Dhar, Shabir Ahmed; Dar, Tahir Ahmed; Wani, Sharief Ahmed; Hussain, Shahid; Dar, Reyaz Ahmed; Wani, Zaid Ahmed; Aazad, Shah; Yaqoob, Suhail; Mansoor, Imtiyaz; Ali, Murtaza Fazal; Ahmed, Muzaffar; Mumtaz, Imran; Azhar, Idrees
The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone. This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes. A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs. The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.
Acharya, Rija; Badhu, Angur; Shah, Tara; Shrestha, Sharmila
An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers. Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection. More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered. The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.
Strong gamme or X-ray sources are utilized for non-destructive testing of i.e. bridges. The activities involve certain risks of accident that might lead to serious injuries caused by radiation. The National Institute of Radiation Protection has during the laste decade greatly yhe inspection rate in this area. It has today made controls of most enterprieses running ambulating radiography. (O.S.)
Occupational accidents among ambulance drivers in the emergency relief Accidentes del trabajo de conductores de ambulancia que brindan atención de urgencia Acidentes de trabalho com motoristas de ambulâncias que realizam socorro de urgência
Full Text Available We analyzed the occurrence of occupational accidents (OA among ambulance drivers in Emergency Relief (ER, with a view to disclosing the types of events and their causes. A quantitative-qualitative study was carried out through the interview of 22 workers in a city in São Paulo, Brazil. The subjects were male, between 36 and 40 years old (40.9%, married (81.82%, with uncompleted primary education (40.9%, individual (90.9% and family (54.55% income between two and four Brazilian minimum wages, not performing any other paid occupation (45.45%. The majority of the OA were typical, due to an excess of exercises and vigorous and repeated movements (42.11% and aggression through body strength and other means (26.33%. The OA occurs mainly because drivers carry out tasks that do not suit their professional formation.Fue estudiada la frecuencia de accidentes del trabajo (AT con chóferes de ambulancia que brinda Atención de Urgencia (AU, buscando encontrar los tipos de accidentes y sus causas. La investigación fue cuanti-cualitativa, para lo cual fueron entrevistados 22 trabajadores de una ciudad en el Estado de São Paulo. Los sujetos eran de sexo masculino, con edades entre 36 y 40 años (40,9%, casados (81,82%, con educación primaria incompleta (40,9%, sueldo individual (90,9%, sueldo familiar (54,55% entre dos y cuatro sueldos mínimos y sin otra ocupación (45,45%. La gran mayoría de los AT fueron típicos, por exceso de ejercicios, movimientos enérgicos y repetidos (42,11% y daño por fuerza corporal y otras formas (26,33%. Los AT se dieron principalmente porque los chóferes realizaban actividades que no iban de acuerdo con su formación profesional.Estudou-se a ocorrência de acidentes de trabalho (AT com motoristas de ambulância que realizam Socorro de Urgência (SU, buscando evidenciar os tipos desses eventos e suas causas. A investigação foi quanti-qualitativa, entrevistando-se 22 trabalhadores que atuam em uma cidade paulista. Os
ion 15 14% Nasogastric Tube 12 11% Foley 10 9% Tracheostomy Care 10 9% Immobilization 8 7% Incubator 3 2% Other 11 10% Total Patients Needing Special...Results indicated that trauma patients travelling to larger medical centers were the primary patient category. Generally, Registered Nurses accompanied...minimal knowledge level of each inflight attendant, and instructor qualifications are not indicated . Further, volunteer air ambulance services are
Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice
Healthcare professionals are frequently confronted with urgent situations and a high-risk human intervention. They are usually exposed to what is called burnout syndrome. To identify the effects of burnout syndrome on the professional conduct and attitudes of doctors and nurses who work in the Romanian public ambulance service. Secondary, the causal relationships between burnout and various socio-demographic variables were analyzed. The 20-item Toronto Alexithymia Scale (TAS- 20), Maslach Burnout Inventory and Job Satisfaction Questionnaire were administered to 122 ambulance doctors, nurses and drivers (62 females and 60 males). The degree of job satisfaction is the most important indicator of burnout syndrome. Significant differences were found between low and high alexithymic subjects. Women are more susceptible to experience higher levels of burnout than men. The level of burnout is influenced by the combined effect of job satisfaction and alexithymia. Burnout syndrome is a common problem among people working in the emergency medical system. The causes of job-related burnout have to be identified in order to apply an appropriate level of burnout intervention program and to increase the efficiency of coping strategies.
Casey, Megan L; Nguyen, Duong T; Idriss, Barrie; Bennett, Sarah; Dunn, Angela; Martin, Stephen
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a
Erbay, Hasan; Alan, Sultan; Kadıoğlu, Selim
This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctor's opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. 'If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,' he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?
RONOJOY GHOSH; VIVEK SHAH; HITESH AGARWAL; ASHUTOSH BHUSHAN; PRASUN KANTI GHOSH
With the increase in traffic road density, several causalities occur due to delay in taking a patient to the hospital in an ambulance. In this paper, we have developed an algorithm to find the shortest path to reach the required destination. As required the software will identify the present location of the vehicle and ask the user for the destination. Then it will show all the available paths, highlighting the shortest one or in several cases the most optimum one. Further we made the traffic...
O'Hara, Niamh B; Reed, Harry J; Afshinnekoo, Ebrahim; Harvin, Donell; Caplan, Nora; Rosen, Gail; Frye, Brook; Woloszynek, Stephen; Ounit, Rachid; Levy, Shawn; Butler, Erin; Mason, Christopher E
Microbial communities in our built environments have great influence on human health and disease. A variety of built environments have been characterized using a metagenomics-based approach, including some healthcare settings. However, there has been no study to date that has used this approach in pre-hospital settings, such as ambulances, an important first point-of-contact between patients and hospitals. We sequenced 398 samples from 137 ambulances across the USA using shotgun sequencing. We analyzed these data to explore the microbial ecology of ambulances including characterizing microbial community composition, nosocomial pathogens, patterns of diversity, presence of functional pathways and antimicrobial resistance, and potential spatial and environmental factors that may contribute to community composition. We found that the top 10 most abundant species are either common built environment microbes, microbes associated with the human microbiome (e.g., skin), or are species associated with nosocomial infections. We also found widespread evidence of antimicrobial resistance markers (hits ~ 90% samples). We identified six factors that may influence the microbial ecology of ambulances including ambulance surfaces, geographical-related factors (including region, longitude, and latitude), and weather-related factors (including temperature and precipitation). While the vast majority of microbial species classified were beneficial, we also found widespread evidence of species associated with nosocomial infections and antimicrobial resistance markers. This study indicates that metagenomics may be useful to characterize the microbial ecology of pre-hospital ambulance settings and that more rigorous testing and cleaning of ambulances may be warranted.
Yamamoto, Y. [Toyota Motor Co. Ltd., Aichi (Japan)
Ambulances are playing an important role in the supporting of the activities of fire fighters belonging to the fire stations in the whole of the country, or saving the irreplaceable lives. In accordance with an increase in recent years in the percentage of the aged in the population of the nation and the number of accidents and disasters, it has become urgently necessary that pre-hospital care (first-aid treatment of a sick or injured person before rushed to a hospital) be set up, and the characteristics which the ambulances are required to possess have greatly changed. This paper describes the main points of and future requirements for the development of ambulances mainly of the second generation of Toyota ambulance `Himedic` of specifications of high standards developed in accordance with the start of the first-aid and life-saving qualifier system in 1991. The characteristics which ambulances are required to have, and which are referred to in this paper, are improved mobility, provision of a sufficient space in the ambulance for internal activity, capability of reducing the patient`s burden and improved safety. The future requirements referred to in the paper include he unification of specifications, reduction of dimensions and weight of medical equipment and adoption of a hybrid system and ITS (Intelligent Transport System). 3 refs., 5 figs., 2 tabs.
Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of
The ambulance is to replace another based on the off-road vehicle design which was originally acquired for the civil engineering phase of LEP construction. Just one figure, in 1999, the CERN ambulance was called out 195 times.
Ferriero, Giorgio; Kristensen, Morten T; Invernizzi, Marco
. EVIDENCE ACQUISITION: A literature search was conducted on research articles published between 2006 and June 2016 in journals indexed by MEDLINE and Scopus databases using as search item: "Cumulated Ambulation Score"[All Fields], and selecting studies that presented a psychometric analysis of the scale...
Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A
The energy expenditures (Ee) for locomotion by nondisabled and disabled Filipino children aged 7 to 13 were determined and compared using indirect calorimetry. Forty-one controls (20 boys and 21 girls) ambulated at a comfortable pace; 16 children (eight boys and eight girls) with lower extremity poliomyelitis of varying severity ambulated by (1) wheelchair propulsion, (2) bilateral axillary crutches, (3) unilateral lower extremity ankle-foot orthoses or knee-ankle-foot orthoses, and (4) unassisted. Disabled children, regardless of their mode of ambulation, had to expend significantly more energy to ambulate than normal children (p less than 0.05). Wheelchair propulsion cost 16% more energy than the normal gait; crutch ambulation cost 41% more than the control. Children using unilateral braces sacrificed speed to attain near-normal Ee. When they ambulated without orthoses, their Ee increased by 109% over the control. In ascending order, the least energy was expanded by normal ambulation followed by disabled ambulation with unilateral brace, disabled propelling a wheelchair, disabled ambulation with bilateral axillary crutches, and disabled ambulation without brace. Efficiency of locomotion was reflected in the values obtained for Ee in terms of kcal x 10(-3)/kg/m, as demonstrated by the lower Ee but slower ambulation of children with braces, as compared to the nondisabled children.
Cardiac arrests claim millions of lives each year. The condition can often be treated with a de ﬁbrillator,buttimeisaverycriticalfactor. Asaconsequence,survivalratesarelow. Recent developments in drone technology have made civilian drones both cheap, easy to operate, and reliable. This paper looks into opportunities to use drones to deliver deﬁbrilla tors to cardiac arrest victims faster than an ambulance, and focuses on unifying the needs of emergencyresponsewiththerulesandreg...
Doherty-King, Barbara; Bowers, Barbara J
Functional decline has been identified as a leading negative outcome of hospitalization for older person. Functional decline is defined as a loss in ability to perform activities of daily living including a loss of independent ambulation. In the hospital literature, a patient's loss in ability to independently ambulate during the hospital stay varies between 15 and 59%. Lack of ambulation and deconditioning effects of bed rest are one of the most predictable causes of loss of independent ambulation in hospitalized older persons. Nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, nurses do not routinely walk patients. The purpose of this study was to explore the relationship between nurses' attributions of responsibility for ambulating hospitalized patients and their decisions about whether to ambulate. A descriptive, secondary analysis of data gathered for a parent study was conducted. Grounded dimensional analysis was used to analyze the data. Participants consisted of 25 registered nurses employed on medical or surgical units from two urban hospitals in the United States. Nurses fell into two groups: those who claimed ambulation of patients within their responsibility of practice and those who attributed the responsibility to another discipline. Nurses who claimed responsibility for ambulation focused on patient independence and psychosocial well-being. This resulted in actions related to collaborating with physical therapy, determining the appropriateness of activity orders, diminishing the risk and adjusting to resource availability. Nurses who attributed the responsibility deferred decisions about initiating ambulation to either physical therapy or medicine. This resulted in actions related to waiting, which involved, waiting for physical therapy clearance, physician orders, risks to decrease, and resources to improve before ambulating. Nurses who claimed responsibility for
Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.
Larsson, Ricard; Engström, Åsa
Effective pre-hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses' experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio-pulmonary resuscitation (CPR) to accord with pre-hospital cardiac guidelines and patients' wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses' experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions. © 2013 Wiley Publishing Asia Pty Ltd.
Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road conditions and traffic volumes. To support spatial planning and provide ...
..., which are defined in § 414.605 of this chapter: (1) Basic life support (BLS) (emergency and nonemergency). (2) Advanced life support, level 1 (ALS1) (emergency and nonemergency). (3) Advanced life support... Coverage of ambulance services. (a). Basic rules. Medicare Part B covers ambulance services if the...
Hinton, C A; Cullen, K E
Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.
Sollid, Stephen J M; Rehn, Marius
The care administered on air ambulances has become increasing complex. This has led to a discussion among experts as to whether air ambulance travel should be manned by physicians. This review provides evidence in support of anaesthesiologists being the physician-leaders in air ambulance medicine, because of their training in advanced airway management, critical care, and resuscitation. Successful prehospital care requires the ability to perform a complex set of advanced diagnostics and interventions. These include airway management, haemorrhage control, pain management, point-of-care diagnostics, complex interfacility transport, and advanced interventions. This skill set closely mirrors the training and expertise of anaesthesiologists. There are few studies investigating the specific benefit of anaesthesiologists in air ambulance medicine. However, current evidence indicates that their presence does improve patient care and safety. Future studies on this topic should use evidence-based quality indicators and standardized data sets to seek answers to optimal staffing of air ambulance teams.
Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul
The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance.
Lee, Yu Jin; Shin, Sang Do; Lee, Eui Jung; Cho, Jin Seong; Cha, Won Chul
Objective The aims of this study were to describe overcrowding in regional emergency departments in Seoul, Korea and evaluate the effect of crowdedness on ambulance turnaround time. Methods This study was conducted between January 2010 and December 2010. Patients who were transported by 119-responding ambulances to 28 emergency centers within Seoul were eligible for enrollment. Overcrowding was defined as the average occupancy rate, which was equal to the average number of patients staying in an emergency department (ED) for 4 hours divided by the number of beds in the ED. After selecting groups for final analysis, multi-level regression modeling (MLM) was performed with random-effects for EDs, to evaluate associations between occupancy rate and turnaround time. Results Between January 2010 and December 2010, 163,659 patients transported to 28 EDs were enrolled. The median occupancy rate was 0.42 (range: 0.10-1.94; interquartile range (IQR): 0.20-0.76). Overcrowded EDs were more likely to have older patients, those with normal mentality, and non-trauma patients. Overcrowded EDs were more likely to have longer turnaround intervals and traveling distances. The MLM analysis showed that an increase of 1% in occupancy rate was associated with 0.02-minute decrease in turnaround interval (95% CI: 0.01 to 0.03). In subgroup analyses limited to EDs with occupancy rates over 100%, we also observed a 0.03 minute decrease in turnaround interval per 1% increase in occupancy rate (95% CI: 0.01 to 0.05). Conclusions In this study, we found wide variation in emergency department crowding in a metropolitan Korean city. Our data indicate that ED overcrowding is negatively associated with turnaround interval with very small practical significance. PMID:26115183
Mahmood, M. A.; Thornes, J. E.; Bloss, W.; Pope, F.
Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature and relative humidity on ambulance call out rates for different medical categories will be investigated. We use call out data obtained from the London Ambulance Service (LAS) and meteorological data from a central London meteorological station. A time-series analysis was utilized to understand the relation between temperature, relative humidity, air pollutants and different call out categories. There are statistically significant relationships between mean temperature and ambulance callout rate for most of the categories investigated. Most categories show a negative dependence on temperature, i.e. call outs increase with decreasing temperature but some categories showed a positive dependence such as alcohol related call outs. Relative humidity is significant for some categories but in general is much less important than temperature. Significant time lag effects were observed for most of the categories related to infectious illnesses, which are transferrable through human contact. These findings support the opinion that ambulance attendance callouts records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorological conditions and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather forecasts.
Tsegaye, Ademe; Somigliana, Edgardo; Alemayehu, Tadesse; Calia, Federico; Maroli, Massimo; Barban, Paola; Manenti, Fabio; Putoto, Giovanni; Accorsi, Sandro
To evaluate the functionality of an ambulance service dedicated to emergency obstetric care (EmOC) that referred pregnant women to health centers for delivery assistance or to a hospital for the management of obstetric complications. A retrospective study investigated an ambulance referral system for EmOC in a rural area of Ethiopia between July 1 and December 31, 2013. The service was available 24h a day and was free of charge. Women requesting referral were transported to nearby health centers. Assistance was provided locally for uncomplicated deliveries. Women with obstetric complications were referred from health centers to a hospital. A total of 528 ambulance referrals were recorded. The majority of patients (314 [59.5%]) were transported from villages to health centers. The remaining individuals were brought to a hospital, having been referred from health centers (179 [33.9%]) or were referred directly from villages owing to hospital proximity (35 [6.6%]). Of the 179 patients referred to the hospital from health centers, 84 (46.9%) were diagnosed with major direct obstetric complications. No maternal deaths were recorded among patients using the ambulance service. The cost of the ambulance service was US$ 18.47 per referred patient. An ambulance service dedicated to EmOC that interconnected health centers and a hospital facilitated referrals and better utilized local resources. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Full Text Available Abstract Background Undergraduate paramedic students undertake clinical placements in a variety of locations. These placements are considered an essential element for paramedic pre-employment education. However, anecdotal evidence suggests some students have not had positive experiences on their emergency ambulance placements. The objective of this study was to identify the type of experiences had by students during ambulance clinical placements and to provide feedback to the ambulance services. Methods In this pilot study we employed a cross-sectional study methodology, using a convenience sample of undergraduate paramedic students available in semester one of 2007 to ascertain the students' views on their reception by on-road paramedics and their overall experience on emergency ambulance clinical placements. Ethics approval was granted. Results There were 77 students who participated in the survey, 64% were females, with 92% of students Conclusion This study demonstrates that for a small group of students, emergency ambulance clinical placements were not a positive experience clinically or educationally. Some qualified paramedics doubt if a number of female students can perform the physical role of a paramedic.
