor strokes. The effectiveness of mechanical thrombectomy (MT) in the subgroup of minor stroke with LVO in the anterior circulation is still open to debate. Data about MT in this subgroup of patients are sparse, and their optimal management has not yet been defined. The purpose of this multicenter cohort study was to evaluate the effectiveness of MT in patients experiencing acute ischemic stroke (AIS) because of LVO in the anterior circulation, presenting with minor-to-mild stroke symptoms (National Institutes of Health Stroke Scale score of <8). Multicenter cohort study involving 4 comprehensive stroke centers having 2 therapeutic approaches (urgent thrombectomy associated with best medical treatment [BMT] versus BMT first and MT if worsening occurs) about management of patients with minor and mild acute ischemic stroke harboring LVO in the anterior circulation. An intention-to-treat analysis was conducted. The primary end point was the rate of excellent outcome defined as the achievement of a modified Rankin Scale score of 0 to 1 at 3 months. Three hundred one patients were included, 170 with urgent MT associated with BMT, and 131 with BMT alone as first-line treatment. Patients treated with MT were younger, more often received intravenous thrombolysis, and had shorter time to imaging. Twenty-four patients (18.0%) in the medical group had rescue MT because of neurological worsening. Overall, excellent outcome was achieved in 64.5% of patients, with no difference between the 2 groups. Stratified analysis according to key subgroups did not find heterogeneity in the treatment effect size. Minor-to-mild stroke patients with LVO achieved excellent and favorable functional outcomes at 3 months in similar proportions between urgent MT versus delayed MT associated with BMT. There is thus an urgent need for randomized trials to define the effectiveness of MT in this patient subgroup. © 2017 American Heart Association, Inc.

  12. Heat and emergency room admissions in the Netherlands.

    PubMed

    van Loenhout, Joris Adriaan Frank; Delbiso, Tefera Darge; Kiriliouk, Anna; Rodriguez-Llanes, Jose Manuel; Segers, Johan; Guha-Sapir, Debarati

    2018-01-05

    Due to a global warming-related increase in heatwaves, it is important to obtain detailed understanding of the relationship between heat and health. We assessed the relationship between heat and urgent emergency room admissions in the Netherlands. We collected daily maximum temperature and relative humidity data over the period 2002-2007. Daily urgent emergency room admissions were divided by sex, age group and disease category. We used distributed lag non-linear Poisson models, estimating temperature-admission associations. We estimated the relative risk (RR) for urgent hospital admissions for a range of temperatures compared to a baseline temperature of 21 °C. In addition, we compared the impact of three different temperature scenarios on admissions using the RR. There is a positive relationship between increasing temperatures above 21 °C and the RR for urgent emergency room admissions for the disease categories 'Potential heat-related diseases' and 'Respiratory diseases'. This relationship is strongest in the 85+ group. The RRs are strongest for lag 0. For admissions for 'circulatory diseases', there is only a small significant increase of RRs within the 85+ age group for moderate heat, but not for extreme heat. The RRs for a one-day event with extreme heat are comparable to the RRs for multiple-day events with moderate heat. Hospitals should adjust the capacity of their emergency departments on warm days, and the days immediately thereafter. The elderly in particular should be targeted through prevention programmes to reduce harmful effects of heat. The fact that this increase in admissions already occurs in temperatures above 21 °C is different from previous findings in warmer countries. Given the similar impact of three consecutive days of moderate heat and one day of extreme heat on admissions, criteria for activation of national heatwave plans need adjustments based on different temperature scenarios.

  13. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

    PubMed

    Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

    2015-09-01

    Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

  14. Impact of preoperative dual antiplatelet therapy on bleeding complications in patients with acute coronary syndromes who undergo urgent coronary artery bypass grafting.

    PubMed

    Nagashima, Zenko; Tsukahara, Kengo; Uchida, Keiji; Hibi, Kiyoshi; Karube, Norihisa; Ebina, Toshiaki; Imoto, Kiyotaka; Kimura, Kazuo; Umemura, Satoshi

    2017-01-01

    A 5- to 7-day washout period before coronary artery bypass grafting (CABG) is recommended for patients who have recently received a thienopyridine derivative; however, data supporting this guideline recommendation are lacking in Japanese patients. Urgent isolated CABG was performed in 130 consecutive patients with acute coronary syndromes (ACS) (101 men; mean age, 69 years). Urgent CABG was defined as operation performed within 5 days after coronary angiography. All patients continued to receive aspirin 100mg/day. The subjects were retrospectively divided into 2 groups: 30 patients with preoperative thienopyridine (clopidogrel in 15 patients, ticlopidine in 15) exposure within 5 days [dual antiplatelet therapy (DAPT) group] and 100 patients without exposure [single antiplatelet therapy (SAPT) group]. Although the DAPT group had a higher proportion of patients who received perioperative platelet transfusions than the SAPT group (50% vs. 18%, p<0.001), intraoperative bleeding (median, 1100ml; interquartile range, 620-1440 vs. 920ml; 500-1100) and total drain output within 48h after surgery (577±262 vs. 543±277ml) were similar. CABG-related major bleeding, which was defined as type 4 or 5 bleeding according to the Bleeding Academic Research Consortium definitions, occurred in a significantly higher proportion of patients in the DAPT group than in the SAPT group (20% vs. 3%, p=0.005). This difference in major bleeding was driven mainly by the higher rate of transfusion of ≥5U red blood cells within a 48-h period in the DAPT group (13% vs. 1%, p=0.01). There was no significant difference in the 30-day composite endpoint including death, myocardial (re)infarction, ischemic stroke, and refractory angina between the DAPT group and SAPT group (17% vs. 19%). Preoperative DAPT increases the risk of CABG-related major bleeding in Japanese patients with ACS undergoing urgent CABG. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  15. Assimilation of Web-Based Urgent Stroke Evaluation: A Qualitative Study of Two Networks

    PubMed Central

    Mathiassen, Lars; Switzer, Jeffrey A; Adams, Robert J

    2014-01-01

    Background Stroke is a leading cause of death and serious, long-term disability across the world. Urgent stroke care treatment is time-sensitive and requires a stroke-trained neurologist for clinical diagnosis. Rural areas, where neurologists and stroke specialists are lacking, have a high incidence of stroke-related death and disability. By virtually connecting emergency department physicians in rural hospitals to regional medical centers for consultations, specialized Web-based stroke evaluation systems (telestroke) have helped address the challenge of urgent stroke care in underserved communities. However, many rural hospitals that have deployed telestroke have not fully assimilated this technology. Objective The objective of this study was to explore potential sources of variations in the utilization of a Web-based telestroke system for urgent stroke evaluation and propose a telestroke assimilation model to improve stroke care performance. Methods An exploratory, qualitative case study of two telestroke networks, each comprising an academic stroke center (hub) and connected rural hospitals (spokes), was conducted. Data were collected from 50 semistructured interviews with 40 stakeholders, telestroke usage logs from 32 spokes, site visits, published papers, and reports. Results The two networks used identical technology (called Remote Evaluation of Acute isCHemic stroke, REACH) and were of similar size and complexity, but showed large variations in telestroke assimilation across spokes. Several observed hub- and spoke-related characteristics can explain these variations. The hub-related characteristics included telestroke institutionalization into stroke care, resources for the telestroke program, ongoing support for stroke readiness of spokes, telestroke performance monitoring, and continuous telestroke process improvement. The spoke-related characteristics included managerial telestroke championship, stroke center certification, dedicated telestroke coordinator, stroke committee of key stakeholders, local neurological expertise, and continuous telestroke process improvement. Conclusions Rural hospitals can improve their stroke readiness with use of telestroke systems. However, they need to integrate the technology into their stroke delivery processes. A telestroke assimilation model may improve stroke care performance. PMID:25601232

  16. Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

    PubMed Central

    Levitt, Naomi S.; Puoane, Thandi; Denman, Catalina A.; Abrahams-Gessel, Shafika; Surka, Sam; Mendoza, Carlos; Khanam, Masuma; Alam, Sartaj; Gaziano, Thomas A.