The arrival of a new vehicle is always an important moment in the life of a fire station. So when a new ambulance was delivered to the CERN Fire Brigade on Wednesday 16 September 2000, it was given a warm welcome, attended by staff of the different divisions involved in its purchase. It took a year from the first administrative moves to the day of acquisition. On the one hand there were the calls for tender needed for such a purchase and on the other the development of this custom-designed ambulance with its unique features. Three visits to the manufacturer had to be made, including two to the head office of the Miesen factory at Bonn to study and incorporate in the ambulance the special requirements called for by its future users. These requirements, born from the past experience of CERNs ambulance crews, concerned not only interior arrangements but also included a new side panel, opening up a stowage compartment where everything will be put that gets dirty during ambulance operations. This will minimize ...
Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)
The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da
Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias
BACKGROUND: Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered...... by ambulance personnel. METHODS: Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival....... Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. RESULTS: Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR...
Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian
Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822
Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema
In this paper we propose an Emergency Department Information System that will be integrated with the ambulance system to improve the communication, enhance the quality of provided emergency services and facilitate information sharing. The proposed system utilizes new advanced technologies such as mobile web services that overcome the problems of interoperability between different systems, HL7 and GPS. The system is unique in that it allows ambulance officers to locate the nearest specialized hospital and allows access to the patient's electronic health record as well as providing the hospital with required information to prepare for the incoming patient.
Clutterbuck, Georgina; Auld, Megan; Johnston, Leanne
Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further
... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553.215 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS APPLICATION OF THE FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire Protection and Law Enforcement Employees of...
Ambulance personnel were required to view a PowerPoint. (Microsoft, USA) presentation of the vignettes (Table 1) and then mention whether stroke was present or absent and motivate how they reached the diagnosis. Three vignettes were positive for stroke diagnosis according to the LAPSS and CPSS, while four vignettes.
Wastell, D.; Newman, M.
The development of information systems (IS) is a problematic process that all too often ends in failure. This paper reports a comparative analysis of two projects involving the computerisation of ambulance control-room operations in London and Manchester. The outcomes were strikingly different. In
Bohström, Dan; Carlström, Eric; Sjöström, Nils
Ambulance nurses display stress symptoms, resulting from their work with patients in an emergency service. Certain individuals seem, however, to handle longstanding stress better than others and remain in exposed occupations such as ambulance services for many years. This paper examines stress inducing and stress defusing factors among ambulance nurses. A qualitative descriptive design using critical incident technique was used. A total of 123 critical incidents were identified, and a total of 61 strategies dealing with stress were confirmed. In all, 13 sub-categories (seven stress factors and five stress reducing factors) were merged into four categories (two stress categories and two stress reducing categories). The study shows that ambulance nurses in general experience emergency calls as being stressful. Unclear circumstances increase the stress level, with cases involving children and childbirth being especially stressful. Accurate information and assistance from the dispatch centre reduced the stress. Having discussions with colleagues directly after the assignment were particularly stress reducing. Advanced team collaboration with teammates was viewed as effective means to decrease stress, in addition to simple rituals to defuse stress such as taking short breaks during the workday. The study confirmed earlier studies that suggest the benefits of defusing immediately after stress reactions. Copyright © 2016 Elsevier Ltd. All rights reserved.
Taylor, Alexander; Boyle, Adrian; Sutherland, Alex; Giacomantonio, Chris
Previous work has demonstrated that much violence requiring medical help is not recorded by the police. Sharing emergency department data on victims of violence is associated with reductions in community violence and is well established throughout the UK. We undertook a critical literature review to determine whether sharing ambulance data was useful to identify violence hotspots and offered unique information for violence prevention. A search of the major medical and criminological databases was undertaken using search terms related to the ambulance service, violence and assault, as well as data collection. The search was conducted within the NICE Evidence, Cochrane Library, Google Scholar, Criminal Justice Abstracts, Scopus and National Criminal Justice Reference Service databases, along with the websites of various relevant institutions. Overall, 36 papers were identified by abstract scanning and bibliography search, of which 10 were considered relevant. A further nine papers were detected in the grey literature, and two were considered to be useful in providing evidence for use of ambulance data in violence surveillance. Two of the identified papers were interventional studies, and the other 10 were observational studies. Although the standard of evidence was generally low, most studies demonstrated that ambulance services detected a substantial proportion of assaults that were not recorded by the police or the emergency departments. We identified only two interventional studies, but they were of low quality. Although the interventional evidence base is currently weak, ambulance data provide a unique source of information about the epidemiology of community violence and have the potential to improve current violent crime surveillance methods.
Krause, James S.
The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…
Fournier, Marc; Chenaitia, Hichem; Masson, Catherine; Michelet, Pierre; Behr, Michel; Auffray, Jean-Pierre
Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment. Firstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality. Forty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G. The crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the "patient" substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.
Hansen, Claus D.; Nielsen, Kent J
alone. Aim This presentation investigates whether failure to use AT is linked to male ambulance workers’ gender identity? Is lifting patients alone a way of performing masculinity for AP’s? Method Data is taken from MARS, a panel study of AP workers in Denmark (n = 1606). Information from questionnaires...... measuring traditional male role norms (MRNI), safety attitudes and safety behavior will be linked to company register information on work injuries categorized as lifting accidents. Logistic regression is used to analyse associations between masculinity, lifting behavior, and lifting accidents. Results...... alone. For those 5% scoring lowest on MRNI the probability of reporting lifting alone was 6% while this figure was 17% for those scoring above the 95th percentile. Conclusion This study suggests that male ambulance workers performance of masculinity might pose a threat to their safety. AP...
Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny
BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision...... surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation...... received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing....
Chin, Su Na; Cheah, Phee Kheng; Arifin, Muhamad Yaakub; Wong, Boh Leng; Omar, Zaturrawiah; Yassin, Fouziah Md; Gabda, Darmesah
Ambulance response time (ART) is one of the standard key performance indicators (KPI) in measuring the emergency medical services (EMS) delivery performances. When the mean time of ART of EMS system reaches the KPI target, it shows that the EMS system performs well. This paper considers the determinants of ART, using data sampled from 967 ambulance runs in a government hospital in Sabah. Multiple regression analysis with backward elimination was proposed for the identification of significant factors. Amongst the underlying factors, travel distance, age of patients, type of treatment and peak hours were identified to be significantly affecting ART. Identifying factors that influence ART helps the development of strategic improvement planning for reducing the ART.
The practice-as-research project Homing Place proposes a transferable percipient-led methodology of performance and research activated by ambulant and conversive mechanisms as the culmination of this research. The thesis is comprised of a range of activity that represents a moment and way of writing practice. Three artworks that comprise part of the practical component of this thesis--- way from home, Take me to a place and Yodel Rodeo-- each involved participation and contribu...
Hignett, Sue; Griffiths, Paula; Murdey, Ian D; Lee, Sandra L
Musculoskeletal disorders (MSDs) are the most common occupational illness in Great Britain affecting 1.1 million people a year. Paramedics, in particular, are known to have a high incidence of MSDs resulting, for many, in early retirement. To explore the management of MSDs at two ambulance services with respect to the implementation of policies and experience of staff. The data were collected at two ambulance services using document retrieval and semi-structured interviews. The first service used a functional-centred occupational health (OH) approach with patient participation. The second service used a more traditional medical model with the patient in a more passive role. The first service reported their MSD management policies and procedures concurred with 28 of the 32 Faculty of Occupational Medicine guidelines (88%) in contrast to the second service, where only 17 (53%) concurred. For both services, the expected recovery pathways (management policies and procedures) had points of variance with the experienced recovery pathways. Both services had haphazard referral to OH resulting in limited referral for treatment in the first 4 weeks post-injury and no difference in median recovery times. These variances resulted in a convergence in the timing and type of treatment received by staff at both services. Both ambulance services were found to have variance in the experienced recovery pathway in comparison to the expected pathway. It was concluded that without systematic monitoring and regular audit, there was likely to be a lack of compliance with the policy and procedures.
Gustavsson, Pär; Nilsson, Peter M
The fact that Sweden has been spared from war on its soil for almost 200 years, has not stopped Swedish citizens from participating in conflicts worldwide during this period. This has been described, especially from the soldiers perspective. The contribution of Swedish physicians has not been written about to the same extent. When Mussolini's Italy in October 1935 invaded the poor and underdeveloped country of Ethiopia (former Abyssinia) an ambulance was immediately organized by the Swedish Red Cross. To lead such an expedition, a great knowledge of Ethiopian culture och maybe most importantly, of the weather and geographical conditions, was undoubtedly demanded. Therefore, the Swedish Red Cross turned to two Ethiopian veterans. Doctor Fride Hylander, a missionary-son who had been working on a hospital project in the Ethiopian province of Harrar and his friend since school years, doctor Gunnar Agge, were assigned the leadership of the ambulance. Dr Agge had also participated in improving the Ethiopian health care both in Harrar and later as civilian and military doctor in the province of Ogaden, where he was medically responsible for the more than 9 000 men strong army that the Ethiopian emperor had stationed there after Italian provocations. Most of the other members of the ambulance were handpicked by these two leaders and many of them had, just like themselves, a stong religious belief. A money-raise was immediately initiated and in less than six weeks 700 000 Swedish crowns had been collected, more then twice the sum the ambulance was calculated to cost. In early november 1935 the ambulance was clear to go. Their primary objective was to travel through British Somaliland and establish a field-hospital in the province of Harrar. However, the Ethiopian emperor had other things in mind. He wanted to reorganize the ambulance and divide it in two and place it closer to the front line. The ambulance decided to go along with his wish. Both groups started eventually
Barclay, Ruth E; Stevenson, Ted J; Poluha, William; Ripat, Jacquie; Nett, Cristabel; Srikesavan, Cynthia S
Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and may walk with others as an important aspect of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. To determine: (1) whether interventions improve community ambulation for stroke survivors, and (2) if any specific intervention method improves community ambulation more than other interventions. We searched the Cochrane Stroke Group Trials Register (September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), PubMed (1946 to November 2013), EMBASE (1980 to November 2013), CINAHL (1982 to November 2013), PsycINFO (1887 to November 2013), Scopus (1960 to November 2013), Web of Science (1900 to November 2013), SPORTDiscus (1975 to November 2013), and PEDro, CIRRIE and REHABDATA (November 2013). We also searched ongoing trials registers (November 2013) and reference lists, and performed a cited reference search. Selection criteria included parallel-group randomised controlled trials (RCTs) and cross-over RCTs, studies in which participants are adult (aged 18 years or more) stroke survivors, and interventions that were aimed at improving community ambulation. We defined the primary outcome as participation; secondary outcomes included activity level outcomes related to gait and self-efficacy. One review author independently screened titles. Two review authors screened abstracts and full text articles, with a third review author was available to resolve any disagreements. Two review authors extracted data and assessed risk of bias. All outcomes were continuous. The analysis for the primary outcome used the generic inverse variance methods for meta-analysis, using the standardised mean difference (SMD) and standard error (SE
Tokuda, Yasuharu; Abe, Toshikazu; Ishimatsu, Shinichi; Hinohara, Shigeaki
Background Few studies have investigated ambulance utilization in people aged 85 years or older, ie, the oldest old. Methods We conducted a 1-year population-based observational study of patients transported by ambulance to emergency departments in Tokyo, Japan, which has a population of about 12 million. Demographic data, symptoms/events associated with ambulance transport, and the proportion of hospital admissions were recorded. Transport rates by age and sex were calculated using data for the background population and ambulance transports, and the 10 most frequent symptoms/events requiring transport were compared between the oldest old and those aged 65 to 84 years. Results Of the 642 764 patients who were transported to hospitals by ambulances, 59 570 (9%) were aged ≥85 years; 64% were women. The annual ambulance transport rate for this population was 250 per 1000/year and was significantly greater than the rate (90 per 1000/year) for those aged 65 to 84 years. The highest rate was for men aged 85 to 99 years (292 per 1000/year). Among the oldest old, the most frequent reason for ambulance transport was fall (38.5 per 1000/year), and the symptom most likely to result in hospital admission was dyspnea. Conclusions The ambulance transport rate for the oldest old was high, particularly among men aged ≥95 years. To reduce the need for ambulance transport among the oldest old, preventive care is needed to reduce falls and acute exacerbations of cardiac and respiratory disorders. PMID:20814165
Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel
Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.
Sep 15, 1990 ... recent months some medical practitioners were of the opinion that ambulance personnel were being trained to do more than they should. Unfortunately many doctors still seem to view the ambulance service as mainly a patient transport service and not as the emergency medical service it has become.
Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen
Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island....
Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S
. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...
Sep 15, 1990 ... basic fIrst aid was administered to the patient. Mter World. War H the value of the ambulance service as a formal health service was realised and Britain. systematically established ambulance services as health services independent from fIre departments. The colonies, however, maintained combined.
Pope, Francis; Chapman, Lee; Fisher, Paul; Mahmood, Marliyyah; Sangkharat, Kamolrat; Thomas, Neil; Thornes, John
Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature, other meteorological and air pollution variables on ambulance call out rates for different medical categories will be investigated. We use ambulance call out obtained from various ambulance services worldwide which have significantly different meteorologies, climatologies and pollution conditions. A time-series analysis is utilized to understand the relation between meteorological conditions, air pollutants and different call out categories. We will present findings that support the opinion that ambulance attendance call outs records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorology, climate, air pollution and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather, climate and pollution forecasts.
This report describes supplemental driver training programs and online basic driver education. It coves supplemental driver training that : focused on knowledge and skills beyond those normally found in traditional driver education delivered in the U...
The Kentucky Department of Vehicle Regulation is exploring the possibility of developing and implementing online : drivers license renewal. The objective of this project was to: 1) evaluate online drivers license and REAL ID renewal : programs ...
Full Text Available This paper proposes a novel approach to analyze potential accessibility to ambulance services by combining the demand-covered-ratio and potential serviceability with the ambulance-covering-ratio. A Geographic Information System (GIS-based spatial analysis will assist ambulance service planners and designers to assess and provide rational service coverage based on simulated random incidents. The proposed analytical model is compared to the gravity-based two-step floating catchment area method. The study found that the proposed model could efficiently identify under-covered and overlapped ambulance service coverage to improve service quality, timeliness, and efficiency. The spatial accessibility and serviceability identified with geospatial random events show that the model is able to plan rational ambulance service coverage in consideration of households and travel time. The model can be applied to both regional and statewide coverage plans to aid the interpretation of those plans.
Keeratisiroj, Orawan; Thawinchai, Nuanlaor; Siritaratiwat, Wantana; Buntragulpoontawee, Montana
The objectives of this study were to determine prognostic predictors for ambulation among Thai children with cerebral palsy and identify their ambulatory status. A retrospective cohort study was performed at 6 special schools or hospitals for children with physical disabilities. The prognostic predictors for ambulation were analyzed by multivariable ordinal continuation ratio logistic regression. The 533 participants aged 2 to 18 years were divided into 3 groups: 186 with independent ambulation (Gross Motor Function Classification System [GMFCS I-II]), 71 with assisted ambulation (Gross Motor Function Classification System III), and 276 with nonambulation (Gross Motor Function Classification System IV-V). The significant positive predictors for ambulation were type of cerebral palsy (spastic diplegia, spastic hemiplegia, dyskinesia, ataxia, hypotonia, and mixed type), sitting independently at age 2 years, and eating independently. These predictors were used to develop clinical scoring for predicting the future ability to walk among Thai children with cerebral palsy. © The Author(s) 2015.
Muhammad Yasir Khan
Full Text Available Philip Larkin is known as a movement poet, because there are many poems which were published in the book of poetic movement, New Lines. This movement was started in 1950, against the unreasonable, inflated and extortionate romanticism of 1930's and 1940's. The common features of movement poetry are; the use of irony and wit, an element of satire, the loneliness of modern man, pessimistic outlook on life, realism, use of ordinary diction, use of symbols, and loss of religious faith. Robert Conquest is known as the representative poet of this movement. The poets of this movement believed that the language of poetry should be simple, lucid and intelligible. The poem Ambulance deals with the important features of movement poetry. Through the stylistics study of this poem the researchers will show the loneliness and concept of death in modern man.
Küpper, Thomas E; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline
Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft - or with the doors opened while the engines are running - must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.
Lee, John D
The rapid evolution of computing, communication, and sensor technology is likely to affect young drivers more than others. The distraction potential of infotainment technology stresses the same vulnerabilities that already lead young drivers to crash more frequently than other drivers. Cell phones, text messaging, MP3 players, and other nomadic devices all present a threat because young drivers may lack the spare attentional capacity for vehicle control and the ability to anticipate and manage hazards. Moreover, young drivers are likely to be the first and most aggressive users of new technology. Fortunately, emerging technology can also support safe driving. Electronic stability control, collision avoidance systems, intelligent speed adaptation, and vehicle tracking systems can all help mitigate the threats to young drivers. However, technology alone is unlikely to make young drivers safer. One promising approach to tailoring technology to teen drivers is to extend proven methods for enhancing young driver safety. The success of graduated drivers license programs (GDL) and the impressive safety benefit of supervised driving suggest ways of tailoring technology to the needs of young drivers. To anticipate the effects of technology on teen driving it may be useful to draw an analogy between the effects of passengers and the effects of technology. Technology can act as a teen passenger and undermine safety or it can act as an adult passenger and enhance safety. Rapidly developing technology may have particularly large effects on teen drivers. To maximize the positive effects and minimize the negative effects will require a broad range of industries to work together. Ideally, vehicle manufacturers would work with infotainment providers, insurance companies, and policy makers to craft new technologies so that they accommodate the needs of young drivers. Without such collaboration young drivers will face even greater challenges to their safety as new technologies emerge.
Kataoka, Hiroaki; Mochimasu, Kazumi Dokai; Katayama, Akihiko; Kanda, Kanae Oda; Sakano, Noriko; Tanaka, Keiko; Miyatake, Nobuyuki
The aim of this study was to investigate the linkage among climate parameters, total ambulance transports and the number of deaths in Asahikawa City in northern Japan. Monthly data on total ambulance transports and the number of deaths from January 2004 to December 2011 were obtained from Asahikawa City Fire Department and the Asahikawa City official website. Climate parameters for the required period were also obtained from the Japan Meteorological Agency, Japan. To adjust for the population, we also used monthly population data on Asahikawa City. The linkage among climate parameters, total ambulance transports and the number of deaths was evaluated by ecological analysis. The mean air temperature in the Asahikawa area was 7.3 ± 10.1 °C. Total ambulance transports (/a hundred thousand people/day) and the number of deaths (/a hundred thousand people/day) were 10.0 ± 0.6 and 2.6 ± 0.3, respectively. Using quadratic curves, total ambulance transports and the number of deaths were weakly correlated with some climate parameters. The number of deaths was weakly and positively correlated with total ambulance transports. A weak linkage among climate parameters, total ambulance transports and the number of deaths was noted in Asahikawa City, Japan. However, these associations were not as high as expected.
Department of Transportation — Information regarding individuals who have had their driver licenses revoked, suspended or otherwise denied for cause, or who have been convicted of certain traffic...
On 19 April the Fire Brigade unveiled its latest acquisition: a brand-new ambulance specially designed for CERN. One of the Fire Brigade's two ambulances has just been replaced by a state-of-the-art vehicle tailor-made to meet CERN's unique requirements. At 4.6 metres long it's much more spacious than its predecessors, providing plenty of room for patient, doctor and paramedic. The ambulance's design and manufacture are the result of a successful collaboration between the Fire Brigade and the technicians from Profile Vehicles, the Finnish company that won the contract following a call for tenders launched in June 2011. "It took us six months to finalise the specification for our new ambulance," explains Patrick Berlinghi, who is responsible for the Fire Brigade's logistics. "We wanted it to be spacious enough for us to be able to work comfortably and to have the latest safety and patient care equipment. We also reques...
Discussion: This multicentre randomised study will be the first to test whether a home-based multi-component physiotherapy intervention targeting specific precursors of community ambulation (PUSH is more likely to lead to community ambulation than a home-based non-specific multi-component physiotherapy intervention (PULSE in older adults after hip fracture. The study will also estimate the potential economic value of the interventions.
Dr. Shantanu K. Dixit; Miss. Ashwini A. Joshi
Proposed paper presents design of such a monitoring system for emergency patient transportation employing ARM 7 processor module. The system will be useful for monitoring ambulance location using Google map. It also include biomedical sensors to monitor heart bit rate and temperature of patient through SMS. The front end application at the monitoring system is developed using visual basic software in Personal Computers. It can display location of ambulance and status of heart ...
Valenzuela Espinoza, Alexis; Devos, Stefanie; van Hooff, Robbert-Jan; Fobelets, Maaike; Dupont, Alain; Moens, Maarten; Hubloue, Ives; Lauwaert, Door; Cornu, Pieter; Brouns, Raf; Putman, Koen
Background Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambu...
Wong, Ho-Ting; Lai, Poh-Chin
The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.
Brown, Lawrence H; Chaiechi, Taha; Buettner, Petra G; Canyon, Deon V; Crawford, J Mac; Judd, Jenni
To evaluate the impact of changing energy prices on Australian ambulance systems. Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Perilli, Viviana; Oliva, Doretta; Buono, Serafino
Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area. Copyright © 2014 Elsevier Ltd. All rights reserved.
Brookhuis, K.A.; De Waard, D.; Fairclough, S.H
Most traffic accidents can be attributed to driver impairment, e.g. inattention, fatigue, intoxication, etc. It is now technically feasible to monitor and diagnose driver behaviour with respect to impairment with the aid of a limited number of in-vehicle sensors. However, a valid framework for the
Full Text Available Objectives: To assess walking ability of spinal cord injury (SCI patients and observe its correlation with functional and neurological outcomes. Patients and Methods: The present prospective, observational study was conducted in a tertiary research hospital in India with 66 patients (46 males between January 2012 and December 2013. Mean age was 32.62 ± 11.85 years (range 16-65 years, mean duration of injury was 85.3 ± 97.6 days (range 14-365 days and mean length of stay in the rehabilitation unit was 38.08 ± 21.66 days (range 14-97 days in the study. Walking Index for spinal cord injury (WISCI II was used to assess ambulation of the SCI patients. Functional recovery was assessed using Barthel Index (BI and Spinal Cord Independence Measures (SCIM. Neurological recovery was assessed using ASIA impairment scale (AIS. We tried to correlate ambulatory ability of the patients with functional and neurological recovery. Results: Ambulatory ability of the patients improved significantly using WISCI II (P < 0.001 when admission and discharge scores were compared (1.4 ± 3.5 vs 7.6 ± 6.03. Similarly, functional (BI: 31.7 ± 20.5 vs 58.4 ± 23.7 and SCIM: 29.9 ± 15.1 vs 56.2 ± 20.6 and neurological recovery were found to be very significant (P < 0.001 when admission vs discharge scores were compared. Improvement in WISCI II scores was significantly correlated with improvement in neurological (using AIS scores and functional status (using BI and SCIM scores (P < 0.001. Conclusions: Significant improvement was seen in WISCI II, BI, and SCIM scores after in-patient rehabilitation. Improvement in WISCI II scores also significantly correlated with functional and neurological recovery.
Branas, C C; MacKenzie, E J; ReVelle, C S
To develop a mathematical model for the location of trauma care resources. Severely injured patients queried from Maryland hospital discharge and vital statistics data. A spatial injury profile was created by parsing these patients into ZIP codes. The Trauma Resource Allocation Model for Ambulances and Hospitals (TRAMAH) was formulated using integer and heuristic programming. To maximize coverage of severely injured patients, trauma centers and aeromedical depots were simultaneously sited using TRAMAH. A severe injury was considered covered if at least one trauma center was sited within a time standard by ground, or if an aeromedical depot-trauma center pair was sited in such a way that the sum of the flying time from the aeromedical depot to the scene of injury plus the flying time from the scene of injury to the trauma center was within the same time standard. From 1992 to 1994, 26,774 severe injuries were considered for coverage. Across Maryland, 94.8 percent of severely injured residents had access to trauma system resources within 30 minutes and 70.3 percent had access within 15 minutes. For the same number of resources as the existing Maryland Trauma System, TRAMAH achieved a coverage objective of 99.97 percent within 30 minutes. This translated into an additional 461 severely injured people covered each year. Holding in place the trauma centers of the existing system, approximately the same percentage of coverage as that of the existing system was achieved within 15 minutes by optimally locating six fewer aeromedical depots. TRAMAH will allow trauma systems planners to better locate their resources with respect to spatial needs and response times.
Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis
Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P
Objective The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety. What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear
, the antecedents of collaborative advantage are theoretically examined, and the organizational competences contributing to collaborative success are identified. The conclusion is that operational processes and social dynamics are vital drivers of collaborative advantage. Another significant conclusion...
Existing traffic analysis and management tools do not model the ability of drivers to recognize their environment and respond to it with behaviors that vary according to the encountered driving situation. The small body of literature on characterizin...
The general oilfield driver improvement (GODI) course was discussed. The course is offered to truckers in the oil and gas industry to help reduce accidents and injuries. Oilfield trucking is one of the most accident and injury prone sectors in the Alberta economy. This paper presented Heck's Trucking company's experience in sending its employees on the course. Drivers were taught (1) the National safety code requirements, (2) Commercial Vehicle Safety Alliance requirements, (3) occupational health and safety concerns, (4) vehicle dimension and GVW restrictions, (5) hours of service regulations, (6) log book and pre-trip inspection requirements, (7) workplace hazardous material information, and (8) transportation of dangerous goods. Overall, the course was judged to provide excellent training before sending drivers into the field. The employee, the customer, and the company, all stand to benefit from having rigorous and uniform standards for all drivers in the oil and gas industry
Randomly selected drivers were stopped at times and places of previous fatal crashes in Lincoln, Nebraska, and Dade County (Miami), Florida. Breath, urnine, blood, and lip swab samples were requested, for later analysis for drugs and medications. A c...
Incorporating technology through online courses, including drivers education (DE), is the wave of the future for : learning. While many states allow online DE as an accepted method of learning, Wisconsin currently only allows it on a : limited bas...
Arnold, W.; Bowen, S.; Cohen, S.; Fine, K.; Kaplan, D.; Kolm, M.; Kolm, H.; Newman, J.; Oneill, G. K.; Snow, W.
The last of a series of three papers by the Mass-Driver Group of the 1977 Ames Summer Study is presented. It develops the engineering principles required to implement the basic mass-driver. Optimum component mass trade-offs are derived from a set of four input parameters, and the program used to design a lunar launcher. The mass optimization procedures is then incorporated into a more comprehensive mission optimization program called OPT-4, which evaluates an optimized mass-driver reaction engine and its performance in a range of specified missions. Finally, this paper discusses, to the extent that time permitted, certain peripheral problems: heating effects in buckets due to magnetic field ripple; an approximate derivation of guide force profiles; the mechanics of inserting and releasing payloads; the reaction mass orbits; and a proposed research and development plan for implementing mass drivers.
Ragnhild J. DAVIDSE
Next, based on the available literature, relevant ADAS are discussed in terms of their availability, their effects on safety and the willingness of older drivers to use and buy them. One of the conclusions is that only very few of the types of support that are thought to be most beneficial to the safety of older drivers are provided by the ADAS that are currently available.
Prokoski, Francine J.
Carjackings are only one of a growing class of law enforcement problems associated with increasingly violent crimes and accidents involving automobiles plays weapons, drugs and alcohol. Police traffic stops have become increasingly dangerous, with an officer having no information about a vehicle's potentially armed driver until approaching him. There are 15 million alcoholics in the US and 90 percent of them have drivers licenses. Many of them continue driving even after their licenses have ben revoked or suspended. There are thousands of unlicensed truck drivers in the country, and also thousands who routinely exceed safe operating periods without rest; often using drugs in an attempt to stay alert. MIKOS has developed the Drivers License Display Systems to reduce these and other related risks. Although every state requires the continuous display of vehicle registration information on every vehicle using public roads, no state yet requires the display of driver license information. The technology exists to provide that feature as an add-on to current vehicles for nominal cost. An initial voluntary market is expected to include: municipal, rental, and high value vehicles which are most likely to be mis-appropriated. It is anticipated that state regulations will eventually require such systems in the future, beginning with commercial vehicles, and then extending to high risk drivers and eventually all vehicles. The MIKOS system offers a dual-display approach which can be deployed now, and which will utilize all existing state licenses without requiring standardization.
Bates, Lyndel J.; Allen, Siobhan; Armstrong, Kerry; Watson, Barry; King, Mark J.; Davey, Jeremy
Graduated driver licensing (GDL) aims to gradually increase the exposure of new drivers to more complex driving situations and typically consists of learner, provisional and open licence phases. The first phase, the learner licence, is designed to allow novice drivers to obtain practical driving experience in lower risk situations. The learner licence can delay licensure, encourage novice drivers to learn under supervision, mandate the number of hours of practice required to progress to the next phase and encourage parental involvement. The second phase, the provisional licence, establishes various driving restrictions and thereby reduces exposure to situations of higher risk, such as driving at night, with passengers or after drinking alcohol. Parental involvement with a GDL system appears essential in helping novices obtain sufficient practice and in enforcing compliance with restrictions once the new driver obtains a provisional licence. Given the significant number of young drivers involved in crashes within Oman, GDL is one countermeasure that may be beneficial in reducing crash risk and involvement for this group. PMID:25364543
This study examined the driver licensing procedures in all 50 States as they apply to the older (65+) driver. A literature review examined reports of possible declines in older driver capabilities and the ability of a driver licensing agency to scree...
Deakin, Charles D; England, Simon; Diffey, Debbie; Maconochie, Ian
Most out-of-hospital paediatric cardiac arrests (CA) are not identified until a call is made to the emergency medical services. Accurate identification increases overall survival by enabling immediate ambulance dispatch and delivery of bystander CPR. European ambulance services use a variety of didactic telephone scripts to interrogate the caller and rapidly identify paediatric CA. The performance of these scripts has not been reported. This study aims to evaluate the diagnostic accuracy of the NHS Pathways as a telephone triage tool to identify patients less than 16 years age in cardiac arrest. All emergency calls to South Central Ambulance Service (SCAS) over a 12-month period screened by 'NHS Pathways' v9.04 were identified. All actual or presumed paediatric CAs (telephone triage system for identifying CA. Further work is required to refine telephone triage pathways for paediatric cardiac arrest. Copyright © 2017 Elsevier B.V. All rights reserved.
Heightman, A J
You can see and hear more about my journey throughout Germany and England in a special, archived, free Webcast on jems.com. And in future articles, videos and Web presentations, you'll see and learn about the different EMS delivery models I saw, the men and women whom I met and rode with on calls, and, most importantly, their impressive attitude about patient care, customer service and safety. Progressive American and Canadian ambulance manufacturers now agree with safety experts and forward-thinking ambulance operators that the squad bench is dead. These manufacturers now offer innovative seats that are much safer and functional than those coffin-like obstructions that gobbled up so much space in our rigs for the past three decades. Design your next ambulance around the needs and safety of your crews and their patients, and spec a patient compartment that is laid out logiclaly and efficient.
Sehnaz Akın Paker
Full Text Available Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED. Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322 of the patients that were transported by physicians and 92.4% (n = 73 of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3% had cardiopulmonary resuscitation (CPR, one (20% was intubated, one (20% received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5% had spinal board. Cervical collar usage was 65.1% (n = 69 We have revealed that 316 (69.3% patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care
Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E
Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore/preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under IRB waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from 8/2008-3/2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression due to metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre- and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS], and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed-rank tests, Pearson correlation coefficient, Cox regression model, log rank analysis, and Kaplan Meir analysis. 40 patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21/40) survived and 43% (17/40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89, although Kaplan Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=0.0342, p=0.0358, respectively) and postoperative KPS (p=0.0221). Tokuhashi score was not significantly related to duration of
Raun, L H; Ensor, K B; Campos, L A; Persse, D
Asthma is a serious, sometimes fatal condition, in which attacks vary in severity, potentially requiring emergency medical services (EMS) ambulance treatment. A portion of asthma attacks requiring EMS ambulance treatment may be prevented with improved education and access to care. The aim of this study was to identify areas of the city with high rates of utilization of EMS ambulance for treatment, and the demographics, socio-economic status, and time of day associated with these rates, to better target future interventions to prevent emergencies and reduce cost. A cross-sectional study was conducted on individuals in Houston, TX (USA) requiring ambulance treatment for asthma attacks from 2004 to 2011. 12,155 EMS ambulance-treated asthma attack cases were linked to census tracts. High rate treatment areas were identified with geospatial mapping. Census tract demographic characteristics of these high rate areas were compared with the remainder of the city using logistic regression. The association between case level demographics and the time of day of asthma attack within the high rate area was also assessed with logistic regression. EMS ambulance-treated high rate areas were identified and found to have a utilization incidence rate over six times higher per 100,000 people than the remainder of the city. There is an increased risk of location in this high rate area with a census tract level increase of percent of population: earning less than $10,000 yearly income (RR 1.21, 1.16-1.26), which is black (RR 1.08, 1.07-1.10), which is female (RR 1.34, 1.20-1.49) and have obtained less than a high school degree (RR 1.02, 1.01-1.03). Within the high rate area, case level data indicates an increased risk of requiring an ambulance after normal doctor office hours for men compared with women (RR 1.13, 1.03-1.22), for black compared with Hispanic ethnicity (RR 1.31, 1.08-1.59), or for adults (less than 41 and greater than 60) compared with children. Interventions to prevent
These principles have been applied to our air ambulance system based from Lanseria International Airport. By combining preventative and control measures, there has been no breach in our infection control strategies, as evidenced by no growth noted on specific and random swabs even when more and more ”super bugs” are being identified in hospital. As an air ambulance service flying patients from various African countries, we have the responsibility to conduct our own ”Border Security” to keep our hospitals, patients, aircraft and crews clean and safe. In this presentation we will share our ”Border Security” principles and experiences with the audience.
Dieperink, Willem; Weelink, E. E. M.; van der Horst, I. C. C.; de Vos, R.; Jaarsma, T.; Aarts, L. P. H. J.; Zijlstra, F.; Nijsten, M. W. N.