    2015-01-01

    Background We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Design Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Results Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. Conclusions The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. PMID:25854780

  17. Is Transient Ischemic Attack a Medical Emergency? An Evidence-Based Analysis

    PubMed Central

    Sehatzadeh, S

    2015-01-01

    Background Transient ischemic attack (TIA) is a brief episode of dysfunction in a confined area of the brain. The risk of stroke following TIA is approximately 4% within the first 2 days and 9% within the first month. Therefore, early diagnosis and treatment is critical to reduce mortality and risk of stroke in patients who have experienced a TIA. Objectives This systematic review aimed to investigate the impact of the urgent evaluation and initiation of treatment of patients with TIA on the risk of subsequent stroke and death. Data Sources A literature search was performed for studies published from January 1, 2007, until December 21, 2012. The search was updated monthly to April 1, 2013. Results All identified studies showed that urgent assessment and initiation of treatment of TIA is an effective strategy in reducing the incidence of stroke. Among these, a large observational study found a large effect in that the risk of stroke was reduced by 80%, and a Canadian study found that providing urgent care significantly reduced the rate of stroke in high-risk patients. Another Canadian study reported a significant reduction in the rate of death among patients referred to stroke prevention clinics, compared to patients not referred to such services. One study showed that patients discharged from an emergency department with standard care had significantly higher rates of stroke and subsequent TIA in the first month, compared to those who were hospitalized. However, another study showed that for patients at low to moderate risk, rate of stroke was similar between inpatients and those managed in a TIA clinic. Limitations Our analysis was restricted to the effect of the combined interventions. The magnitude of benefit of each individual component of the intervention cannot be determined through this review. Conclusions The results of this systematic review have important clinical and health system implications. Urgent management of TIA patients in specialized TIA clinics rather than regular practice results in a lower rate of stroke and disability. PMID:26355823

  18. The "weekend effect" in urgent general operative procedures.

    PubMed

    Zapf, Matthew A C; Kothari, Anai N; Markossian, Talar; Gupta, Gopal N; Blackwell, Robert H; Wai, Phillip Y; Weber, Cynthia E; Driver, Joseph; Kuo, Paul C

    2015-08-01

    There is growing concern that the quality of inpatient care may differ on weekends versus weekdays. We assessed the "weekend effect" in common urgent general operative procedures. The Healthcare Cost and Utilization Project Florida State Inpatient Database (2007-2010) was queried to identify inpatient stays with urgent or emergent admissions and surgery on the same day. Included were patients undergoing appendectomy, cholecystectomy for acute cholecystitis, and hernia repair for obstructed/gangrenous hernia. Outcomes included duration of stay, inpatient mortality, hospital-adjusted charges, and postoperative complications. Controlling for hospital and patient characteristics and type of surgery, we used multilevel mixed-effects regression modeling to examine associations between patient outcomes and admissions day (weekend vs weekday). A total of 80,861 same-day surgeries were identified, of which 19,078 (23.6%) occurred during the weekend. Patients operated on during the weekend had greater charges by $185 (P < .05), rates of wound complications (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.05-1.58; P < .05), and urinary tract infection (OR 1.39, 95% CI 1.05-1.85; P < .05). Patients undergoing appendectomy had greater rates of transfusion (OR 1.43, 95% CI 1.09-1.87; P = .01), wound complications (OR 1.32, 95% CI 1.04-1.68; P < .05), urinary tract infection (OR 1.76, 95% CI 1.17-2.67; P < .01), and pneumonia (OR 1.41, 95% CI 1.05-1.88; P < .05). Patients undergoing cholecystectomy had a greater duration of stay (P = .001) and greater charges (P = .003). Patients undergoing weekend surgery for common, urgent general operations are at risk for increased postoperative complications, duration of stay, and hospital charges. Because the cause of the "weekend effect" is still unknown, future studies should focus on elucidating the characteristics that may overcome this disparity. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Increased risk of volume overload with plasma compared with four‐factor prothrombin complex concentrate for urgent vitamin K antagonist reversal

    PubMed Central

    Refaai, Majed A.; Goldstein, Joshua N.; Lee, Martin L.; Durn, Billie L.; Milling, Truman J.; Sarode, Ravi

    2015-01-01

    BACKGROUND Plasma is commonly used for vitamin K antagonist (VKA) reversal, but observational studies suggest that it is associated with transfusion‐related adverse reactions (e.g., volume overload). However, this issue has not previously been addressed in a randomized controlled trial (RCT). STUDY DESIGN AND METHODS Factors associated with volume overload were examined using data from two Phase IIIb RCTs comparing plasma with four‐factor prothrombin complex concentrate (4F‐PCC, Beriplex/Kcentra, CSL Behring) for urgent VKA reversal. VKA‐treated patients with major bleeding (NCT00708435) or requiring an urgent surgical or invasive procedure (NCT00803101) were randomly assigned (1:1) to receive either plasma or 4F‐PCC, concomitant with vitamin K. Adverse events (AEs) and serious AEs were prospectively captured up to Day 10 and 45, respectively. Volume overload predictors were evaluated on a univariate and multivariate basis. RESULTS A total of 388 patients (4F‐PCC, n = 191; plasma, n = 197) were enrolled. Volume overload occurred in 34 (9%) patients (4F‐PCC, n = 9; plasma, n = 25). In univariate analyses, use of plasma (vs. 4F‐PCC), use of nonstudy plasma and/or platelets, race, history of congestive heart failure (CHF), and history of renal disease were associated with volume overload. In multivariate analyses, use of plasma (vs. 4F‐PCC), history of CHF, and history of renal disease were independent volume overload predictors. In an additional analysis restricted to volume overload events recorded up to Day 7, only use of plasma (vs. 4F‐PCC) was an independent volume overload predictor. CONCLUSIONS After adjusting for other potential risk factors, plasma use was independently associated with a greater risk of volume overload than 4F‐PCC in patients requiring urgent VKA reversal. PMID:26135740

  20. Primary care professionals providing non-urgent care in hospital emergency departments.

    PubMed

    Gonçalves-Bradley, Daniela; Khangura, Jaspreet K; Flodgren, Gerd; Perera, Rafael; Rowe, Brian H; Shepperd, Sasha

    2018-02-13

    In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective. This is the first update of the original Cochrane Review published in 2012. To assess the effects of locating primary care professionals in hospital EDs to provide care for patients with non-urgent health problems, compared with care provided by regularly scheduled emergency physicians (EPs). We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library; 2017, Issue 4), MEDLINE, Embase, CINAHL, PsycINFO, and King's Fund, from inception until 10 May 2017. We searched ClinicalTrials.gov and the WHO ICTRP for registered clinical trials, and screened reference lists of included papers and relevant systematic reviews. Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs attending to patients with non-urgent conditions, as compared to the care provided by regularly scheduled EPs.  DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We identified four trials (one randomised trial and three non-randomised trials), one of which is newly identified in this update, involving a total of 11,463 patients, 16 general practitioners (GPs), 9 emergency nurse practitioners (NPs), and 69 EPs. These studies evaluated the effects of introducing GPs or emergency NPs to provide care to patients with non-urgent problems in the ED, as compared to EPs for outcomes such as resource use. The studies were conducted in Ireland, the UK, and Australia, and had an overall high or unclear risk of bias. The outcomes investigated were similar across studies, and there was considerable variation in the triage system used, the level of expertise and experience of the medical practitioners, and type of hospital (urban teaching, suburban community hospital). Main sources of funding were national or regional health authorities and a medical research funding body.There was high heterogeneity across studies, which precluded pooling data. It is uncertain whether the intervention reduces time from arrival to clinical assessment and treatment or total length of ED stay (1 study; 260 participants), admissions to hospital, diagnostic tests, treatments given, or consultations or referrals to hospital-based specialist (3 studies; 11,203 participants), as well as costs (2 studies; 9325 participants), as we assessed the evidence as being of very low-certainty for all outcomes.No data were reported on adverse events (such as ED returns and mortality). We assessed the evidence from the four included studies as of very low-certainty overall, as the results are inconsistent and safety has not been examined. The evidence is insufficient to draw conclusions for practice or policy regarding the effectiveness and safety of care provided to non-urgent patients by GPs and NPs versus EPs in the ED to mitigate problems of overcrowding, wait times, and patient flow.

  1. Hypersensitivity to aspirin and urgent percutaneous coronary intervention: A therapeutic challenge.

    PubMed

    Duarte, Tatiana; Gonçalves, Sara; Sá, Catarina; Marinheiro, Rita; Rodrigues, Rita; Seixo, Filipe; Tomas, Elza; Caria, Rui

    2016-11-01

    Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are common and five types of reactions have been defined. The prevalence of such reactions in patients with myocardial infarction is unclear, and so antiplatelet therapy in this population is a challenge. Various desensitization protocols have been developed but there are no specific guidelines for their use. The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography. Aspirin desensitization therapy is safe and successful in many patients, but more randomized trials are needed to confirm its benefits in coronary artery disease patients. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Hybrid Revascularization for Critical Limb Ischemia Triggered by Multiple Organ Dysfunction Due to Acute Pneumonia; Urgent Catheter Intervention Followed by Low-Density-Lipoprotein Apheresis and Elective Peripheral Bypass Surgery

    PubMed Central

    2014-01-01

    A 66-year-old man was referred for treatment of critical limb ischemia arising with multiple organ dysfunction due to acute pneumonia. Angiographic examinations demonstrated total obstruction of the bilateral external iliac arteries and the bilateral superficial femoral arteries with collateral circulation to the distal vessels. Urgent percutaneous transluminal angioplasty dissolved the obstruction of the left external iliac artery, and subsequent low-density-lipoprotein apheresis ameliorated his progressive ischemia in the lower extremities. Femoro-femoral and bilateral femoro-popliteal bypasses were performed 31 days after the endovascular intervention, which achieved successful limb salvage with the relief of ischemic symptoms related to arteriosclerotic obliterans. PMID:24995063

  3. Child with Abdominal Pain.

    PubMed

    Iyer, Rajalakshmi; Nallasamy, Karthi

    2018-01-01

    Abdominal pain is one of the common symptoms reported by children in urgent care clinics. While most children tend to have self-limiting conditions, the treating pediatrician should watch out for underlying serious causes like intestinal obstruction and perforation peritonitis, which require immediate referral to an emergency department (ED). Abdominal pain may be secondary to surgical or non-surgical causes, and will differ as per the age of the child. The common etiologies for abdominal pain presenting to an urgent care clinic are acute gastro-enteritis, constipation and functional abdominal pain; however, a variety of extra-abdominal conditions may also present as abdominal pain. Meticulous history taking and physical examination are the best tools for diagnosis, while investigations have a limited role in treating benign etiologies.

  4. Recombinant influenza H7 hemagglutinins induce lower neutralizing antibody titers in mice than do seasonal hemagglutinins

    PubMed Central

    Blanchfield, Kristy; Kamal, Ram P; Tzeng, Wen-Pin; Music, Nedzad; Wilson, Jason R; Stevens, James; Lipatov, Aleksander S; Katz, Jacqueline M; York, Ian A

    2014-01-01

    Background Vaccines against avian influenza viruses often require high hemagglutinin (HA) doses or adjuvants to achieve serological titers associated with protection against disease. In particular, viruses of the H7 subtype frequently do not induce strong antibody responses following immunization. Objectives To evaluate whether poor immunogenicity of H7 viruses is an intrinsic property of the H7 hemagglutinin. Methods We compared the immunogenicity, in naïve mice, of purified recombinant HA from two H7 viruses [A/Netherlands/219/2003(H7N7) and A/New York/107/2003(H7N2)] to that of HA from human pandemic [A/California/07/2009(H1N1pdm09)] and seasonal [A/Perth16/2009(H3N2)] viruses. Results After two intramuscular injections with purified hemagglutinin, mice produced antibodies to all HAs, but the response to the human virus HAs was greater than to H7 HAs. The difference was relatively minor when measured by ELISA, greater when measured by hemagglutination inhibition assays, and more marked still by microneutralization assays. H7 HAs induced little or no neutralizing antibody response in mice at either dose tested. Antibodies induced by H7 were of significantly lower avidity than for H3 or H1N1pdm09. Conclusions We conclude that H7 HAs may be intrinsically less immunogenic than HA from seasonal human influenza viruses. PMID:25213778

  5. The return of the natural philosopher

    NASA Astrophysics Data System (ADS)

    Lehner, Ed

    2010-03-01

    John R. Staver's article calling for a constructivist epistemology to maneuver between the disparate ways of knowing between science and religion prompts this response. This paper acknowledges Staver's scholarly analysis of the issue. Scientific and religious conflicts do present prominent challenges because these are profound but often-monolithic ways of constructing knowledge. However, my response withholds fully embracing Staver's call for a constructivist epistemology chiefly because his work goes beyond the confines of constructivism. Conversely, Staver's call for constructivist epistemology does not go far enough to advance a resolution between science and religion. Why? Because both science and religion often employ hyper-rationality in understanding the world, a process that does little to clarify the world's complexities. Philosophically, I refrain from accepting a complete schism between the two because such a framing does little to heal a conflict between those who praise the seen and those who praise the unseen. My response explores how hyper-rationality has triumphed over both science and religion, leaving the believer in one, or both, to navigate the journey alone. This article calls for the return of the natural philosopher. Utilizing this nineteenth-century term for scientist, this paper calls for an inquirer, one who can rise above the ideologies of science and religion to observe the current concerns of each field anew. Finally, taking a cue from Staver, this response introduces a potential discourse between science and religion in ways that each may, without embracing a variant ideology, make space for dialogue and mutual respect.

  6. A stockpile of ova in the grass frog Rana temporaria is established once for the life span. Do ovaries in amphibians and in mammals follow the same evolutionary strategy?

    PubMed

    Ogielska, Maria; Kotusz, Agnieszka; Augustyńska, Renata; Ihnatowicz, Jerzy; Paśko, Łukasz

    2013-04-01

    Most anuran amphibians produce high numbers of eggs during several consecutive breeding seasons. The question is still open whether oocytes are formed anew as a result of oogonial proliferation after each spawning or the definitive pool of oocytes is established during the juvenile period and is sufficient for the whole reproductive life span of a female. Our quantitative studies show that primary oogonia in adult female frogs can proliferate, but they fail to differentiate further and do not enter meiosis, and thereby there is no supplementation of new generations of oocytes after each spawning. Ovaries of one-year-old grass frogs contain (median) 53,447 diplotene oocytes, in two-years-old frogs this number decreased to 33,583 and eventually reached 25,679 in virgin mature females. More than 50% decrease in the total oocyte number was accompanied by massive degeneration (atresia) of oocytes. The final number of oocytes in a female forms a stock for 11-12 breeding seasons and exceeds the number of eggs produced during the potential reproductive life span of this species. The phylogenetic context of oocyte recruitment modes in the major clades of vertebrates is discussed in respect to their ability to replenish the stock (a renewable stock in ovaries named "open" vs. a non-renewable stock in ovaries named "closed"). Copyright © 2013 Wiley Periodicals, Inc.

  7. Front propagation and clustering in the stochastic nonlocal Fisher equation

    NASA Astrophysics Data System (ADS)

    Ganan, Yehuda A.; Kessler, David A.