Background: Early initiation of continuous positive airway pressure (CPAP) applied by face mask benefits patients with acute cardiogenic pulmonary oedema (ACPE). The simple disposable Boussignac CPAP (BCPAP) has been used in ambulances by physicians. In the Netherlands, ambulances are manned by
Wihlborg, Jonas; Edgren, Gudrun; Johansson, Anders; Sivberg, Bengt
The Swedish ambulance health care services are changing and developing, with the ambulance nurse playing a central role in the development of practice. The competence required by ambulance nurses in the profession remains undefined and provides a challenge. The need for a clear and updated description of ambulance nurses' competence, including the perspective of professional experiences, seems to be essential. The aim of this study was to elucidate ambulance nurses' professional experiences and to describe aspects affecting their competence. For data collection, the study used the Critical Incident Technique, interviewing 32 ambulance nurses. A qualitative content analysis was applied. This study elucidates essential parts of the development, usage and perceptions of the competence of ambulance nurses and how, in various ways, this is affected by professional experiences. The development of competence is strongly affected by the ability and possibility to reflect on practice on a professional and personal level, particularly in cooperation with colleagues. Experiences and communication skills are regarded as decisive in challenging clinical situations. The way ambulance nurses perceive their own competence is closely linked to patient outcome. The results of this study can be used in professional and curriculum development. Copyright © 2016 Elsevier Ltd. All rights reserved.
Nabeyama, Bobby; Sturmey, Peter
The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when staff taught new students.
Nabeyama, Bobby; Sturmey, Peter
The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when…
Jacobs, Bart; Men, Cheanrithy; Sam, Oeun Sam; Postma, Sjoerd
Emergency referral care is considered an essential component of the district health system. Nevertheless, the establishment of effective and durable transport arrangements of such referral care by use of an ambulance is considered controversial in low-income countries. We aim to assess the extent to which an ambulance service as part of the district health system is feasible in rural Cambodia. In a rural health district, we assessed the population's perception of the ambulance service, its recurrent costs requirements, government financial contribution to its operations, profile and medical conditions of ambulance (non)users, reasons for (non)use of the ambulance and contextual factors required for the ambulance services to operate. This observation was obtained through nine key informant interviews, five focus group discussions, structured interviews with 225 caretakers of admitted patients, a 1-month census of admitted emergency cases and assessment of annual recurrent costs for the ambulance services. The ambulance services were well received by the population and authorities and appeared to reinforce an appreciation of the hospital. Ambulance services were mainly used by the poor and by women, especially for emergency obstetric care. Less than half the number of transported patients, 44%, was considered a medical emergency. The direct cost to the hospital per collected emergency case was $34.4. When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I
The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.
Schoenmakers, MAGC; Gulmans, VAM; Gooskens, RHJM; Pruijs, JEH; Helders, PJM
The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at
Simpson, Paul M; Bendall, Jason C; Patterson, Jillian; Tiedemann, Anne; Middleton, Paul M; Close, Jacqueline Ct
To quantify the size and scope of the operational burden for a large ambulance service arising from older people who have fallen and to describe this population. Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as 'falls' in the period 1 July 2008 to 30 June 2009. There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76-87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-1.9) and on weekends (OR 1.06, 95%CI 1.0-1.1). Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.
Schull, Michael J.; Morrison, Laurie J.; Vermeulen, Marian; Redelmeier, Donald A.
Objective Emergency department overcrowding sometimes results in diversion of ambulances to other locations. We sought to determine the resulting prehospital delays for cardiac patients. Methods Data on consecutive patients with chest pain who were transported to Toronto hospitals by ambulance were obtained for a 4-month period in 1997 and a 4-month period in 1999, which represented periods of low and high emergency department overcrowding respectively. Multivariate analyses were used to model 90th percentile system response (initiation of 9-1-1 call to arrival on scene), on-scene (arrival on scene to departure from scene) and transport (departure from scene to arrival at hospital) intervals. Predictor variables were study period (1997 or 1999), day of the week, time of day, geographic location of the patient, dispatch priority, case severity, return priority and number of other patients with chest pain transported within 2 hours of the index transport. Results A total of 3609 patients (mean age 66.3 years, 50.3% female) who met the study criteria were transported by ambulance during the 2 study periods. There were no significant differences in patient characteristics between the 2 periods, despite the fact that more patients were transported during the second period (p overcrowding in emergency departments was associated with a substantial increase in the system response interval and the ambulance transport interval for patients with chest pain. PMID:12566332
Nilsson, Tomas; Lindström, Veronica
Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home. The ambulance service provides a learning environment where the students face a multifaceted picture of health and illness. This learning environment helps nursing students to learn independently how to use professional nursing skills and how to care by employing a holistic approach. However, further research is needed to explore if and how this knowledge about nursing and caring in the ambulance service is useful when working as a Registered Nurse in other health care settings. Copyright © 2017 Elsevier Ltd. All rights reserved.
Ambulance Services of Lagos State, Nigeria: A Six-Year (2001–2006) Audit. ... The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government ... Analysis of the data was done using the Microsoft Excel software. RESULTS: A ...
Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran
Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p prosthesis systems may be feasible.
It would be in the interest of the patient if a sound working relationship between pre-hospital, hospital and private medical practitioners could be established and that each group becomes familiar with the capabilities of the other. It is equally important that ambulance personnel be welcomed into the health profession of ...
Cuijpers, N.; Brown, P.R.
Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the
Ten Duis, K.; Bosmans, J. C.; Voesten, H. G. J.; Geertzen, J. H. B.; Dijkstra, P. U.
The aim of this study was to analyze survival, wound healing and ambulation after knee disarticulation (KD). A historic cohort study using medical records and nursing home records was performed. Data included demographics, reason for amputation, concomitant diseases, survival, wound healing,
Ackermann, Ole [Wedau-Kliniken Duisburg (Germany). Klinik fuer Unfallchirurgie; Ruchholtz, Steffen [Universitaetsklinikum Giessen und Marburg GmbH, Marburg (Germany). Klinik fuer Unfall-, Hand- und Wiederherstellungschirurgie; Siemann, Holger [LVR Klinikum Essen (Germany); Barkhausen, Joerg [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin
The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.
Nijmeijer, Rachelle; Voesten, Henricus G. J. M.; Geertzen, Joannes H. B.; Dijkstra, Pieter U.
OBJECTIVE: This study analyzed survival of the amputee patients, wound healing, and ambulation after knee disarticulation (KD). METHODS: Between July 1989 and October 2015, 153 KDs in 138 patients were performed at Nij Smellinghe Hospital, Drachten. Data were retrieved from hospital medical records.
Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad
After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma. None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography.
Ali Akbar Abdollahi
Full Text Available Introduction: After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. Methods: In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol, early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS of pain and Kristin Swain’s check list was applied to evaluate the severity of bleeding and hematoma. Results: None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference.Conclusion: Based on the findings of this study, changing patients’ position can be safe and they can be ambulated early after angiography.
Full Text Available conditions and traffic volumes. To support spatial planning and provide input to the Integrated Development Plan of the City of Tshwane, a GIS based analysis of ambulance response time was undertaken. The purpose was to make recommendations aimed...
Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.
Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (pmetabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038
van de Port, Ingrid G.; Kwakkel, Gert; Lindeman, Eline
Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke
van de Port, I.; Kwakkel, G.; Lindeman, E.
Objective: To explore the strength of the association between gait speed and community ambulation and whether this association is significantly distorted by other variables. Design: Cross-sectional study conducted 3 years after stroke. Subjects: A total of 102 patients after first-ever stroke
Mulder, L. J. M.; Dijksterhuis, C.; Stuiver, A.; de Waard, D.
Adaptive support has the potential to keep the operator optimally motivated, involved, and able to perform a task. in order to use such support, the operator's state has to be determined from physiological parameters and task performance measures. In an environment where the task of an ambulance
van Halteren, Aart; Konstantas, D.; Bults, Richard G.A.; Wac, K.E.; Dokovski, N.T.; Koprinkov, G.T.; Jones, Valerie M.; Widya, I.A.; Demiris, G.
The wide availability of high bandwidth public wireless networks as well as the miniaturisation of medical sensors and network access hardware allows the development of advanced ambulant patient monitoring systems. The MobiHealth project developed a complete system and service that allows the
To describe motor development toward ambulation in children with myelomeningocele. Forty-three children were followed prospectively from 6 months to 6 years of age. Walking function had been achieved at the 1-year follow-up in 2 of 38 children, at the 1.5-year follow-up in 7 of 39, at the 2-year follow-up in 14 of 36, at the 3-year follow-up in 21 of 28, at the 4-year follow-up in 28 of 36, and at the 6-year follow-up in 30 of 38. At the 6-year follow-up, spasticity was present in 22 of 38 children, 42 of 43 used orthoses, and 9 children had not achieved ambulation expected with respect to muscle function. In children with myelomeningocele, walking starts in some during the first year of life and is seen increasingly more frequently until 6 years of age. Motor development before ambulation varies among children with similar muscle function. An increased incidence of spasticity is found among those not having achieved ambulation with respect to muscle function.
Results: The median total, indirect and direct annual costs to rural ambulating HIV/AIDS patients on HAART were estimated to be $US71.18 (115.16 Ghana cedis), $US2.740 (3.92 Ghana cedis) and $US53.04 (75.00 Ghana cedis) respectively. Conclusion: Although the cost of antiretroviral drugs has been subsidized by ...
Williams, Teresa A; Finn, Judith; Celenza, Antonio; Teng, Tiew-Hwa; Jacobs, Ian G
Acute pulmonary edema (APE) is a common cause of acute dyspnea. In the prehospital setting, it is often difficult to differentiate APE from other causes of shortness of breath (SOB). Radiography and echocardiography aid in the identification of APE but are often not available. There is little information on how accurately ambulance paramedics identify patients with APE. Objectives. This study aimed to 1) describe the prehospital clinical presentation and management of patients with a clinical diagnosis of APE and 2) compare the accuracy of coding of APE by paramedics against the emergency department (ED) medical discharge diagnosis. This study included a retrospective cohort of all patients who had episodes identified as APE by ambulance paramedics and were transported to a metropolitan hospital ED in 2011. Two databases were used: an ambulance database and the Emergency Department Information System. The ED medical discharge diagnosis (using International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian Modification [ICD-10-AM] codes) was used as the comparator with paramedic-assigned problem codes for APE. The outcomes for the study were the positive predictive value, i.e., the proportion of patients identified as having APE in the ambulance database who also had an ED discharge diagnosis of APE, and the sensitivity of paramedic identification of APE, i.e., the proportion of patients with an ED discharge diagnosis of APE that were correctly identified as APE by the ambulance paramedics. Four hundred ninety-five patients were transported to an ED with APE identified by the paramedics as the primary problem code. Shortness of breath, crepitations, high systolic blood pressure, and chest pain were the most common presenting signs and symptoms. Pink frothy sputum was rare (3% of patient episodes of APE). One hundred eighty-six patients received an ED discharge diagnosis of APE, i.e., a positive predictive value of 41%. Of 631 ED
Ssebunya, Rogers; Matovu, Joseph K B
Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances
Teen drivers have the highest crash risk of any age group. Per mile traveled, they have the highest involvement rates in all types of crashes, from those involving only property damage to those that are fatal. The problem is worst among 16 year-olds,...
In 2010, about 150 driving simulators were being used for the basic driver training in the Netherlands. According to theories about how people learn, simulator training has both advantages and disadvantages. In order to be able to learn something from a simulator, its technical quality must be
New federal rules mandate drug and alcohol testing for all school district employees who are required to have a commercial driver's license. Describes the major elements of a testing program and the types of testing required. Recommends building support for the testing program by involving employee labor leaders, board members, and a cross-section…
Kathryn van Boom
N Rugbeer, 1 M Sport Science; N Neveling, 1 MSc Med;. T Sandla, 1 BTech Biokinetics. 1 Department of Sport, Rehabilitation and Dental Science, Tshwane. University of Technology, Pretoria, South Africa ... excessive stress along the kinetic chain and affect the driver's personal and social life. A study in Ghana revealed ...
Gray, Walter W.
Describes experimental Driver and Traffic Safety Education Center--a project involving a five-phase instructional program, a variety of teaching innovations, and a specially-constructed facility which includes a classroom building, multiple car driving range, simulators, communications equipment, and the most recent electronic teaching devices.…
Takegawa, Ryosuke; Ohnishi, Mitsuo; Hirose, Tomoya; Hatano, Yayoi; Imada, Yuko; Endo, Yoko; Shimazu, Takeshi
In cases of transport by rescue helicopter or ambulance of patients having ingested hazardous substances, medical personnel may be at a certain risk of inhaling the substances. However, few reports have addressed such risk of causing secondary casualties. This simulation study aimed to assess the risk of inhalation of hydrogen sulfide and chlo-opicrin in the cabin of a helicopter or an ambulance transporting a patient who has ingested calcium polysulfide or chloropicrin, which were previously reported to cause secondary casualties. Concentrations of hydrogen sulfide and chloropicrin were assessed on the following as-umptions :The patient ingested 100 mL of the causative or original chemical. All chemical substances reacted with the gastric juice or were thoroughly vomited and evaporated uniformly within the cabin space of the helicopter or ambulance. Environmental conditions were 20 *degrees at 1 atmosphere of pres-ure in a 5 m3 cabin volume in the helicopter and a 13.5 m3 cabin volume in the ambulance. In the case of calcium polysulfide ingestion which produced hydrogen sulfide, its concen-ration reached 774 ppm in the helicopter and 287 ppm in the ambulance. For chloropicrin ingestion, the concentrations were 4,824 ppm and 1,787 ppm, respectively. The simulated concentration of hydrogen sulfide was more than 500 ppm in the heli-opter, which may lead to respiratory paralysis and death. The simulated concentration of chloropicrin was more than 300 ppm, which has a risk of death within 10 minutes. Currently, as far as Japanese laws are concerned, there are no restrictions requiring pretransport assessment or setting criteria for transporting patients who might have ingested hazardous substances that could cause secondary casu-lties when vomited. When patients who might have ingested hazardous chemicals are transported, it is important to recognize the risk of causing secondary casualties by vomiting the chemicals.
Yun, Jong Geun; Jeung, Kyung Woon; Lee, Byung Kook; Ryu, Hyun Ho; Lee, Hyoung Youn; Kim, Mu Jin; Heo, Tag; Min, Yong Il; You, Yeonho
The available data suggest that automated external defibrillators (AED) can be safely used in vibration-like moving conditions such as rigid inflatable boats and aircraft environments. However, little literature exists examining their performance in a moving ambulance. The present study was undertaken to determine whether an AED is able to analyse the heart rhythm correctly during ambulance transport. An ambulance was driven on paved (20-100 km/h) and unpaved (10 km/h) roads. The performance of two AED devices (CU ER 2, CU Medical Systems Inc., Korea, and Heartstart MRx, Phillips, USA) was determined in a moving ambulance using manikins. Vibration intensity was measured simultaneously with a digital vibrometer. AED performance was then evaluated again on manikins and on a swine model under simulated vibration intensities (0.5-5m/s(2)) measured by the vibrometer in the previous phase of the investigation. The vibration intensity increased with increasing speeds on paved roads (1.98+/-0.44 m/s(2) at 100 km/h). While driving on unpaved roads, it increased to 6.40+/-1.06 m/s(2). Both AED algorithms analysed the heart rhythm correctly under resting state. When tested on pigs, both algorithms showed substantially degraded performances, even at low vibration intensities of 0.5-1m/s(2), which corresponded to vibration intensities while driving on paved roads at 20-60 km/h. This study also showed that electrocardiograms generated on manikins were more resistant to motion artifacts than were the pig electrocardiograms. Ambulance personnel should consider the possibility of misinterpretation by an AED when this device is used while transporting a patient. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Thornes, John Edward; Fisher, Paul Anthony; Rayment-Bishop, Tracy; Smith, Christopher
Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.
Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick
U.K ambulance services assess patients with suspected stroke using the Face Arm Speech Test (FAST). The Recognition Of Stroke In the Emergency Room (ROSIER) tool has been shown superior to the FAST in identifying strokes in emergency departments but has not previously been tested in the ambulance setting. We investigated whether ROSIER use by ambulance clinicians can improve stroke recognition. Ambulance clinicians used the ROSIER in place of the FAST to assess patients with suspected stroke. As the ROSIER includes all FAST elements, we calculated a FAST score from the ROSIER to enable comparisons between the two tools. Ambulance clinicians' provisional stroke diagnoses using the ROSIER and calculated FAST were compared with stroke consultants' diagnosis. We used stepwise logistic regression to compare the contribution of individual ROSIER and FAST items and patient demographics to the prediction of consultants' diagnoses. Sixty-four percent of strokes and 78% of nonstrokes identified by ambulance clinicians using the ROSIER were subsequently confirmed by a stroke consultant. There was no difference in the proportion of strokes correctly detected by the ROSIER or FAST with both displaying excellent levels of sensitivity. The ROSIER detected marginally more nonstroke cases than the FAST, but both demonstrated poor specificity. Facial weakness, arm weakness, seizure activity, age, and sex predicted consultants' diagnosis of stroke. The ROSIER was not better than the FAST for prehospital recognition of stroke. A revised version of the FAST incorporating assessment of seizure activity may improve stroke identification and decision making by ambulance clinicians.
textabstractAnalysis of the strength of value drivers is crucial to understand their influence in the process of free cash flow generation. The paper addresses the issue of value driver measurement and ranking. The research reveals that, value drivers have similar pattern across industries.