    2018-04-01

    In this work, we study the problem of front propagation and pattern formation in the stochastic nonlocal Fisher equation. We find a crossover between two regimes: a steadily propagating regime for not too large interaction range and a stochastic punctuated spreading regime for larger ranges. We show that the former regime is well described by the heuristic approximation of the system by a deterministic system where the linear growth term is cut off below some critical density. This deterministic system is seen not only to give the right front velocity, but also predicts the onset of clustering for interaction kernels which give rise to stable uniform states, such as the Gaussian kernel, for sufficiently large cutoff. Above the critical cutoff, distinct clusters emerge behind the front. These same features are present in the stochastic model for sufficiently small carrying capacity. In the latter, punctuated spreading, regime, the population is concentrated on clusters, as in the infinite range case, which divide and separate as a result of the stochastic noise. Due to the finite interaction range, if a fragment at the edge of the population separates sufficiently far, it stabilizes as a new cluster, and the processes begins anew. The deterministic cutoff model does not have this spreading for large interaction ranges, attesting to its purely stochastic origins. We show that this mode of spreading has an exponentially small mean spreading velocity, decaying with the range of the interaction kernel.

  8. Structures of Receptor Complexes of a North American H7N2 Influenza Hemagglutinin with a Loop Deletion in the Receptor Binding Site

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

    Yang, Hua; Chen, Li-Mei; Carney, Paul J.

    2012-02-21

    Human infections with subtype H7 avian influenza viruses have been reported as early as 1979. In 1996, a genetically stable 24-nucleotide deletion emerged in North American H7 influenza virus hemagglutinins, resulting in an eight amino acid deletion in the receptor-binding site. The continuous circulation of these viruses in live bird markets, as well as its documented ability to infect humans, raises the question of how these viruses achieve structural stability and functionality. Here we report a detailed molecular analysis of the receptor binding site of the North American lineage subtype H7N2 virus A/New York/107/2003 (NY107), including complexes with an avianmore » receptor analog (3'-sialyl-N-acetyllactosamine, 3'SLN) and two human receptor analogs (6'-sialyl-N-acetyllactosamine, 6'SLN; sialyllacto-N-tetraose b, LSTb). Structural results suggest a novel mechanism by which residues Arg220 and Arg229 (H3 numbering) are used to compensate for the deletion of the 220-loop and form interactions with the receptor analogs. Glycan microarray results reveal that NY107 maintains an avian-type ({alpha}2-3) receptor binding profile, with only moderate binding to human-type ({alpha}2-6) receptor. Thus despite its dramatically altered receptor binding site, this HA maintains functionality and confirms a need for continued influenza virus surveillance of avian and other animal reservoirs to define their zoonotic potential.« less

  9. Seismic Microzonation of Breginjski Kot (NW Slovenia) Based on Detailed Engineering Geological Mapping

    PubMed Central

    2013-01-01

    Breginjski kot is among the most endangered seismic zones in Slovenia with the seismic hazard assessed to intensity IX MSK and the design ground acceleration of 0.250 g, both for 500-year return period. The most destructive was the 1976 Friuli Mw = 6.4 earthquake which had maximum intensity VIII-IX. Since the previous microzonation of the area was based solely on the basic geological map and did not include supplementary field research, we have performed a new soil classification of the area. First, a detailed engineering geological mapping in scale 1 : 5.000 was conducted. Mapped units were described in detail and some of them interpreted anew. Stiff sites are composed of hard to medium-hard rocks which were subjected to erosion mainly evoked by glacial and postglacial age. At that time a prominent topography was formed and different types of sediments were deposited in valleys by mass flows. A distinction between sediments and weathered rocks, their exact position, and thickness are of significant importance for microzonation. On the basis of geological mapping, a soil classification was carried out according to the Medvedev method (intensity increments) and the Eurocode 8 standard (soil factors) and two microzonation maps were prepared. The bulk of the studied area is covered by soft sediments and nine out of ten settlements are situated on them. The microzonation clearly points out the dependence of damage distribution in the case of 1976 Friuli earthquake to local site effects. PMID:24453884

  10. Compact self-aligning assemblies with refractive microlens arrays made by contactless embossing

    NASA Astrophysics Data System (ADS)

    Schulze, Jens; Ehrfeld, Wolfgang; Mueller, Holger; Picard, Antoni

    1998-04-01

    The hybrid integration of microlenses and arrays of microlenses in micro-optical systems is simplified using contactless embossing of microlenses (CEM) in combination with LIGA microfabrication. CEM is anew fabrication technique for the production of precise refractive microlens arrays. A high precision matrix of holes made by LIGA technique is used as a compression molding tool to form the microlenses. The tool is pressed onto a thermoplastic sample which is heated close to the glass transformation temperature of the material. The material bulges into the openings of the molding tool due to the applied pressure and forms lens-like spherical structures. The name refers to the fact that the surface of the microlens does not get in contact with the compression molding tool during the shaping process and optical quality of the surface is maintained. Microlenses and arrays of microlenses with lens diameters from 30 micrometers up to 700 micrometers and numerical aperture values of up to 0.25 have been fabricated in different materials. Cost-effectiveness in the production process, excellent optical performance and the feature of easy replication are the main advantages of this technique. The most promising feature of this method is the possibility to obtain self- aligned assemblies then can be further integrated into a micro-optical bench setup. The CEM fabrication method in combination with LIGA microfabrication considerably enhances the hybrid integration in micro-optical devices which results in a more cost-effective production of compact micro-opto-electro-mechanical systems.

  11. Comparative pathology in ferrets infected with H1N1 influenza A viruses isolated from different hosts.

    PubMed

    Smith, Jennifer Humberd; Nagy, Tamas; Driskell, Elizabeth; Brooks, Paula; Tompkins, S Mark; Tripp, Ralph A

    2011-08-01

    Virus replication and pulmonary disease pathogenesis in ferrets following intranasal infection with a pandemic influenza virus strain (A/California/4/09 [CA09]), a human seasonal influenza H1N1 virus isolate (A/New Caledonia/20/99 [Ncal99]), a classical swine influenza H1N1 virus isolate (A/Swine/Iowa/15/30 [Sw30]), or an avian H1N1 virus isolate (A/Mallard/MN/A108-2355/08 [Mal08]) were compared. Nasal wash virus titers were similar for Ncal99 and Sw30, with peak virus titers of 10(5.1) 50% tissue culture infectious doses (TCID(50))/ml and 10(5.5) TCID(50)/ml occurring at day 3 postinfection (p.i.), respectively. The mean peak titer for CA09 also occurred at day 3 p.i. but was higher (10(7) TCID(50)/ml). In contrast, the peak virus titers (10(3.6) to 10(4.3) TCID(50)/ml) for Mal08 were delayed, occurring between days 5 and 7 p.i. Disease pathogenesis was characterized by microscopic lesions in the nasal turbinates and lungs of all ferrets; however, Sw30 infection was associated with severe bronchointerstitial pneumonia. The results demonstrate that although CA09 is highly transmissible in the human population and replicates well in the ferret model, it causes modest disease compared to other H1N1 viruses, particularly Sw30 infection.

  12. Comparative Pathology in Ferrets Infected with H1N1 Influenza A Viruses Isolated from Different Hosts ▿

    PubMed Central

    Smith, Jennifer Humberd; Nagy, Tamas; Driskell, Elizabeth; Brooks, Paula; Tompkins, S. Mark; Tripp, Ralph A.

    2011-01-01

    Virus replication and pulmonary disease pathogenesis in ferrets following intranasal infection with a pandemic influenza virus strain (A/California/4/09 [CA09]), a human seasonal influenza H1N1 virus isolate (A/New Caledonia/20/99 [Ncal99]), a classical swine influenza H1N1 virus isolate (A/Swine/Iowa/15/30 [Sw30]), or an avian H1N1 virus isolate (A/Mallard/MN/A108-2355/08 [Mal08]) were compared. Nasal wash virus titers were similar for Ncal99 and Sw30, with peak virus titers of 105.1 50% tissue culture infectious doses (TCID50)/ml and 105.5 TCID50/ml occurring at day 3 postinfection (p.i.), respectively. The mean peak titer for CA09 also occurred at day 3 p.i. but was higher (107 TCID50/ml). In contrast, the peak virus titers (103.6 to 104.3 TCID50/ml) for Mal08 were delayed, occurring between days 5 and 7 p.i. Disease pathogenesis was characterized by microscopic lesions in the nasal turbinates and lungs of all ferrets; however, Sw30 infection was associated with severe bronchointerstitial pneumonia. The results demonstrate that although CA09 is highly transmissible in the human population and replicates well in the ferret model, it causes modest disease compared to other H1N1 viruses, particularly Sw30 infection. PMID:21593156

  13. THE RELATIVE REACTION WITHIN LIVING MAMMALIAN-TISSUES

    PubMed Central

    Rous, Peyton

    1925-01-01

    The acidity of the macrophage granules in which litmus comes to be stored during life is considerable. It has proved possible to stain these granules in vivo with some of the phthalein indicators and the results, had they been obtained under controlled conditions, would indicate a pH of 3.0 or less. The amount of acid material which may accumulate within the cells of animals stained with litmus is great, sufficient in the case of the elements of a peritoneal exudate for the acid reaction to prevail when they are gathered together and crushed. The material is derived, not from the dye, but from living elements responding characteristically to a stimulus far from unique. Such responses may well play a rôle in normal physiological activities and in the cellular defense against microorganisms. Vital staining with litmus demonstrates anew that the intracellular reaction during life is independent of that of the body fluids. By means of color changes in the stored indicator one can distinguish sick as well as dead cells of certain sorts and follow their distribution and fate within the organism. There are data to suggest that with the aid of the indicator the normal period of survival of certain elements at least can be determined. By the indicator method, of which the foregoing observations afford a crude illustration, much should be learnt in the future about body processes. The present paper is the second of a series upon the theme. PMID:19868996

  14. Front propagation and clustering in the stochastic nonlocal Fisher equation.

    PubMed

    Ganan, Yehuda A; Kessler, David A

    2018-04-01

    In this work, we study the problem of front propagation and pattern formation in the stochastic nonlocal Fisher equation. We find a crossover between two regimes: a steadily propagating regime for not too large interaction range and a stochastic punctuated spreading regime for larger ranges. We show that the former regime is well described by the heuristic approximation of the system by a deterministic system where the linear growth term is cut off below some critical density. This deterministic system is seen not only to give the right front velocity, but also predicts the onset of clustering for interaction kernels which give rise to stable uniform states, such as the Gaussian kernel, for sufficiently large cutoff. Above the critical cutoff, distinct clusters emerge behind the front. These same features are present in the stochastic model for sufficiently small carrying capacity. In the latter, punctuated spreading, regime, the population is concentrated on clusters, as in the infinite range case, which divide and separate as a result of the stochastic noise. Due to the finite interaction range, if a fragment at the edge of the population separates sufficiently far, it stabilizes as a new cluster, and the processes begins anew. The deterministic cutoff model does not have this spreading for large interaction ranges, attesting to its purely stochastic origins. We show that this mode of spreading has an exponentially small mean spreading velocity, decaying with the range of the interaction kernel.

  15. Comparative effect of chewing sticks and toothbrushing on plaque removal and gingival health.

    PubMed

    Al-Otaibi, Meshari; Al-Harthy, Mohammed; Söder, Birgitta; Gustafsson, Anders; Angmar-Månsson, Birgit

    2003-01-01

    The aim of the study was to compare the effect of the chewing stick (miswak), and toothbrushing on plaque removal and gingival health. The participants comprised 15 healthy Saudi Arabian male volunteers aged 21 to 36 years, attending the Dental Center at Al-Noor Specialist Hospital in Makkah City in Saudi Arabia. The study was designed as a single, blind, randomized crossover study. The Turesky modified Quigley-Hein plaque and Löe-Silness gingival indices and digital photographs of plaque distribution were recorded at baseline, one week after professional tooth cleaning, and again following three weeks use of either the miswak or toothbrush. Professional tooth cleaning was repeated, and after a further three weeks use of either the miswak or toothbrush (using the alternative method to that used in the first experimental period), plaque and gingival indices, and digital photographs of plaque distribution were recorded anew. Compared to toothbrushing, the use of the miswak resulted in significant reductions in plaque (p < 0.001) and gingival (p < 0.01) indices. Image analysis of the plaque distribution showed a significant difference in reduction of plaque between the miswak and toothbrush periods (p < 0.05). It is concluded that the miswak is more effective than toothbrushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than toothbrushing for removing plaque from the embrasures, thus enhancing interproximal health.

  16. Determination of reference ranges for elements in human scalp hair.

    PubMed

    Druyan, M E; Bass, D; Puchyr, R; Urek, K; Quig, D; Harmon, E; Marquardt, W

    1998-06-01

    Expected values, reference ranges, or reference limits are necessary to enable clinicians to apply analytical chemical data in the delivery of health care. Determination of references ranges is not straightforward in terms of either selecting a reference population or performing statistical analysis. In light of logistical, scientific, and economic obstacles, it is understandable that clinical laboratories often combine approaches in developing health associated reference values. A laboratory may choose to: 1. Validate either reference ranges of other laboratories or published data from clinical research or both, through comparison of patients test data. 2. Base the laboratory's reference values on statistical analysis of results from specimens assayed by the clinical reference laboratory itself. 3. Adopt standards or recommendations of regulatory agencies and governmental bodies. 4. Initiate population studies to validate transferred reference ranges or to determine them anew. Effects of external contamination and anecdotal information from clinicians may be considered. The clinical utility of hair analysis is well accepted for some elements. For others, it remains in the realm of clinical investigation. This article elucidates an approach for establishment of reference ranges for elements in human scalp hair. Observed levels of analytes from hair specimens from both our laboratory's total patient population and from a physician-defined healthy American population have been evaluated. Examination of levels of elements often associated with toxicity serves to exemplify the process of determining reference ranges in hair. In addition the approach serves as a model for setting reference ranges for analytes in a variety of matrices.

  17. The role of the microenvironment in tumor growth and invasion.

    PubMed

    Kim, Yangjin; Stolarska, Magdalena A; Othmer, Hans G

    2011-08-01

    Mathematical modeling and computational analysis are essential for understanding the dynamics of the complex gene networks that control normal development and homeostasis, and can help to understand how circumvention of that control leads to abnormal outcomes such as cancer. Our objectives here are to discuss the different mechanisms by which the local biochemical and mechanical microenvironment, which is comprised of various signaling molecules, cell types and the extracellular matrix (ECM), affects the progression of potentially-cancerous cells, and to present new results on two aspects of these effects. We first deal with the major processes involved in the progression from a normal cell to a cancerous cell at a level accessible to a general scientific readership, and we then outline a number of mathematical and computational issues that arise in cancer modeling. In Section 2 we present results from a model that deals with the effects of the mechanical properties of the environment on tumor growth, and in Section 3 we report results from a model of the signaling pathways and the tumor microenvironment (TME), and how their interactions affect the development of breast cancer. The results emphasize anew the complexities of the interactions within the TME and their effect on tumor growth, and show that tumor progression is not solely determined by the presence of a clone of mutated immortal cells, but rather that it can be 'community-controlled'. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Value innovation: the strategic logic of high growth.

    PubMed

    Kim, W C; Mauborgne, R

    1997-01-01

    Why are some companies able to sustain high growth in revenues and profits--and others are not? To answer that question, the authors, both of INSEAD, spent five years studying more than 30 companies around the world. They found that the difference between the high-growth companies and their less successful competitors was in each group's assumptions about strategy. Managers of the less successful companies followed conventional strategic logic. Managers of the high-growth companies followed what the authors call the logic of value innovation. Conventional strategic logic and value innovation differ along the basic dimensions of strategy. Many companies take their industry's conditions as given; value innovators don't. Many companies let competitors set the parameters of their strategic thinking; value innovators do not use rivals as benchmarks. Rather than focus on the differences among customers, value innovators look for what customers value in common. Rather than view opportunities through the lens of existing assets and capabilities, value innovators ask, What if we start anew? The authors tell the story of the French hotelier Accor, which discarded the notion of what a hotel is supposed to look like in order to offer what most customers want: a good night's sleep at a low price. And Virgin Atlantic challenged industry conventions by eliminating first-class service and channeling savings into innovations for business-class passengers. Those companies didn't set out to build advantages over the competition, but they ended up achieving the greatest competitive advantages.