Soriguera Marti, F.; Miralles Miquel, E.
This paper faces the human factor in driving and its consequences for road safety. It presents the concepts behind the development of a smartphone app capable of evaluating drivers’ performance. The app provides feedback to the driver in terms of a grade (between 0 and 10) depending on the aggressiveness and risks taken while driving. These are computed from the cumulative probability distribution function of the jerks (i.e. the time derivative of acceleration), which are measured using the smartphones’ accelerometer. Different driving contexts (e.g. urban, freeway, congestion, etc.) are identified applying cluster analysis to the measurements, and treated independently. Using regression analysis, the aggressiveness indicator is related to the drivers' safety records and to the probability of having an accident, through the standard DBQ - Driving Behavior Questionnaire. Results from a very limited pilot test show a strong correlation between the 99th percentile of the jerk measurements and the DBQ results. A linear model is fitted. This allows quantifying the safe driving behavior only from smartphone measurements. Finally, this indicator is translated into a normalized grade and feedback to the driver. This feedback will challenge the driver to train and to improve his performance. The phone will be blocked while driving and will incorporate mechanisms to prevent bad practices, like competition in aggressive driving. The app is intended to contribute to the improvement of road safety, one of the major public health problems, by tackling the human factor which is the trigger of the vast majority of traffic accidents. Making explicit and quantifying risky behaviors is the first step towards a safer driving. (Author)
Full Text Available Today’s automobiles leverage powerful sensors and embedded computers to optimize efficiency, safety, and driver engagement. However the complexity of possible inferences using in-car sensor data is not well understood. While we do not know of attempts by automotive manufacturers or makers of after-market components (like insurance dongles to violate privacy, a key question we ask is: could they (or their collection and later accidental leaks of data violate a driver’s privacy? In the present study, we experimentally investigate the potential to identify individuals using sensor data snippets of their natural driving behavior. More specifically we record the in-vehicle sensor data on the controllerarea- network (CAN of a typical modern vehicle (popular 2009 sedan as each of 15 participants (a performed a series of maneuvers in an isolated parking lot, and (b drove the vehicle in traffic along a defined ~ 50 mile loop through the Seattle metropolitan area. We then split the data into training and testing sets, train an ensemble of classifiers, and evaluate identification accuracy of test data queries by looking at the highest voted candidate when considering all possible one-vs-one comparisons. Our results indicate that, at least among small sets, drivers are indeed distinguishable using only incar sensors. In particular, we find that it is possible to differentiate our 15 drivers with 100% accuracy when training with all of the available sensors using 90% of driving data from each person. Furthermore, it is possible to reach high identification rates using less than 8 minutes of training data. When more training data is available it is possible to reach very high identification using only a single sensor (e.g., the brake pedal. As an extension, we also demonstrate the feasibility of performing driver identification across multiple days of data collection
Full Text Available The characteristics of the driver are manifested in his/her behaviour. For safe driving one must have a driver's knowledge. The contents of educational material are determined by law, and are both theoretical and practical, yet frequently they do not suffice to meet the requirements of safe driving. In this paper, the author suggests that, in the training of drivers, more educational elements should be included, such a would have an effective influence on the driver's moti ves and attitudes. The driver's motives - which may result in incorrect driving are diverse: most often, the default is overspeeding, even though the drivers always over-estimate the potential time gain. In fact, over-fast driving is a way of satisfying other, different needs; and, above all, it is a form of compensation for unsettled life problems, and at the same time an indication of the driver's personal inability to cope with stress.
Anund, Anna; Ahlström, Christer; Fors, Carina; Åkerstedt, Torbjörn
Objective It is generally believed that professional drivers can manage quite severe fatigue before routine driving performance is affected. In addition, there are results indicating that professional drivers can adapt to prolonged night shifts and may be able to learn to drive without decreased performance under high levels of sleepiness. However, very little research has been conducted to compare professionals and non-professionals when controlling for time driven and time of day. Method The aim of this study was to use a driving simulator to investigate whether professional drivers are more resistant to sleep deprivation than non-professional drivers. Differences in the development of sleepiness (self-reported, physiological and behavioral) during driving was investigated in 11 young professional and 15 non-professional drivers. Results Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. In contradiction, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness. They also drove faster. The reason for the discrepancy in the relation between the different sleepiness indicators for the two groups could be due to more experience to sleepiness among the professional drivers or possibly to the faster speed, which might unconsciously have been used by the professionals to try to counteract sleepiness. Conclusion Professional drivers self-reported significantly lower sleepiness while driving a simulator than non-professional drivers. However, they showed longer blink durations and more line crossings, both of which are indicators of sleepiness, and they drove faster.
Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme. The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature-a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation. Cross-sectional. Community-dwelling older adults in the United States. Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a "Discrepancy Score" (measure of gap between speed and endurance) amongst those with gait speeds speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health. Research should continue to investigate how to optimize SRM.
van Bergen, Leo
The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.
Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis
Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne
We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration. We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction. We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P introduction was noticed, reflecting adaptation process to a new way of working.
Jenstrup, M T; Jæger, P; Lund, J
Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...... hypothesized that the adductor-canal-blockade may reduce morphine consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with placebo....
Our attention has focused on the choice of a relevant work. It concerns an implemented and conceived service of medical Teleassistance for monitoring risky persons brought by ambulance service. Thus, a medical bulletin is automatically filled on mobile terminal, immediately transmitted to the service of the emergency (on doctors mobile terminal, data base of clinic). This paper recalls a complete architecture of an economic wireless transmission system with the implementation of an effective ...
Mort, Alasdair J.; Fitzpatrick, David; Wilson, Philip M. J.; Mellish, Chris; Schneider, Anne
The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth? Low Energy protocol. Sensor data were ...
Gjersing, Linn; Bretteville-Jensen, Anne Line
To assess whether people who inject drugs (PWID) and who are treated for overdose by ambulance services have a greater mortality risk compared with other PWID, and to compare mortality risk within potentially critical time-periods (1 week, 1 month, 3 months, 6 months, 1 year, 5 years) after an overdose attendance with the mortality risk within potentially non-critical time-periods (time before and/or after critical periods). A prospective cohort study. Oslo, Norway. A total of 172 PWID street-recruited in 1997 and followed-up until the end of 2004. Interview data linked to data from ambulance records, Norwegian Correctional Services, Opioid Substitution Treatment records and National Cause of Death Registry. Separate Cox regression models (one for each critical time-period) were estimated. Ambulance services treated 54% of the participants for an overdose during follow-up. The mortality rate was 2.8 per 100 person-years for those with an overdose and 3.3 for those without; the adjusted hazard ratio (HR) was 1.3 (95% CI = 0.6, 2.6, P = 0.482). Mortality risk was greater in all but the shortest critical time-period following ambulance attendance than in the non-critical periods. The mortality risk remained significantly elevated during critical periods, even when adjusted for total time spent in prison and substitution treatment. The HR ranged from 9.4 (95% CI = 3.5, 25.4) in the month after an overdose to 13.9 (95% CI = 6.4, 30.2) in the 5-year period. Mortality risk among people who inject drugs is significantly greater in time-periods after an overdose attendance than outside these time-periods. © 2015 Society for the Study of Addiction.
Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; J Gómez-Jiménez, Francisco; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis
To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.
Full Text Available The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the “First Person on Scene” Business and Technology Education Council (BTEC qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs, alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min. The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.
Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.
Holmberg, Mats; Fagerberg, Ingegerd; Wahlberg, Anna Carin
The aim of the study was to identify the types of knowledge that Swedish Emergency Medical Service (EMS) managers considered desirable in their Ambulance Clinicians. Emergency medical service managers are responsible for organisational tasking and in this are dependent on the knowledge possessed by their ambulance clinicians. It would therefore be of value to explore EMS managers' approach to this knowledge. A modified Delphi method in three rounds. In total thirty-six EMS managers participated, and twenty-four finished all three rounds. They were encouraged to rate each sub-category, and the ten with the highest mean were interdependently ranked in the final round. Five categories and twenty-six sub-categories emerged in the first round, covering knowledge related to; contextual aspects, medical and holistic assessments, formal education and organisational issues. Eventually, the sub-category 'Knowledge to assess the patient's situation from a holistic perspective' was the highest ranked, followed by 'Medical knowledge to assess and care for different diseases' and 'Knowledge to be able to care for critically ill patients'. Taken together the knowledge areas address essentially medical care, contextual aspects and nursing. The boundaries between these can sometimes be seen as elusive, calling for ambulance clinicians to balance these areas of knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.
Halpern, Janice; Maunder, Robert G; Schwartz, Brian; Gurevich, Maria
Ambulance workers are exposed to critical incidents that may evoke intense distress and can result in long-term impairment. Individuals who can regulate distress may experience briefer post-incident distress and fewer long-term emotional difficulties. Attachment research has contributed to our understanding of individual differences in stress regulation, suggesting that secure attachment is associated with effective support-seeking and coping strategies, and fewer long-term difficulties. We tested the effect of attachment insecurity on emotional distress in ambulance workers, hypothesizing that (1) insecure attachment is associated with symptoms of current distress and (2) prolonged recovery from acute post-critical incident distress, coping strategies and supportive contact mediate this relationship. We measured (1) attachment insecurity, (2) acute distress, coping and social contact following an index critical incident and (3) current symptoms of post-traumatic stress, depression, somatization and burnout and tested the hypothesized associations. Fearful-avoidant insecure attachment was associated with all current symptoms, most strongly with depression (R=0.38, pinsecurity was also associated with maladaptive coping, reduced social support and slower recovery from social withdrawal and physical arousal following the critical incident, but these processes did not mediate the relationship between attachment insecurity and current symptoms. These findings are relevant for optimizing post-incident support for ambulance workers. Copyright © 2011 John Wiley & Sons, Ltd.
Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Dan; Coster, Joanne; Siriwardena, A Niroshan
Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. The PPI event described in detail in this article focusses on the process of involving patients and public representatives in identifying, prioritizing and refining a set of outcome measures that can be used to support ambulance service performance measurement. To obtain public feedback on little known, complex aspects of ambulance service performance measurement. The event was codesigned and coproduced with the PhOEBE PPI reference group and PhOEBE research team. The event consisted of brief researcher-led presentations, group discussions facilitated by the PPI reference group members and electronic voting. Data were collected from eighteen patient and public representatives who attended an event venue in Yorkshire. The results of the PPI event showed that this interactive format and mode of delivery was an effective method to obtain public feedback and produced a clear indication of which ambulance performance measures were most highly favoured by event participants. The event highlighted valuable contributions the PPI reference group made to the design process, supporting participant recruitment and facilitation of group discussions. In addition, the positive team working experience of the event proved a catalyst for further improvements in PPI within the PhOEBE project. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
van Silfhout, L; Peters, A E J; Graco, M; Schembri, R; Nunn, A K; Berlowitz, D J
Retrospective study. To determine the accuracy of a previously described Dutch clinical prediction rule for ambulation outcome in routine clinical practice. Adult (⩾18 years) patients who were admitted to the Austin Hospital with a traumatic spinal cord injury between January 2006 and August 2014. Data from medical records were extracted to determine the score of the Dutch clinical ambulation prediction rule proposed by van Middendorp et al. in 2011. A receiver-operating characteristics (ROC) curve was generated to investigate the performance of the prediction rule. Univariate analyses were performed to investigate which factors significantly influence ambulation after a traumatic spinal cord injury. The area under the ROC curve (AUC) obtained during the current study (0.939, 95% confidence interval (CI) (0.892, 0.986)) was not significantly different from the AUC from the original Dutch clinical prediction model (0.956, 95% CI (0.936, 0.976)). Factors that were found to have a significant influence on ambulation outcome were time spent in the ICU, number of days hospitalised and injury severity. Age at injury initially showed a significant influence on ambulation however, this effect was not apparent after inclusion of the 24 patients who died due to the trauma (and therefore did not walk after their injuries). The Dutch ambulation prediction rule performed similarly in routine clinical practice as in the original, controlled study environment in which it was developed. The potential effect of survival bias in the original model requires further investigation.
Major differences between fusion drivers and traditional accelerators include the following. The final beam current needed (/approximately/20 kA in a short pulse) is very much larger for a driver; such beams are dominated by repulsive space-charge effects since, even at 10 GeV, the ions are non-relativistic (v/c = 0.3). Also, the optical quality of the beams (called emittance by accelerator people) must be extremely good to ensure a suitably small focal spot at the pellet. Two schemes, one with a rf linac and storage rings, the other with a single-pass current-amplifying induction linac, are under study, the latter exclusively in the US. The induction linac approach lends itself to an examination in a sequence of scaled-down laboratory experiments since the most difficulties are expected to occur at the low energy end. Experiments and simulation have centered on a study of the transverse and longitudinal control of space-charge-dominated beams which are best described in terms of a non-neutral plasma rather than the traditional single-particle dynamics picture. An understanding of the high-current instability limits is required for arriving at a safe driver design. The final on-target beam current is so high that it must be carried in 16 separate focusing channels leading into the combustion chamber. While the energy deposition of the ions is expected to be entirely classical, there is a wealth of plasma physics phenomena to be explored (by theory and simulation) in the final propagation of these beams through the low-density gas in the chamber and in the environment of the hot target; it is important that none of these could result in a significant portion of the beam missing the focal spot. 13 refs., 9 figs., 1 tab
on the empirical material, the paper proposes a ‘driver’ model for context sensitive research of innovation in welfare workplaces. The model involves three elements which can be regarded as drivers for innovation: i) craft (i.e. professional skills and knowledge), ii) levers (i.e. experiments and adjustment......Innovation has become a key goal towards which teaching and workplace learning needs to be directed. Now perceived as germane and even necessary in almost all kinds of welfare work, the innovation potential in everyday practices and ways of allowing for employer creativity have become a highly...
YOUNG, K; SALMON, P; REGAN MICHAEL, M
There is converging evidence that driver distraction is a contributing factor in car crashes, in Australia and overseas. Surprisingly, no known previous research has attempted to identify and assess the potentially distracting activities undertaken by the drivers of public passenger vehicles. This paper describes research undertaken on this issue. The research was partitioned into three phases: an analysis of the functions and tasks currently undertaken by public passenger vehicle drivers; th...
Olsen, R.N.; Untermyer, S. II; Miller, H.; Lung, J.
This paper discusses two new Random Drivers built by NNC. The smaller machine, Mini Random Driver, is designed to give high sensitivity for small samples (10 mg Pu). The larger machine, Jumbo Random Driver, is designed to assay material in large containers including 200 1 (55 gal) waste barrels and large filters. These systems can assay uranium or plutonium in either active or passive modes. A description of each instrument with calibration results is presented
Bielawska-Drózd, Agata; Cieślik, Piotr; Wlizło-Skowronek, Bożena; Winnicka, Izabela; Kubiak, Leszek; Jaroszuk-Ściseł, Jolanta; Depczyńska, Daria; Bohacz, Justyna; Korniłłowicz-Kowalska, Teresa; Skopińska-Różewska, Ewa; Kocik, Janusz
Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU)/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices - between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces), coagulase - negative Staphylococci (air and surfaces), Aspergillus and Penicillium genera (air and surfaces). The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup Med Environ Health 2017;30(4):617-627. This work is available in Open Access
Kotani, Kazuya; Ueda, Kayo; Seposo, Xerxes; Yasukochi, Shusuke; Matsumoto, Hiroko; Ono, Masaji; Honda, Akiko; Takano, Hirohisa
The elderly population has been the primary target of intervention to prevent heat-related illnesses. According to the literature, the highest risks have been observed among the elderly in the temperature-mortality relationship. However, findings regarding the temperature-morbidity relationship are inconsistent. This study aimed to examine the association of temperature with ambulance dispatches due to acute illnesses, stratified by age group. Specifically, we explored the optimum temperature, at which the relative health risks were found to be the lowest, and quantified the health risk associated with higher temperatures among different age groups. We used the data for ambulance dispatches in Fukuoka, Japan, during May and September from 2005 to 2012. The data were grouped according to age in 20-year increments. We explored the pattern of the association of ambulance dispatches with temperature using a smoothing spline curve to identify the optimum temperature for each age group. Then, we applied a distributed lag nonlinear model to estimate the risks of the 85th-95th percentile temperature relative to the overall optimum temperature, for each age group. The relative risk of ambulance dispatches at the 85th and 95th percentile temperature for all ages was 1.08 [95% confidence interval (CI): 1.05, 1.12] and 1.12 (95% CI: 1.08, 1.16), respectively. In comparison, among age groups, the optimum temperature was observed as 25.0°C, 23.2°C, and 25.3°C for those aged 0-19, 60-79, and ≥80, respectively. The optimum temperature could not be determined for those aged 20-39 and 40-59. The relative risks of high temperature tended to be higher for those aged 20-39 and 40-59 than those for other age groups. We did not find any definite difference in the effect of high temperature on ambulance dispatches for different age groups. However, more measures should be taken for younger and middle-aged people to avoid heat-related illnesses.
Full Text Available Objectives: Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. Material and Methods: The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. Results: The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices – between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces, coagulase – negative Staphylococci (air and surfaces, Aspergillus and Penicillium genera (air and surfaces. Conclusions: The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup
Full Text Available Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation.Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of "deep vein thrombosis", "pulmonary embolism", "venous thrombosis", "bed rest", "immobilization", "mobilization" and "ambulation". We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE, progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema.13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD -0.03, 95% CI -0.05∼ -0.02; Z = 1.24, p = 0.22; random effect model, Tau2 = 0.01. Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau2 = 0.04. Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies.Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb.
Sergei N. Drachev
Full Text Available Objectives. To assess daily variations in ambulance calls for cardiovascular diseases (CVDs, mental and behavioral disorders, and external causes in Arkhangelsk, Northwest Russia, in 2000–2008. Study design. A population-based study. Methods. Data about all ambulance calls during the years 2000–2008 were obtained from the Arkhangelsk ambulance station. Information about patient's gender, age, doctor's diagnosis according to International Classification of Diseases, 10th revision, and the date of call were recorded. Pearson's Chi-squared tests were used for comparing proportions of ambulance calls across the week for CVDs (I00-99, mental and behavioral disorders (F00-F99, and external causes (S00-T98, V01-Y98. The ratio of incidence of ambulance calls on Saturday, Sunday, and Monday versus the rest of week was also calculated. Results. There is a significant daily variation (p < 0.001 in calls for CVDs in men and women aged 18–59 and women aged 60 years and older, with increased numbers of calls on weekends and Mondays varying between 2 and 3% excess calls. For mental and behavioral disorders, a similar pattern was found in the age group of 18–59 year-olds. Ratios for the number of calls during weekends and Mondays vs. the rest of the week were 1.05 (95% CI: 1.02–1.08 among women and 1.02 (95% CI: 1.00–1.05 among men. For external causes, a significant variation and an increase in ambulance calls during Saturdays, Sundays, and Mondays from 4 to 17% excess calls was observed for both age and gender groups. Conclusions. The observed daily variations in ambulance calls with an increased number of calls on weekends and Mondays for CVDs, mental and behavioral disorders, and external causes may be associated with excessive alcohol consumption on the weekends. Further research using data on individual levels of alcohol consumption are warranted.
Abebe, Yonas; Dida, Tolesa; Yisma, Engida; Silvestri, David M
Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes. Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity. Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
Drawing upon extant alliance literature, this article substantiates the argument that we need to look beyond mere structural and formative aspects of cooperation in order to fully understand the performance antecedents of public-private partnerships. Currently, scholarly work on operational......, the antecedents of collaborative advantage are theoretically examined, and the organizational competences contributing to collaborative success are identified. The conclusion is that operational processes and social dynamics are vital drivers of collaborative advantage. Another significant conclusion...... is that public management research can benefit from drawing upon existing alliance research. Alliance scholars have during the past couple of decades accumulated an impressive amount of knowledge on different aspects of inter-firm cooperation, and therefore the learning potential for public management scholars...
Since company boards are increasingly discussing 'sustainability', it becomes necessary to examine the nature of sustainability drivers. Most approaches to corporate sustainability drivers have focused either on internal or external drivers. This paper is aimed at providing a more holistic
Since company boards are increasingly discussing 'sustainability', it becomes necessary to examine the nature of sustainability drivers. Most approaches to corporate sustainability drivers have focused either on internal or external drivers. This paper is aimed at providing a more holistic
Full Text Available Background: Stroke subjects face reduced tolerance to activity and sedentary lifestyle due to various impairments, such as muscle weakness, pain, spasticity, and poor balance. Thus, loss of independent ambulation especially outdoors is generally observed in them. Methods: Chronic stroke patients (> 6 months with Functional Ambulation Category score > 2 and able to walk at least 10 meters of distance with and without assistance from a tertiary healthcare centre were selected and treated. Subjects were randomly divided into 2 groups control group (n=14 and experimental group (n=13. Each group received Motor Relearning Programme for 60 minutes, 6 times a week for 4 weeks. The experimental group received an additional shoe-raise of 1 cm on the unaffected side along with while ambulating during therapy as well as at home. Pre and post treatment the patients were assessed for spatio-temporal parameters using foot print analysis method and Rivermead Visual Gait Assessment (RVGA Score using RVGA scale. Results: There was significant improvement seen in almost all the spatio-temporal gait parameters and RVGA score in within group analysis. Whereas on between group the results from between group comparison suggests that subjects in MRP with shoe-raise group showed better results in spatio-temporal parameters of gait than subjects receiving MRPalone. But there was no additional benefit of shoe-raise seen on RGVA score and angle of toe-out parameter. Conclusion: Additional use of shoe-raise helps to improve spatio-temporal gait parameters. However, there was no additional change seen in RVGA score.
Simon, Ann M.; Ingraham, Kimberly A.; Fey, Nicholas P.; Finucane, Suzanne B.; Lipschutz, Robert D.; Young, Aaron J.; Hargrove, Levi J.
Lower limb prostheses that can generate net positive mechanical work may restore more ambulation modes to amputees. However, configuration of these devices imposes an additional burden on clinicians relative to conventional prostheses; devices for transfemoral amputees that require configuration of both a knee and an ankle joint are especially challenging. In this paper, we present an approach to configuring such powered devices. We developed modified intrinsic control strategies—which mimic the behavior of biological joints, depend on instantaneous loads within the prosthesis, or set impedance based on values from previous states, as well as a set of starting configuration parameters. We developed tables that include a list of desired clinical gait kinematics and the parameter modifications necessary to alter them. Our approach was implemented for a powered knee and ankle prosthesis in five ambulation modes (level-ground walking, ramp ascent/descent, and stair ascent/descent). The strategies and set of starting configuration parameters were developed using data from three individuals with unilateral transfemoral amputations who had previous experience using the device; this approach was then tested on three novice unilateral transfemoral amputees. Only 17% of the total number of parameters (i.e., 24 of the 140) had to be independently adjusted for each novice user to achieve all five ambulation modes and the initial accommodation period (i.e., time to configure the device for all modes) was reduced by 56%, to 5 hours or less. This approach and subsequent reduction in configuration time may help translate powered prostheses into a viable clinical option where amputees can more quickly appreciate the benefits such devices can provide. PMID:24914674
Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.
Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808
Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne
The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.
Full Text Available MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old. Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer and comorbidity (abbreviated Charlson index were considered to be confounding variables. Statistical analysis: Simple comparisons and mixed models of multiple ordinal regression. Results: The sample presented generalized weakness in scapular (mean 4.22 and pelvic (mean 3.82 muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001, pelvic waist strength (P=0.005 and walking ability (P=0.001. A statistically significant relationship in the regression analysis was found between the grip (right and left hands and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale. The confounding variables showed no statistical significance in the results.Conclusion: Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful. Keywords: gait
Zorab, Ollie; Robinson, Maria; Endacott, Ruth
A shift from a predominantly emergency service, towards one where a wide range of conditions are managed and treated on scene presents numerous challenges for ambulance services and clinicians. The effective management of a broad range of patients and conditions in the ambulance setting will have an impact on other parts of the health service including emergency departments and primary care. A two part online survey was distributed to operational staff working for a regional UK ambulance service. Clinicians were asked to report their experiences of accessing patient information and making decisions about patient management based on four hypothetical patient scenarios. A survey of clinical staff (n = 302) revealed that (i) the vast majority experienced difficulties in accessing patients' health information, (ii) this was particularly true in the out of hours period and (iii) They felt that better access would likely lead to more appropriate selection of care pathways. Decisions regarding the most appropriate care for patients presenting to the ambulance service are best informed by access to accurate and complete health information and records. An understanding of patients' pre-existing medical conditions, recent treatments and health information is needed for the selection of the most appropriate care; this information is often difficult to obtain in the ambulance service setting.
Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman
Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Ojha, Heidi A; Kern, Rebecca W; Lin, Chien-Ho Janice; Winstein, Carolee J
Approximately 75% of all injury-producing falls on steps for people of all ages occur in people 65 years of age and older. Diminished attentional capacity contributes to fall risk in older adults, particularly when task demands are high. The purpose of this study was to compare the attentional demands of ascending and descending a set of stairs (stair ambulation) in older adults and younger adults. This was a nonblinded, prospective, single-site, observational cohort study. Ten older (>65 years of age) and 10 younger (21-33 years of age) adults without disabilities were recruited. A dual-task approach was used for 2 task conditions: the first task was standing and responding verbally to an unanticipated auditory tone as quickly as possible (probe task), and the second task was ascending or descending a set of stairs with the same probe task. A 2-factor (group x task) analysis of variance with repeated measures on task (standing and stair ambulation) was performed for voice response time (VRT). Significance for the analysis was set at Ptask interaction was significant for VRT. Post hoc analyses indicated that during stair ambulation, the VRT for older adults was significantly longer than that for younger adults. For the standing task, the VRTs (X+/-SD) were similar for younger (322+/-65 milliseconds) and older (306+/-22 milliseconds) participants. For stair ascent and descent, the average VRTs were more than 100 milliseconds longer for older participants (493+/-113 and 470+/-127 milliseconds, respectively) than for younger participants (365+/-56 and 356+/-67 milliseconds, respectively). Because of the small sample size and generally fit older group, generalization of findings to older people at risk for falls is not recommended until further research is done. The results demonstrated that although both older and younger adults required similar attentional resources for the standing task, older adults required significantly more resources during stair ambulation. The
Beseler, MR; Rubio, C; Duarte, E; Hervás, D; Guevara, MC; Giner-Pascual, M; Viosca, E
MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle ...
Bieri, R.; Monsler, M.; Meier, W.; Stewart, L.
Parametric models for scaling heavy-ion driver designs are described. Scaling of target performance and driver cost is done for driver parameters including driver energy, number of beams, type of superconductor used in focusing magnets, maximum magnetic field allowed at the superconducting windings, linear quadrupole array packing fraction mass, and ion charge state. The cumulative accelerator voltage and beam currents are determined from the Maschke limits on beam current for each choice of driver energy and post-acceleration pulse duration. The heavy-ion driver is optimized over the large available driver parameter space. Parametric studies and the choice of a base driver model are described in a companion paper
Anund, Anna; Ahlström, Christer; Fors, Carina; Åkerstedt, Torbjorn
Objective It is generally believed that professional drivers can manage quite severe fatigue before routine driving performance is affected. In addition, there are results indicating that professional drivers can adapt to prolonged night shifts and may be able to learn to drive without decreased performance under high levels of sleepiness. However, very little research has been conducted to compare professionals and non-professionals when controlling for time driven and time of day. Method Th...
When addressing the global societal challenges most solutions will require Nano electronics and Smart Systems - therefore innovation today is mainly based on nanoelectronics which has become one of the most important key enabling technologies and innovation drivers. Nanoelectronics has been extended by other microtechnologies. This results in additional functionalities. The combination of analog and digital electronics, the integration of sensors and actuators, of power devices and rf components on wafer level makes it possible to shrink shoebox sized systems to the size of a matchbox. But there is no innovation without research. Europe (Germany) is top in invention but poor in commercialization - many good ideas fail when going from research to production within the so-called Valley of Death. To overcome this, a clear strategy is necessary. Silicon Saxony, the big Saxonian cluster on micro- and nanoelectronics is presented as a best practice example: clear focus, addressing whole value chains and establishing joint technology platforms has led to a remarkable commercial success in the Dresden area.
Yang, Yea-Ru; Tsai, Meng-Pin; Chuang, Tien-Yow; Sung, Wen-Hsu; Wang, Ray-Yau
This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.
Wijsman, Carolien A; van Heemst, Diana; Hoogeveen, Evelien S; Slagboom, P Eline; Maier, Andrea B; de Craen, Anton J M; van der Ouderaa, Frans; Pijl, Hanno; Westendorp, Rudi G J; Mooijaart, Simon P
Glucose metabolism marks health and disease and is causally inferred in the aging process. Ambulant continuous glucose monitoring provides 24-h glucose rhythms under daily life conditions. We aimed to describe ambulant 24-h glucose rhythms measured under daily life condition in relation to calendar and biological age in apparently healthy individuals. In the general population and families with propensity for longevity, we studied parameters from 24-h glucose rhythms; glucose levels; and its variability, obtained by continuous glucose monitoring. Participants were 21 young (aged 22-37 years), 37 middle-aged (aged 44-72 years) individuals from the general population, and 26 middle-aged (aged 52-74 years) individuals with propensity for longevity. All were free of diabetes. Compared with young individuals, middle-aged individuals from the general population had higher mean glucose levels (5.3 vs. 4.7 mmol L(-1) , P rhythms depending on calendar and biological age. © 2012 The Authors Aging Cell © 2012 Blackwell Publishing Ltd/Anatomical Society of Great Britain and Ireland.
Brand, T; Slob, A K
The validity of the hypothesis put forward earlier, that testicular secretions during puberty have an organizing effect on open field ambulation was examined. Male rats were castrated or sham-operated at days 21, 43 or 70. At the age of 17 weeks the males were tested in an automated, octagonal open field (3 consecutive days, 3 min/day) for locomotor activity. Male rats castrated at day 21 or day 43 ambulated more than sham-castrated controls. Males castrated at day 70 did not differ from sham-castrated controls. It thus appears that pubertal testicular secretion(s) organize adult open field locomotor activity in male rats. From 18 weeks of age partner preference behavior was tested in the same open field apparatus with one adjacent cage containing an ovariectomized female and an opposite one containing an ovariectomized female brought into heat. The females in the adjacent cages were separated from the experimental males in the octagonal cage by wire mesh. Peripubertally castrated males did not show a clear-cut partner preference, whereas the intact males preferred the vicinity of the estrous female. There were no differences among the males castrated either before, during or after puberty. Testosterone treatment (crystalline T in silastic capsules) caused peripubertally castrated males to prefer the estrous female. Thus, adult partner preference behavior does not seem to be organized by peripubertal testicular androgens.
Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.
Somers, John M.; Halliday, Katharine E.; Chapman, Stephen
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)
Severinsen, Kaare; Jakobsen, Johannes K; Pedersen, Asger R; Overgaard, Kristian; Andersen, Henning
The aim of this study was to directly compare the effects of aerobic training (AT) with progressive resistance training (RT) after stroke to determine whether AT-induced fitness gains or RT-induced strength gains translate into improved ambulation across a 12-wk intervention and whether gains are retained 1 yr after cessation of formal training. This study is a randomized controlled 12-wk intervention trial with a 1-yr follow-up. Forty-three community-dwelling independent walkers with a chronic ischemic hemiparetic stroke were allocated to AT using a cycle ergometer (n = 13), RT using training machines (n = 14), or low-intensity sham training of the arms (n = 16). The main outcome measures were 6-min walk distance and fast 10-m walking speed. Comparisons between AT, RT, and sham training revealed no clinically relevant effects on walking velocity or walking distance. Muscle strength improved after RT (P muscle strength or aerobic capacity using non-task-specific training methods does not result in improved ambulation in patients with chronic stroke. Muscle strength gains were maintained at follow-up, whereas all improvements of aerobic capacity were lost, indicating a long-lasting effect of intensive RT even without maintenance training.
Somers, John M.; Halliday, Katharine E. [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Chapman, Stephen [Birmingham Children' s Hospital, Birmingham (United Kingdom)
Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)
N. F. Plavunov
Full Text Available Over the last years the incidence of cardiovascular diseases had increased in Russian Federation. In a period of 2010-2014 y. the number of patients diagnosed hypertension increased by 16,8% (139,5 thousand patients. High prevalence of hypertension leads to different cardiac complications that could be responsible for death. Hypertension is a major risk factor for ischemic heart disease and stroke, increases the risk in 3-4 times, and therefore one of the most important causes of morality. The major cause that required emergency hospitalization in adult population was estimated to be cardiovascular diseases (23,9%, including ischemic heart disease (10,7%, cerebrovascular diseases (6%, and diseases attributable to high blood pressure (3,3%. We studied 1 605 374 (9,6% emergency ambulance calls to patients with high blood pressure during the period of 6 month (2015 y. . In 16,1% cases emergency service calls were related to hypertensive crisis and 1,45% of patients needed emergency evacuation. We determined that in 7,2% cases patients with high blood pressure called for emergency service again during 24 hours period. Among this group of patients the percent of hypertensive crisis and evacuation was higher — 19,4% and 4,1% respectively. Also we identified that in 59,5% cases the diagnosis was hypertensive disease. We determined that majority of frequent ambulance callers were elderly persons.
This study explored how drivers 60 and older control the accelerator and brake while driving and parking. It built upon : the findings of a study documenting the prevalence and characteristics associated with pedal misapplication crashes : (Lococo, S...
Many drivers are apprehensive to accept a roundabout as a viable form of intersection, but their : safety and mobility benefits are increasing their popularity among designers. This thesis is an indepth study of a specific approach at a roundabout in...
Researchers have examined the effects of alcohol consumption : on older adults functioning, and some have : addressed alcohols effects on older drivers crash risk. : Generally, the findings have shown that alcohol is less : likely to be a fa...
This study was a randomized control intervention to measure the effectiveness of a cellular phone control device : that communicates with the vehicles of teen drivers to deny them access to their phone while driving for the : purpose of reducing dist...