  19. The role of the microenvironment in tumor growth and invasion

    PubMed Central

    Kim, Yangjin; Stolarska, Magdalena A.; Othmer, Hans G.

    2011-01-01

    Mathematical modeling and computational analysis are essential for understanding the dynamics of the complex gene networks that control normal development and homeostasis, and can help to understand how circumvention of that control leads to abnormal outcomes such as cancer. Our objectives here are to discuss the different mechanisms by which the local biochemical and mechanical microenvironment, which is comprised of various signaling molecules, cell types and the extracellular matrix (ECM), affects the progression of potentially-cancerous cells, and to present new results on two aspects of these effects. We first deal with the major processes involved in the progression from a normal cell to a cancerous cell at a level accessible to a general scientific readership, and we then outline a number of mathematical and computational issues that arise in cancer modeling. In Section 2 we present results from a model that deals with the effects of the mechanical properties of the environment on tumor growth, and in Section 3 we report results from a model of the signaling pathways and the tumor microenvironment (TME), and how their interactions affect the development of breast cancer. The results emphasize anew the complexities of the interactions within the TME and their effect on tumor growth, and show that tumor progression is not solely determined by the presence of a clone of mutated immortal cells, but rather that it can be ‘community-controlled’. It Takes a Village – Hilary Clinton PMID:21736894

  20. El Cobreloa: A geyser with two distinct eruption styles

    NASA Astrophysics Data System (ADS)

    Namiki, Atsuko; Muñoz-Saez, Carolina; Manga, Michael

    2014-08-01

    We performed field measurements at a geyser nicknamed "El Cobreloa," located in the El Tatio Geyser Field, Northern Andes, Chile. The El Cobreloa geyser has two distinct eruption styles: minor eruptions and more energetic and long-lived major eruptions. Minor eruptions splash hot water intermittently over an approximately 4 min time period. Major eruptions begin with an eruption style similar to minor eruptions, but then transition to a voluminous liquid water-dominated eruption, and finally end with energetic steam discharge that continues for approximately 1 h. We calculated eruption intervals by visual observations, acoustic measurements, and ground temperature measurements and found that each eruption style has a regular interval: 4 h and 40 min for major eruptions and ˜14 min for minor eruptions. Eruptions of El Cobreloa and geochemical measurements suggest interaction of three water sources. The geyser reservoir, connected to the surface by a conduit, is recharged by a deep, hot aquifer. More deeply derived magmatic fluids heat the reservoir. Boiling in the reservoir releases steam and hot liquid water to the overlying conduit, causing minor eruptions, and heating the water in the conduit. Eventually the water in the conduit becomes warm enough to boil, leading to a steam-dominated eruption that empties the conduit. The conduit is then recharged by a shallow, colder aquifer, and the eruption cycle begins anew. We develop a model for minor eruptions which heat the water in the conduit. El Cobreloa provides insight into how small eruptions prepare the geyser system for large eruptions.

  1. Effect of circulatory assistance on premature death and long-term prognosis.

    PubMed

    Sánchez Lázaro, I J; Almenar Bonet, L; Martínez-Dolz, L; Moro López, J; Rueda Soriano, J; Arnau Vives, M A; Buendía Fuentes, F; Ortiz Martínez, V; Cano Pérez, O; Sánchez Soriano, R; Salvador Sanz, A

    2008-11-01

    Patients undergoing urgent heart transplantation (HT) have a poorer prognosis and more long-term complications. The objective of this study was to compare the preoperative course in patients undergoing urgent HT according to the need for preoperative intra-aortic balloon counterpulsation (IABP). We studied 102 consecutive patients including 23 patients with IABP who underwent urgent HT between January 2000 and September 2006. We excluded patients who received combination transplants, those who underwent repeat HT, and pediatric patients who underwent HT. The statistical methods used were the t test for quantitative variables and the chi(2) test for qualitative variables. A logistic regression model was constructed to assess the possible relationship between IABP and other variables on premature death within 30 days after HT. Mean (SD) patient-age was 50 (10) years. No significant differences were observed in baseline characteristics between the IABP and the non-IAPB groups. The IABP patient group had higher rates of acute graft failure (45.5% vs 35.4%; P = .46) and premature death (18.8% vs 14.8%; P = .67) and shorter long-term survival (40.6 [34.9] vs 54.5 [43.7] mo; P = .30). Multivariate analysis demonstrated no association between the need for IABP and increased frequency of premature death. Use of IABP is not associated with premature or late death. We recommend use of IABP in patients with acute decompensated heart failure to stabilize them before HT.

  2. Laparoscopic peritoneal lavage: our experience and review of the literature.

    PubMed

    Parisi, Amilcare; Gemini, Alessandro; Desiderio, Jacopo; Petrina, Adolfo; Trastulli, Stefano; Grassi, Veronica; Sani, Marco; Pironi, Daniele; Santoro, Alberto

    2016-01-01

    Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.

  3. Practice nurse and health visitor management of acute minor illness in a general practice.

    PubMed

    Pritchard, A; Kendrick, D

    2001-11-01

    To evaluate practice nurse (PN) and health visitor (HV) management of patients with acute minor illnesses, monitor the effect on general practitioner (GP) workload, and describe the range of conditions seen by nurses. Patients requesting 'urgent' appointments (within 24 hours) were offered consultations with a PN or HV trained in the management of acute minor illness. Comparative data were collected before and after the establishment of the acute minor illness service. A general practice in Nottingham, England. Patient satisfaction, consultation rate, prescriptions, investigations, referrals and urgent re-consultations for the same condition within 2 weeks. About 2056 urgent consultations were recorded in the study period, of which 332 (16.1%) were seen by PNs and 46 (2.2%) by a HV. High levels of patient satisfaction were reported for all health professionals. Patients seeing the HV reported higher levels of satisfaction than those consulting GPs (P=0.033) and PNs (P=0.010). There was no difference by health professional for prescription rates (P=0.76), re-consultations (P=0.14), or referrals to secondary care (P=0.07). General practitioners were more likely to initiate further investigations than the PNs or HV (P < 0.001). With suitable training, PNs and HVs can successfully manage patients with a range of conditions. General practitioner workload can be reduced while maintaining high patient satisfaction levels.

  4. Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality

    PubMed Central

    Alavi, Nazanin; Roberts, Nasreen; Sutton, Chloe; Axas, Nicholas; Repetti, Leanne

    2015-01-01

    Objective: To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. Method: A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen’s University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. Results: The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). Conclusions: Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment. PMID:26720189

  5. 77 FR 6482 - Conductor Certification

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-08

    ... resource management'' (CRM), a concept perfected in aviation and urgently pressed on the railroad industry..., 1999). Major railroads have included CRM in their training programs. It is particularly important that...

  6. Testicle pain

    MedlinePlus

    ... Causes The testicles are very sensitive. Even a minor injury can cause pain. In some conditions, abdominal ... Non-urgent causes of testicle pain, such as minor injuries and fluid collection, can often be treated ...

  7. Anal Pain

    MedlinePlus

    ... hot water soaks (sitz baths). Seek immediate medical attention Have someone drive you to urgent care or ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

  8. Hip Pain

    MedlinePlus

    ... an appointment with your doctor. Seek immediate medical attention Ask someone to drive you to urgent care ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

  9. Children and refusal of medical treatment: in urgent need of reform.

    PubMed

    Lennings, Nicholas

    2013-09-01

    The ability of children to refuse medical treatment is far from certain. The New South Wales Law Reform Commission report on this topic, released in 2008, addressed a number of key concerns. As yet, no action on that report has been taken. Neither the present statutory nor common law regime provides sufficient guidance on this issue. The case of Gillick v West Norfolk and Wisbech Area Health Authority [1986] AC 112, while important, is not as far-reaching as it first appeared and has been subject to substantial limitations regarding refusals of treatment. Specifically, the position in relation to the assessment of competency, and the weight of a competent decision, remains outstanding. The ability of children to refuse medical treatment is in urgent need of attention and rectification.