Dwyer, R; Gabbe, B; Tran, T D; Smith, K; Lowthian, J A
to examine demand for emergency ambulances by older people. retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. Victoria, Australia. people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. rates of emergency ambulance attendance. older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.
Kressler, Jochen; Wymer, Tracie; Domingo, Antoinette
To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Case series. Four participants with chronic, motor-incomplete spinal cord injury. Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption) and metabolic (caloric expenditure and substrate utilization) measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Cardiorespiratory responses ranged from low (24% VO2peak) for the least impaired and fittest individual to supramaximal (124% VO2peak) for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3-8% VO2peak) differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak) difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.
Full Text Available Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption and metabolic (caloric expenditure and substrate utilization measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Results: Cardiorespiratory responses ranged from low (24% VO2peak for the least impaired and fittest individual to supramaximal (124% VO2peak for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3–8% VO2peak differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Conclusion: Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.
... 49 Transportation 5 2010-10-01 2010-10-01 false Driver testing. 380.109 Section 380.109....109 Driver testing. (a) Testing methods. The driver-student must pass knowledge and skills tests in... LCV driver-instructor. (d) Guidance for testing methods and proficiency determinations. Motor carriers...
Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa
In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution. Copyright © 2014 Elsevier Ltd. All rights reserved.
Jensen, Anker; Kaerlev, Linda; Tüchsen, Finn
-249) and for other truck drivers (SHR: 130, 95% CI: 108-156) compared to bus drivers (SHR: 110, 95% CI: 79-149). All drivers had high SHR for lesions of the ulnar nerve (SHR: 159, 95% CI: 119-207), especially bus drivers (SHR: 197, 95% CI: 116-311). Long-haul truck drivers had high SHRs for synovitis and bursitis...
Raaber, Nikolaj; Duvald, Iben; Riddervold, Ingunn; Christensen, Erika F; Kirkegaard, Hans
Emergency departments (ED) recognize crowding and handover from prehospital to in-hospital settings to be major challenges. Prehospital Geographical Information Systems (GIS) may be a promising tool to address such issues. In this study, the use of prehospital GIS data was implemented in an ED in order to investigate its effect on 1) wait time and unprepared activations of Trauma Teams (TT) and Medical Emergency Teams (MET) and 2) nurses' perceptions regarding patient reception, workflow and resource utilization. From May 1st 2014 to October 31th 2014, GIS data was displayed in the ED. Data included real-time estimated time of arrival, distance to ED, dispatch criteria, patient data and ambulance contact information. Data was used by coordinating nurses for time activation of TT and MET involved in the initial treatment of severely-injured or critically-ill patients. In addition, it was used as a logistics tool for handling all other patients transported by ambulance to the ED. The study followed a mixed-methods design, consisting of a quantitative study (before and after intervention) and a qualitative study (survey and interviews). Participants included all patients received by TT or MET and coordinating nurses in the ED. 1.) Quantitative: 599 patients were included. The median wait time for TT and MET was 5 min both before and after the GIS intervention, showing no difference (p = 0.18). A significant reduction in the subgroup of waits >10 min was found (p GIS data as a tool to optimize resource utilization and quality of all patients' reception, critically or non-critically ill. No substantial disadvantages were reported. The contradiction of measured median wait time and nurses perceived improved timing of team activation may result from having both RT- ETA and supplemental patient information not only for seriously-injured or critically-ill patients received by the TT and MET, but for all patients transported by ambulance. The reduction in waits > 10
Jyoti V. Dube
Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative
Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie
OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study...
Sommers, Juultje; Wieferink, Denise C.; Dongelmans, Dave A.; Nollet, Frans; Engelbert, Raoul H. H.; van der Schaaf, Marike
Purpose: Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore
Jorge Luis Alvarado‐Socarras
Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation to obtain good clinical outcomes according type of ambulance.
Knorth, Erik J; Knot-Dickscheit, Jana; Tausendfreund, Tim; Schulze, Gisela C; Strijker, Johan
The enhancement of community-based, ambulant care for children with serious behavioural problems (in German: "Ambulantisierung") implies supporting them as long as possible in their own family environment. One tries to avoid an out-of-home placement. This policy, strongly underlined during the last
Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe
BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...... fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program....... Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS). RESULTS: Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p transfusions during...
Gait analysis systems are widely used for the assessment of gait disabilities and provide more accurate and detailed information than clinical tests. Scores and indexes have been proposed to summarize the large volume of data produced, each emphasizing different aspects of gait. Based on specific spatiotemporal parameters, the Functional Ambulation Performance Score (FAPS) quantifies gait at a self-selected speed. Integrated within electronic walkways, the FAPS is commonly used for clinical evaluations and has been used in an increasing number of publications over the past few years. However, its use is sometimes distorted by misunderstandings of its composition and calculation, practical and/or conceptual limits, and even the meaning of the score. This technical report reviews the use of the FAPS for the evaluation of gait based on peer-reviewed articles and clinical experience and addresses important issues that must be considered for an optimal unbiased understanding and analysis of the score.
Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip
This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.
The first six months of unsupervised driving are the most : hazardous in a novice drivers driving experience. Most : States adopted graduated driver licensing (GDL) systems : to give novice drivers experience in a protective environment, : gradual...
James Robert Langabeer
Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.
Full Text Available We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs, in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T, wind speed (WS, relative humidity, and barometric pressure (BP. We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s increased the daily number of elevated arterial blood pressure (EABP by 12% (RR = 1.12; 95% confidence interval (CI 1.04–1.21; and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12. An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions.
Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye
Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies. Copyright © 2012. Published by Elsevier B.V.
Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Aardal, Karen; van Essen, J Theresia
Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5-95 percentile) of 13 (1-391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis. 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/.
Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali
Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217
Full Text Available Objective: Emergency departments are the first places to which patients present with unexpected or unforeseen health problems. The purpose of this study was to assess the urgency of cases brought by ambulance to the Hospital on the basis of a three-level triage system. Methods: This study was performed between 01.06.2013 and 31.09.2013 at the Diyarbakır Education and Research Hospital. Our emergency service unit is a third degree service for all adult patient groups and all child trauma types. Triage of patients brought to the emergency department by ambulance was performed by emergency medicine specialists. Patients’ vital findings, identity data and triage categories were assessed. Results: 712 patients were included, 382 (53.7% male and 330 (46.3% female, with a mean age of 45. In this study, 619 (86.9% patients were transferred from the scene and 93 (13.1 between hospitals, 483 (67.8% patients were brought by emergency medicine technician (EMT teams, 107 (15% by physician-led teams, 107 (15 by paramedic teams and 15 (2.1% by other teams, 442 (62.1% patients were assessed as yellow, 141 (19.8% as green and 129 (19.1% as red zone. Five hundred eighty (81.5% patients were discharged and 115 (15.9% were hospitalized. Conclusion: Emergency health services are clearly developing rapidly in Turkey. In order for pre-hospital emergency health services not to be abused, we think that these services should be up to the standards of those in developed countries and that public awareness needs to be increased, particularly with regard to triage. J Clin Exp Invest 2015; 6 (2: 126-129
Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas
In most places all over the world–including our country–services in emergency rooms are oversaturated. This situation frequently forces the continuously arriving ambulances to be redirected to other medical units, delaying the admission of patients moved and thus adversely affecting their physical condition. To introduce an improvement to the Índicede Saturación Modificado computational system, which monitors the degree of saturation of a network of emergency medical services, to include a network of ambulances, enabling in the system: (i) the effective allocation of ambulances to the site of the accident, or severe clinical event, and (ii) the remote booking of beds in the nearest and least saturated emergency room available. The evaluation and connectivity of the computational improvement to the Índicede Saturación Modificado system was carried out with a computational test verifying these two aspects, using only differences in postal codes, for time measuring. The verification of its sustainability online showed the new Índice de Saturación Modificado y Ambulancias system (ISMA) has a robust structure capable of being adapted to mobile phones, laptops or tablets, and can efficiently administrate: (i) the quantification of excessive demand in the emergency room services of a hospital network, (ii) the allocation of ambulances attending the site of the event or contingency, and (iii) the allocation of ambulances and patients, in the best distance-time conditions, from the site of the accident or clinical event to the nearest and least saturated emergency room service. This administrative management tool is efficient and simple to use, and it optimally relates independent service networks.
Abrams, Darryl C; Brenner, Keith; Burkart, Kristin M; Agerstrand, Cara L; Thomashow, Byron M; Bacchetta, Matthew; Brodie, Daniel
Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes. We assessed the feasibility of achieving early extubation and ambulation in subjects requiring IMV for exacerbations of COPD using single-site ECCO₂R. Five subjects with exacerbations of COPD with uncompensated hypercapnia requiring IMV were enrolled in this single-center, prospective, feasibility trial using a protocol of ECCO₂R, extubation, and physical rehabilitation. The primary endpoint was extubation within 72 hours of starting ECCO₂R. Mean preintubation pH and PaCO₂ were 7.23 ± 0.05 and 81.6 ± 15.9 mm Hg, respectively. All subjects met the primary endpoint (median duration, 4 h; range, 1.5-21.5 h). Mean duration of extracorporeal support was 193.0 ± 76.5 hours. Mean time to ambulation after extracorporeal initiation was 29.4 ± 12.6 hours. Mean maximal ambulation on extracorporeal support was 302 feet (range, 70-600). Four subjects were discharged home, and one underwent planned lung transplantation. Two minor bleeding complications occurred. There were no complications from mobilization on extracorporeal support. ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.
Dolnicar, Sara; Grabler, Klaus; Grün, Bettina; Kulnig, Anna
This study investigates drivers of airline loyalty. It contributes to the body of knowledge in the area by investigating loyalty for a number of a priori market segments identified by airline management and by using a method which accounts for the multi-step nature of the airline choice process. The study is based on responses from 687 passengers. Results indicate that, at aggregate level, frequent flyer membership, price, the status of being a national carrier and the reputation of the airline as perceived by friends are the variables which best discriminate between travellers loyal to the airline and those who are not. Differences in drivers of airline loyalty for a number of segments were identified. For example, loyalty programs play a key role for business travellers whereas airline loyalty of leisure travellers is difficult to trace back to single factors. For none of the calculated models satisfaction emerged as a key driver of airline loyalty. PMID:27064618
Dallum, Gregory E [Livermore, CA; Pratt, Garth C [Discovery Bay, CA; Haugen, Peter C [Livermore, CA; Zumstein, James M [Livermore, CA; Vigars, Mark L [Livermore, CA; Romero, Carlos E [Livermore, CA
A dual burst transmitter for ultra-wideband (UWB) communication systems generates a pair of precisely spaced RF bursts from a single trigger event. An input trigger pulse produces two oscillator trigger pulses, an initial pulse and a delayed pulse, in a dual trigger generator. The two oscillator trigger pulses drive a gated RF burst (power output) oscillator. A bias driver circuit gates the RF output oscillator on and off and sets the RF burst packet width. The bias driver also level shifts the drive signal to the level that is required for the RF output device.
In South Africa (SA), the school transport industry provides millions of children with a means of travelling to and from school. The industry has, however, been reported to be plagued by widespread safety concerns. The consequent road traffic incidents have often been attributed to driver factors, including driving in excess of ...
Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio
The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
Martinussen, Laila Marianne; Møller, Mette; Prato, Carlo Giacomo
, annual mileage and accident involvement. 3908 drivers aged 18–84 participated in the survey. The results suggested that the drivers have good insight into their own driving ability, as the driving skill level mirrored the frequency of aberrant driving behaviors. K-means cluster analysis revealed four...... distinct clusters that differed in the frequency of aberrant driving behavior and driving skills, as well as individual characteristics and driving related factors such as annual mileage, accident frequency and number of tickets and fines. Thus, two sub-groups were identified as more unsafe than the two...
Kristensen, Niels Buus; Nielsen, Thomas A. Sick; Gudmundsson, Henrik
This report summarizes key outcomes of the study ’Drivers and Limits’ that was supported for the period 2009-2013 by a research grant from the Danish Strategic Research Council. The project investigated - for the empirical context of Denmark - key driving forces behind transport growth, as well...
With the rapid increase in vehicle automation technology, the call for understanding how humans behave while driving in an automated vehicle becomes more urgent. Vehicles that have automated systems such as Lane Keeping Assist (LKA) or Adaptive Cruise Control (ACC) not only support drivers in their
This study explored how older drivers use their accelerator and : brake pedals, to identify characteristics that could pose an increased : risk of a pedal application error. The study also explored whether : driver-vehicle fit was related to these ch...
Prosnitz, D.; Schlitt, L.
The Free Electron Laser (FEL) is shown to be a potentially attractive solution to the problem of finding a suitable short wavelength fusion driver. The design of a 3 MJ, 250 nm FEL fusion driver is discussed
One way to attempt to reduce the problem of teen driving crashes is professional driver education. However, despite the : seemingly universal appeal of driver education, scientific evaluations have indicated that such programs generally do not : prod...
"The purpose of this project was to provide MDOT with insight regarding the effectiveness of potential implementations of behavioral countermeasures for increasing driver safety in Michigan. The Center for Driver Evaluation, Education, and Research a...
Various drivers of construction innovation are distinguished and classified in four distinctive categories: environmental pressure, technological capability, knowledge exchange, and boundary spanning. Innovation drivers in these categories are active at the transfirm, intrafirm, and interfirm level
Booker, Matthew J; Purdy, Sarah; Shaw, Alison R G
To understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a 'primary care sensitive' condition. A comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of Nursing and Allied Health, Health Management Information Systems, Healthcare Management Information Consortium, OpenSigle, EThOS and Digital Archive of Research Theses databases were systematically searched for studies exploring patient, carer or healthcare professional interactions with ambulance services for 'primary care sensitive' problems. Studies using wholly qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. An analytical thematic synthesis was undertaken, using a line-by-line qualitative coding method and a hierarchical inductive approach. Of 1458 initial results, 33 studies met the first level (relevance) inclusion criteria, and six studies met the second level (methodology and quality) criteria. The analysis suggests that patients define situations worthy of 'emergency' ambulance use according to complex socioemotional factors, as well as experienced physical symptoms. There can be a mismatch between how patients and professionals define 'emergency' situations. Deciding to call an ambulance is a process shaped by practical considerations and a strong emotional component, which can be influenced by the views of caregivers. Sometimes the value of a contact with the ambulance service is principally in managing this emotional component. Patients often wish to hand over responsibility for decisions when experiencing a perceived emergency. Feeling empowered to take control of a situation is a highly valued aspect of ambulance care. When responding to a request for 'emergency' help for a low-acuity condition, urgent-care services need to be sensitive to how the patient's emotional and practical perception of the situation
... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS INSPECTION, REPAIR, AND MAINTENANCE § 396.13 Driver inspection. Before driving a motor vehicle, the driver shall: (a) Be satisfied that the motor vehicle is in safe operating condition; (b) Review the last driver vehicle inspection...
Villarreal, Manuel; Leach, Jonathan; Ngianga-Bakwin, Kandala; Dale, Jeremy
Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) . The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED. Of 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72). Support of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is
Alemdaroğlu, Ipek; Karaduman, Ayşe; Yilmaz, Öznur Tunca; Topaloğlu, Haluk
We investigated and compared the effects of 2 different types of upper extremity exercise training on upper extremity function, strength, endurance, and ambulation in patients with early-stage Duchenne muscular dystrophy (DMD). The study group (n = 12) exercised with an arm ergometer under the supervision of a physiotherapist, whereas the control group (n = 12) underwent a strengthening range-of-motion (ROM) exercise program under the supervision of their families at home for 8 weeks. Upper extremity functional performance, strength, endurance, and ambulatory status were assessed before and after the training. Ambulation scores, endurance, and arm functions, as well as proximal muscle strength, were improved after the training in the study group (P exercises alone. © 2014 Wiley Periodicals, Inc.
Simon, Ann M; Ingraham, Kimberly A; Spanias, John A; Young, Aaron J; Finucane, Suzanne B; Halsne, Elizabeth G; Hargrove, Levi J
Powered lower limb prostheses can assist users in a variety of ambulation modes by providing knee and/or ankle joint power. This study's goal was to develop a flexible control system to allow users to perform a variety of tasks in a natural, accurate, and reliable way. Six transfemoral amputees used a powered knee-ankle prosthesis to ascend/descend a ramp, climb a 3- and 4-step staircase, perform walking and standing transitions to and from the staircase, and ambulate at various speeds. A mode-specific classification architecture was developed to allow seamless transitions at four discrete gait events. Prosthesis mode transitions (i.e., the prosthesis' mechanical response) were delayed by 90 ms. Overall, users were not affected by this small delay. Offline classification results demonstrate significantly reduced error rates with the delayed system compared to the non-delayed system (p knee-ankle prosthesis.
Full Text Available Resalta la experiencia de comunicación que plantea Le Cinéma Numérique Ambulant CNA (África cuyo objetivo es difundir filmes de ficción, acompañados de documentos audiovisuales destinados a sensibilizar a los espectadores sobre los problemas de desarrollo de salud, o de convivencia en sociedad, en las regiones donde no existe el cine.
Azimi, S.; Delavar, M. R.; Rajabifard, A.
In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.
Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.