  10. Regulations and guidelines should be strengthened urgently for re-evaluation on post-marketing medicines in China.

    PubMed

    Xie, Yan-Ming; Tian, Feng

    2013-07-01

    This paper reviewed the situation of regulations and guidelines on post-marketing medicines in the developed countries and in China. The developed countries have accumulated a lot of empirical principles and techniques on postmarketing surveillance (also named pharmacovigilance), therefore, their regulation systems are nearly perfect. In China, the regulations on post-marketing re-evaluation and relative technical guidelines do not cover the whole aspects, even lack in some important aspects, and long-term risk management mechanisms have not been established. So it is urgent to establish new regulations and improve the regulatory system in China based on the existing regulations and guidelines, by learning from the ideas of foreign advanced regulations, then fully integrating them with China's actual conditions, and cooperating with multidisciplinary researchers.

  11. A priority dispatch system for emergency medical services.

    PubMed

    Slovis, C M; Carruth, T B; Seitz, W J; Thomas, C M; Elsea, W R

    1985-11-01

    A decision tree priority dispatch system for emergency medical services (EMS) was developed and implemented in Atlanta and Fulton County, Georgia. The dispatch system shortened the average response time from 14.2 minutes to 10.4 minutes for the 30% of patients deemed most urgent (P less than or equal to .05); resulted in a significant increase in the use of advanced life support units for this group (P less than or equal to .02); decreased the number of calls that required a backup ambulance service; and significantly increased conformity to national EMS response time standards for critically ill and injured patients (P less than or equal to .0009). Due to dispatch error, 0.3% of calls were dispatched as least severe but subsequently were found to be most urgent.

  12. CORRIGENDUM to The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis.

    PubMed

    2018-06-01

    The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis by F Marmelo et al. European Journal of Preventive Cardiology January 2018 25: 404-417, DOI: 2016 doi: 10.1177/2047487317752373 The third author's name, affiliation and Funding information were incorrect, the correct details are below: Daniel Moreira-Gonçalves Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Portugal CIAFEL, Faculdade de Desporto, Universidade do Porto, Portugal Funding D.M.G is supported by an individual fellowship grant from Fundação para a Ciência e Tecnologia (SFRH/BPD/90010/ 2012) This has been corrected in the online article.

  13. Regulation, Privacy and Security: Chairman's Opening Remarks

    PubMed Central

    Gabrieli, E.R.

    1979-01-01

    Medical privacy is a keystone of a free democratic society. To conserve the right of the patient to medical privacy, computerization of the medical data must be regulated. This paper enumerates some steps to be taken urgently for the protection of computerized sensitive medical data. A computer-oriented medical lexicon is urgently needed for accurate coding. Health industry standards should be drafted. The goals of various data centers must be sharply defined to avoid conflicts of interest. Medical privacy should be studied further, and medical data centers should consider cost-effectiveness. State boards for medical privacy should be created to monitor data security procedures. There is a need for purposeful decentralization. A national medical information policy should be drafted, and a national clinical information board should implement the nation's medical information policy.

  14. Phenazopyridine

    MedlinePlus

    ... well as urgent and frequent urination caused by urinary tract infections, surgery, injury, or examination procedures. However, phenazopyridine is ... prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. ...

  15. Umbilical hernia repair

    MedlinePlus

    ... painful and stuck in the bulging position. Blood supply to the intestine is affected. The hernia has ... in. This is usually painful. If the blood supply to this area is cut off (strangulation), urgent ...

  16. [Early management of cerebrovascular accidents].

    PubMed

    Libot, Jérômie; Guillon, Benoit

    2013-01-01

    A cerebrovascular accident requires urgent diagnosis and treatment.The management of a stroke must be early and adapted in order to improve the overall clinical outcome and lower the risk of mortality.

  17. Nausea and Vomiting

    MedlinePlus

    ... in the vomit Rectal bleeding Seek immediate medical attention Ask someone to drive you to urgent care ... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization ...

  18. 47 CFR 80.1109 - Distress, urgency, and safety communications.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Global Maritime Distress and Safety System (GMDSS... communications include: navigational and meteorological warnings and urgent information; ship-to-ship safety...

  19. 47 CFR 80.1109 - Distress, urgency, and safety communications.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Global Maritime Distress and Safety System (GMDSS... communications include: navigational and meteorological warnings and urgent information; ship-to-ship safety...

  20. 47 CFR 80.1109 - Distress, urgency, and safety communications.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Global Maritime Distress and Safety System (GMDSS... communications include: navigational and meteorological warnings and urgent information; ship-to-ship safety...

  1. 47 CFR 80.1109 - Distress, urgency, and safety communications.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Global Maritime Distress and Safety System (GMDSS... communications include: navigational and meteorological warnings and urgent information; ship-to-ship safety...

  2. 47 CFR 80.1109 - Distress, urgency, and safety communications.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Global Maritime Distress and Safety System (GMDSS... communications include: navigational and meteorological warnings and urgent information; ship-to-ship safety...

  3. [Application of antiseptic dekasan in urgent abdominal surgery].

    PubMed

    Fomin, P D; Lissov, A I; Kozlov, S N; Mikhal'chishin, S N

    2009-01-01

    Experience in local application of antiseptic Dekasan in the complex treatment of abdominal infections of various origins are presented. The clinical and economic efficacy of the drug application is notice.

  4. Alosetron

    MedlinePlus

    ... urgent need to have bowel movements caused by irritable bowel syndrome (IBS; a condition that causes stomach pain, bloating, constipation, ... alosetron and call your doctor.Alosetron may control IBS but will not cure it. If alosetron helps ...

  5. Compliance of child care centers in Pennsylvania with national health and safety performance standards for emergency and disaster preparedness.

    PubMed

    Olympia, Robert P; Brady, Jodi; Kapoor, Shawn; Mahmood, Qasim; Way, Emily; Avner, Jeffrey R

    2010-04-01

    To determine the preparedness of child care centers in Pennsylvania to respond to emergencies and disasters based on compliance with National Health and Safety Performance Standards for Out-of-Home Child Care Programs. A questionnaire focusing on the presence of a written evacuation plan, the presence of a written plan for urgent medical care, the immediate availability of equipment and supplies, and the training of staff in first aid/cardiopulmonary resuscitation (CPR) as delineated in Caring for Our Children: National Health and Safety Performance Standards for Out-of-Home Child Care Programs, 2nd Edition, was mailed to 1000 randomly selected child care center administrators located in Pennsylvania. Of the 1000 questionnaires sent, 496 questionnaires were available for analysis (54% usable response rate). Approximately 99% (95% confidence interval [CI], 99%-100%) of child care centers surveyed were compliant with recommendations to have a comprehensive written emergency plan (WEP) for urgent medical care and evacuation, and 85% (95% CI, 82%-88%) practice their WEP periodically throughout the year. More than 20% of centers did not have specific written procedures for floods, earthquakes, hurricanes, blizzards, or bomb threats, and approximately half of the centers did not have specific written procedures for urgent medical emergencies such as severe bleeding, unresponsiveness, poisoning, shock/heart or circulation failure, seizures, head injuries, anaphylaxis or allergic reactions, or severe dehydration. A minority of centers reported having medications available to treat an acute asthma attack or anaphylaxis. Also, 77% (95% CI, 73%-80%) of child care centers require first aid training for each one of its staff members, and 33% (95% CI, 29%-37%) require CPR training. Although many of the child care centers we surveyed are in compliance with the recommendations for emergency and disaster preparedness, specific areas for improvement include increasing the frequency of practice of the WEP, establishing specific written procedures for external disasters and urgent medical emergencies, maintaining the immediate availability of potentially life-saving medications, and ensuring that all child care center staff are trained in first aid and CPR.

  6. Evolving practice patterns in the management of acute colonic diverticulitis: a population-based analysis.

    PubMed

    Li, Debbie; Baxter, Nancy N; McLeod, Robin S; Moineddin, Rahim; Wilton, Andrew S; Nathens, Avery B

    2014-12-01

    There is increasing evidence to support the use of percutaneous abscess drainage, laparoscopy, and primary anastomosis in managing acute diverticulitis. The aim of this study was to evaluate how practices have evolved and to determine the effects on clinical outcomes. This is a population-based retrospective cohort study using administrative discharge data. This study was conducted in Ontario, Canada. All patients had been hospitalized for a first episode of acute diverticulitis (2002-2012). Temporal changes in treatment strategies and outcomes were evaluated by using the Cochran-Armitage test for trends. Multivariable logistic regression with generalized estimating equations was used to test for trends while adjusting for patient characteristics. There were 18,543 patients hospitalized with a first episode of diverticulitis, median age 60 years (interquartile range, 48-74). From 2002 to 2012, there was an increase in the proportion of patients admitted with complicated disease (abscess, perforation), 32% to 38%, yet a smaller proportion underwent urgent operation, 28% to 16% (all p < 0.001). The use of percutaneous drainage increased from 1.9% of admissions in 2002 to 3.3% in 2012 (p < 0.001). After adjusting for changes in patient and disease characteristics over time, the odds of urgent operation decreased by 0.87 per annum (95% CI, 0.85-0.89). In those undergoing urgent surgery (n = 3873), the use of laparoscopy increased (9% to 18%, p <0.001), whereas the use of the Hartmann procedure remained unchanged (64%). During this time, in-hospital mortality decreased (2.7% to 1.9%), as did the median length of stay (5 days, interquartile range, 3-9; to 3 days, interquartile range, 2-6; p <0.001). There is the potential for residual confounding, because clinical parameters available for risk adjustment were limited to fields existing within administrative data. There has been an increase in the use of nonoperative and minimally invasive strategies in treating patients with a first episode of acute diverticulitis. However, the Hartmann procedure remains the most frequently used urgent operative approach. Mortality and length of stay have improved during this time.

  7. The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial.

    PubMed

    Hardy, Victoria; O'Connor, Yvonne; Heavin, Ciara; Mastellos, Nikolaos; Tran, Tammy; O'Donoghue, John; Fitzpatrick, Annette L; Ide, Nicole; Wu, Tsung-Shu Joseph; Chirambo, Griphin Baxter; Muula, Adamson S; Nyirenda, Moffat; Carlsson, Sven; Andersson, Bo; Thompson, Matthew

    2017-10-11

    There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries. ClinicalTrials.gov, ID: NCT02763345 . Registered on 3 May 2016.

  8. Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair.

    PubMed

    Bin Jabr, Adel; Lindblad, Bengt; Dias, Nuno; Resch, Timothy; Malina, Martin

    2015-04-01

    This study reports the early and midterm to long-term experience of chimney grafts (CGs) in urgent endovascular repair of complex lesions in the thoracic aorta. Twenty-nine high-risk patients (20 men) who were unfit for open repair were treated using CG technique for ruptured (n = 14) or symptomatic (n = 15) aortic lesions engaging the aortic arch itself (n = 9), the descending aorta (n = 10), or the thoracoabdominal aorta (n = 10). Twenty-two patients (76%) were treated urgently (≤24 hours) and seven were semiurgent (≤3 days). Of 41 chimneys used, 24 were placed in supra-aortic branches and 17 in visceral branches. Median follow-up (interquartile range) for the entire cohort was 2 years (0.6-3.8 years), 2.5 years (1-4 years) for 30-day survivors, and 3.5 years (1.9-6.4 years) for those who were still alive. Four patients (14%) died ≤30 days of cerebral infarction (n = 1), visceral ischemia secondary to the initial rupture (n = 1), multiple organ failure (n = 1), or heart failure (n = 1). There were 11 late deaths (38%); however, only two deaths were related to the CG technique. The primary and secondary technical success rates were 86% (25 of 29) and 97% (28 of 29), respectively. The secondary patency rate of CGs was 98%. Seventeen (68%) of the aortic lesions shrank significantly. Three patients (10%) had primary type I endoleak and another three (10%) had secondary type I endoleak. The endoleaks were managed with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) or coil embolization (n = 2), restenting (n = 1), and conversion to open repair (n = 2). One secondary endoleak is still under observation after >20 months. All primary endoleaks and one secondary endoleak originated from CGs in the brachiocephalic trunk (4 of 6 [67%]). The midterm to long-term results of the CG technique for urgent and complex lesions of the thoracic aorta in high-risk patients are promising, with low early mortality and long durability of the CGs. More patients with longer follow-up are still needed. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. American Institute for Cancer Research

    MedlinePlus

    ... Mailbox: An Urgent Appeal for Your Help Cancer research for prevention and survival. News Liver Inflammation May ... for non-alcoholic fatty liver disease, and AICR research has found that obesity increases risk of liver ...

  10. Real-Time Characterization of Special Nuclear Materials

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

    Walston, Sean; Candy, Jim; Chambers, Dave

    2015-09-04

    When confronting an item that may contain nuclear material, it is urgently necessary to determine its characteristics. Our goal is to provide accurate information with high-con dence as rapidly as possible.

  11. Passive, wireless corrosion sensors for transportation infrastructure.

    DOT National Transportation Integrated Search

    2011-07-01

    Many industrial segments including utilities, manufacturing, government and infrastructure have an urgent need for a means to detect corrosion before significant damage occurs. Transportation infrastructure, such as bridges and roads, rely on reinfor...

  12. 36 CFR 223.53 - Urgent removal contract extensions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... limited to, severe wildfire, wind, floods, insects and disease infestation, and drought. (b) Regional... requirement that purchasers make cash payment to cover the costs of remarking timber on the sale area or...

  13. 36 CFR 223.53 - Urgent removal contract extensions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... limited to, severe wildfire, wind, floods, insects and disease infestation, and drought. (b) Regional... requirement that purchasers make cash payment to cover the costs of remarking timber on the sale area or...

  14. 36 CFR 223.53 - Urgent removal contract extensions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... limited to, severe wildfire, wind, floods, insects and disease infestation, and drought. (b) Regional... requirement that purchasers make cash payment to cover the costs of remarking timber on the sale area or...

  15. 36 CFR 223.53 - Urgent removal contract extensions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... Catastrophic events include, but are not limited to, severe wildfire, wind, floods, insects and disease... cover the costs of remarking timber on the sale area or reestablishing cutting unit boundaries if the...

  16. 36 CFR 223.53 - Urgent removal contract extensions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... limited to, severe wildfire, wind, floods, insects and disease infestation, and drought. (b) Regional... requirement that purchasers make cash payment to cover the costs of remarking timber on the sale area or...

  17. A Conceptual Model for Urgent Acquisition Programs

    DTIC Science & Technology

    2017-04-06

    Research ............................................................................................... 3 Overview of Research Methodology ... Research Methodology .............................................................................................. 13 Research Question...community. The last 60 years of history show three broad examples of priority reset. Welby (2016), Assistant Secretary of Defense for Research and

  18. Fixed Versus Variable Dosing of 4-factor Prothrombin Complex Concentrate for Emergent Warfarin Reversal

    ClinicalTrials.gov

    2018-04-06

    Acute Bleeding on Long-Term Anticoagulation Therapy; Hemorrhage; Significant Bleeding in Patients With a Coagulopathy (Prolonged Thrombin Time); Urgent Reversal of Vitamin K Antagonist (VKA) Anticoagulation

  19. Aviation Security: Urgent Issues Need to Be Addressed

    DOT National Transportation Integrated Search

    1996-09-11

    This is the statement of Keith O. Fultz, Assistant Comptroller General, Resources, Community, and Economic Development Division, General Accounting Office (GAO), before the Subcommittee on Aviation, Committee on Transportation and Infrastructure, Hou...

  20. Finance issue brief: long-term care insurance.

    PubMed

    Mintz, E

    1999-08-03

    States are turning their attention to long-term care insurance, spurred by a 1996 federal law and an increasingly urgent need for more options to finance the care of their rapidly growing elderly populations.

Some links on this page may take you to non-federal websites. Their policies may differ from this site.
Top