Lund, Cathrine; Bjornaas, Mari A; Sandvik, Leiv; Ekeberg, Oivind; Jacobsen, Dag; Hovda, Knut E
The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003-2004. A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9-14), 10 (CI 8-12), and 6 (CI 5-7), respectively. The overall SMR was 9 (CI 8-10), while the SMR after opioid poisoning was 27 (CI 21-32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6-3.0), older age (HR 1.6, CI 1.5-1.7), and male sex (HR 1.4, CI 1.1-1.9) predicted death, whereas the treatment level did not predict death. The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death.
Full Text Available Background: In general, many patients with acute proximal deep vein thrombosis (DVT are treated with heparin and oral anticoagulant. Many physicians have been taught to admit these patients to absolute bed rest for the first 24-48 hours due to the fear of dislodging clots that may lead to fatal pulmonary embolism (PE. Objective: The aim of this study is to compare the differences among the changing circumference of affected limb, the severity of pain, and the incidence of symptomatic PE in 3 groups of acute proximal DVT, including absolute bed rest with compression bandages (group 1, ambulation with compression bandages (group 2, and ambulation without compression bandages (group 3. Methods: Between January 2006 and March 2011, 60 patients were enrolled in this study. In this analysis, the clinical characteristics, the changes of affected limb circumference and pain score during the first week of admis- sion and the incidence of symptomatic PE among 3 groups of this study were analyzed. Results: There were no statistical differences in the characteristics among 3 groups of patients. The most gender was female and the mean age for 3 groups ranged from 55.1 to 63.7 years. Comparing among 3 groups, it showed a significant difference of calf circumferences between group 1 and group 3. None of pain score differences were statistically significant among 3 groups. In addition, there was no incidence of symptomatic PE in the three groups of the present study. Conclusion: Our findings confirm that acute proximal DVT treatment with ambulation does not increase the incidence of symptomatic PE, compared with absolute bed rest. Although there is no statistical decrease of the severity of pain between those 3 groups, the group of absolute bed rest and compression can promote the resolution of calf swelling, compared with the group of ambulation without compression bandages.
Full Text Available In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.
Lyndel J. Bates
Full Text Available Young drivers are the group of drivers most likely to crash. There are a number of factors that contribute to the high crash risk experienced by these drivers. While some of these factors are intrinsic to the young driver, such as their age, gender or driving skill, others relate to social factors and when and how often they drive. This article reviews the factors that affect the risk of young drivers crashing to enable a fuller understanding of why this risk is so high in order to assist in developing effective countermeasures.
Serene S Paul; Lara Harvey; Therese Carroll; Qiang Li; Soufiane Boufous; Annabel Priddis; Anne Tiedemann; Lindy Clemson; Stephen R Lord; Sandy Muecke; Jacqueline CT Close; Serigne Lo; Catherine Sherrington
Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Study type: Retrospective population-based descriptive study. Methods: Fall-related ambulance use and hospita...
Berntsson, Tommy; Hildingh, Cathrine
The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30 was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30 no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS, subjective comments on cold experiences, and finger, ear and air temperatures. Results: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001 but decreased in the control group (p=0.014. A significant higher proportion (57% of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001. At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions: The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.
Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.
Jochen Kressler; Tracie Wymer; Antoinette Domingo
Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assis...
Mudumbai, Seshadri C; Kim, T Edward; Howard, Steven K; Workman, J Justin; Giori, Nicholas; Woolson, Steven; Ganaway, Toni; King, Robert; Mariano, Edward R
Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay. Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10(th)-90(th) percentiles]: 37 m [0-90 m] versus 6 m [0-51 m]; p randomized studies are needed to validate our major findings. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald
Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), pautomated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Pearn, J; Wales, M
Surgeon John Thomson (1847-1909), a Scot who made his life's work in Queensland, was a pioneer surgeon, radiologist and bacteriologist, and one of the founders of the St John Ambulance movement in Australia and the Railway Ambulance Corps. He was variously President of the British Medical Association (Queensland Branch), the Medical Board of Queensland, the Medico-Ethical Association, and the Intercolonial Medical Congress, which was held in Brisbane in 1899. A pioneer military surgeon in this country, he was the foundation Principal Medical Officer (as Surgeon-Major) of the Queensland Ambulance Corps within the Queensland Defence Force. His advocacy for a university north of Sydney was one of the factors which led to the foundation of the University of Queensland, a body which honoured him by the establishment of the John Thomson Lectureship, which for half a century was its most prestigious public oration. The life and times of this singular doctor exemplify one small class of pre-Federation medical pioneers whose professional outreach established a number of voluntary organisations which have blossomed in Australian society to the present day.
Simon, Ann M; Fey, Nicholas P; Finucane, Suzanne B; Lipschutz, Robert D; Hargrove, Levi J
Recently developed powered lower limb prostheses allow users to more closely mimic the kinematics and kinetics of non-amputee gait. However, configuring such a device, in particular a combined powered knee and ankle, for individuals with a transfemoral amputation is challenging. Previous attempts have relied on empirical tuning of all control parameters. This paper describes modified stance phase control strategies - which mimic the behavior of biological joints or depend on the instantaneous loads within the prosthesis - developed to reduce the number of control parameters that require individual tuning. Three individuals with unilateral transfemoral amputations walked with a powered knee and ankle prosthesis across five ambulation modes (level ground walking, ramp ascent/descent, and stair ascent/descent). Starting with a nominal set of impedance parameters, the modified control strategies were applied and the devices were individually tuned such that all subjects achieved comfortable and safe ambulation. The control strategies drastically reduced the number of independent parameters that needed to be tuned for each subject (i.e., to 21 parameters instead of a possible 140 or approximately 4 parameters per mode) while relative amplitudes and timing of kinematic and kinetic data remained similar to those previously reported and to those of non-amputee subjects. Reducing the time necessary to configure a powered device across multiple ambulation modes may allow users to more quickly realize the benefits such powered devices can provide.
This document is on Geant 4 visualization tools (drivers), evaluating pros and cons of each option, including recommendations on which tools to support at Fermilab for different applications. Four visualization drivers are evaluated. They re OpenGL, HepRep, DAWN and VRML. They all have good features, OpenGL provides graphic output with out an intermediate file. HepRep provides menus to assist the user. DAWN provides high quality plots and even for large files produces output quickly. VRML uses the smallest disk space for intermediate files. Large experiments at Fermilab will want to write their own display. They should proceed to make this display graphics independent. Medium experiment will probably want to use HepRep because of it's menu support. Smaller scale experiments will want to use OpenGL in the spirit of having immediate response, good quality output and keeping things simple
Beretvas, Andy; /Fermilab
This document is on Geant4 visualization tools (drivers), evaluating pros and cons of each option, including recommendations on which tools to support at Fermilab for different applications. Four visualization drivers are evaluated. They are OpenGL, HepRep, DAWN and VRML. They all have good features, OpenGL provides graphic output without an intermediate file. HepRep provides menus to assist the user. DAWN provides high quality plots and even for large files produces output quickly. VRML uses the smallest disk space for intermediate files. Large experiments at Fermilab will want to write their own display. They should proceed to make this display graphics independent. Medium experiment will probably want to use HepRep because of it's menu support. Smaller scale experiments will want to use OpenGL in the spirit of having immediate response, good quality output and keeping things simple.
Tashman, S; Zajac, F E; Perkash, I
We developed a three dimensional, four segment, eight-degree-of-freedom model for the analysis of paraplegic ambulation in a reciprocating gait orthosis (RGO). Model development was guided by experimental analysis of a spinal cord injured individual walking in an RGO with the additional assistance of arm crutches. Body forces and torques required to produce a dynamic simulation of the RGO gait swing phase were found by solving an optimal control problem to track the recorded kinematics and ground reaction forces. We found that high upper body forces are required, not only during swing but probably also during double support to compensate for the deceleration of the body during swing, which is due to the pelvic thrust necessary to swing the leg forward. Other stimulations showed that upper body forces and body deceleration during swing can be reduced substantially by producing a ballistic swing. Functional neuromuscular stimulation of the hip musculature during double support would then be required, however, to establish the initial conditions needed in a ballistic swing.
Lloyd, Gemma; Dean, Catherine M; Ada, Louise
Recruitment to clinical trials is often slow and difficult, with a growing body of research examining this issue. However there is very little work related to stroke. The aim of this study was to examine the success and efficiency of recruitment of community-dwelling stroke survivors over the first two years of a clinical trial aiming to improve community ambulation. Recruitment strategies fell into 2 broad categories: (i) advertisement (such as newspaper advertising and media releases), and (ii) referral (via hospital and community physiotherapists, a stroke liaison officer and other researchers). Records were kept of the number of people who were screened, were eligible and were recruited for each strategy. The recruitment target of 60 in the first two years was not met. 111 stroke survivors were screened and 57 were recruited (i.e., a recruitment rate of 51%). The most successful strategy was referral via hospital-based physiotherapists (47% of recruited participants) and the least successful were media release and local newspaper advertising. The referral strategies were all more efficient than any of the advertisement strategies. In general, recruitment was inefficient and costly in terms of human resources. Given that stroke research is underfunded, it is important to find efficient ways of recruiting stroke survivors to clinical trials. An Australian national database similar to other disease-specific data bases (such as the National Cancer Database) is under development. In the interim, recruiting for several clinical trials at once may increase efficiency.
Oster, Jörg; Moser, Anna Sophie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn
The aim of this study was to analyze the experiences of patients suffering from mostly chronic psychosomatic disorders in an ambulant art therapy in the group. Especially, the focus was on the experienced changes, helpful factors and specifics of the therapy as well as on the experienced benefit. For this, 30 patients were interviewed in a semi-standardized way. Additionally, the symptom-based strain was psychometrically recorded in a part of the patients (21) at the beginning of the therapy and after at least 6 months of participation. The evaluation of those interviews with the qualitative analysis of the therapy subjects surrendered an improvement of the health state in most of the participants. Especially group factors, art as a mean of communication, becoming aware of feelings but also diversion and fun were proved to be beneficial. The art therapy also serves for structuring the week as well as a contact point and a resource in the interpersonal communication of everyday life. Nearly all of the patients referred to some important turning point pictures. Mostly, the benefit was valued as being high. But, in contrast, the psychometric measure did not show any significant change. The results emphasize the stabilizing function of art therapy in the examined patients, whereat the classification of the psychometric result is complicated by the absence of a control group. © Georg Thieme Verlag KG Stuttgart · New York.
Bello, Luca; Morgenroth, Lauren P; Gordish-Dressman, Heather; Hoffman, Eric P; McDonald, Craig M; Cirak, Sebahattin
To correlate time to loss of ambulation (LoA) and different truncating DMD gene mutations in a large, prospective natural history study of Duchenne muscular dystrophy (DMD), with particular attention to mutations amenable to emerging molecular treatments. We analyzed data from the Cooperative International Neuromuscular Research Group Duchenne Natural History Study for participants with DMD single- or multi-exon deletions or duplications with defined exon boundaries (n = 186), or small mutations identified by sequencing (n = 26, including 16 nonsense point mutations). We performed a time-to-event analysis of LoA, a strong indicator of overall disease severity, adjusting for glucocorticoid treatment and genetic modifiers. Participants with deletions amenable to skipping of exon 44 had later LoA (median 14.8 years, hazard ratio 0.31, 95% confidence interval 0.14-0.69, p = 0.004). Age at LoA did not differ significantly in participants with deletions amenable to exon 45, 51, and 53 skipping, duplications, and small rearrangements. Nonsense mutation DMD also showed a typical median age at LoA (11.1 years), with a few outliers (ambulatory around or after 16 years of age) carrying stop codons within in-frame exons, more often situated in the rod domain. As exon 44 skipping-amenable DMD has a later LoA, mutation-specific randomization and selection of placebo groups are essential for the success of clinical trials. © 2016 American Academy of Neurology.
Full Text Available Reconstructive surgery following an internal hemipelvectomy for a malignant pelvic tumor is difficult due to the structural complexity of the pelvis and the massive extension of the tumor. While high complication rates have been encountered in various types of reconstructive surgery, resection without reconstruction reportedly involved fewer complications. However, this method often results in limb shortening with resultant instability during walking. We reported herein leg lengthening performed to correct lower limb shortening after an internal hemipelvectomy, which improved ambulatory stability and overall QOL. An 18-year-old male patient came to our hospital to correct a lower limb discrepancy resulting from a left internal hemipelvectomy. His left pelvis and proximal femur had been resected, and the femur remained without an acetabular roof. His left lower limb was about 8 centimeters shorter. The left tibia was lengthened 8 centimeters with an external fixator. After the lengthening, the patient was able to walk without support and his gait remarkably improved. Additionally he no longer required placing a wallet in his back pocket as a pad as a means of raising the left side of his torso while sitting. Leg lengthening was a useful method of improving ambulation after an internal hemipelvectomy.
Russell Esposito, Elizabeth; Lipe, Delbert H; Rábago, Christopher A
Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis. She underwent gait analysis in athletic shoes and 10-cm stiletto high heels worn with a pediatric running foot to determine if these claims could be substantiated through biomechanical measures. Global gait asymmetry indices were calculated. Findings and outcomes: Asymmetry indices were nearly identical between athletic shoes and heels but joint-level findings differed substantially. Ankle mechanics were more symmetrical in heels but hip mechanics were less. The maintenance of symmetry in stiletto high heels does not imply maintenance of gait quality, as high heels are known to adversely affect some components walking mechanics. Clinical relevance Returning to high-heel wear is achievable for prosthesis users. Accommodations can be made using creativity in prosthetic foot selection to enable successful ambulation; however, attention to gait mechanics may be important for patient safety.
Beil, Tracy L; Street, Glenn M; Covey, Steven J
Interface pressures were measured during ambulation with a normal total-surface weight-bearing suction socket and a vacuum-assisted socket. The vacuum-assisted socket has been shown to eliminate daily volume loss. Urethane liners were instrumented with five force-sensing resistors to measure positive pressures and one air pressure sensor at the distal end of the liner to document negative pressures. Nine unilateral transtibial amputees participated in the study. The vacuum-assisted socket created significantly lower positive-pressure impulse (42.8, 39.6 kPa x s) and peak pressures (83.5, 80.0 kPa) during the stance phase. The pressure impulse (-10.5, -13.3 kPa x s), average (-21.2, -26.5 kPa), and peak (-28.5, -36.3 kPa) negative pressures during swing phase were significantly greater in magnitude with the vacuum-assisted socket. We believe that lower positive pressures seen during stance using the vacuum-assisted socket reduces the fluid forced out and greater negative pressures seen during swing increases the amount of fluid drawn into the limb, thereby preventing volume loss.
Halter, Mary; Vernon, Susan; Snooks, Helen; Porter, Alison; Close, Jacqueline; Moore, Fionna; Porsz, Simon
Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance.
Fine, K.; Williams, F.; Mongeau, P.; Kolm, H.
The cryogenic module of Mass Driver Two comprises a 3.25 inch (82.55 mm) OD bucket with two 44 kilo-ampere-turn coils made with .028 inch (.71 mm) diam niobium-titanium multi-filamentary cable in a copper matrix, impregnated with lead alloy for thermal inertia, as well as the service station to refrigerate, energize and eject the bucket. The station is housed in a six inch flanged pyrex cross which connects to the four inch pyrex tube of the mass driver itself. The bucket is refrigerated by being forced against a copper braid cradle attached to the bottom of a liquid helium reservoir which protrudes into the cross from above. The bucket is energized inductively by turning off two superconducting coils which are also attached to the helium reservoir, and which have maintained the correct flux linkage through the bucket coils during their cool-down through the critical temperature. Once charging is completed, the clamping pressure is released and the bucket is injected into the mass driver by means of two normal-conductor pulse coils surrounding the horizontal branches of the cross.
Meng, Fanxing; Li, Shuling; Cao, Lingzhi; Li, Musen; Peng, Qijia; Wang, Chunhui; Zhang, Wei
Fatigue among truck drivers has been studied extensively; however, less is known regarding the fatigue experience of taxi drivers in heavily populated metropolitan areas. This study aimed to compare the differences and similarities between truck and taxi driver fatigue to provide implications for the fatigue management and education of professional drivers. A sample of 274 truck drivers and 286 taxi drivers in Beijing was surveyed via a questionnaire, which included items regarding work characteristics, fatigue experience, accident information, attitude toward fatigue, and methods of counteracting fatigue. Driver fatigue was prevalent among professional drivers, and it was even more serious for taxi drivers. Taxi drivers reported more frequent fatigue experiences and were involved in more accidents. Among the contributing factors to fatigue, prolonged driving time was the most important factor identified by both driver groups. Importantly, the reason for the engagement in prolonged driving was neither due to the lack of awareness concerning the serious outcome of fatigue driving nor because of their poor detection of fatigue. The most probable reason was the optimism bias, as a result of which these professional drivers thought that fatigue was more serious for other drivers than for themselves, and they thought that they were effective in counteracting the effect of fatigue on their driving performance. Moreover, truck drivers tended to employ methods that require stopping to counteract fatigue, whereas taxi drivers preferred methods that were simultaneous with driving. Although both driver groups considered taking a nap as one of the most effective means to address fatigue, this method was not commonly used. Interestingly, these drivers were aware that the methods they frequently used were not the most effective means to counteract fatigue. This study provides knowledge on truck and taxi drivers' characteristics in fatigue experience, fatigue attitude, and
Brinkrolf, Peter; Lukas, Roman; Harding, Ulf; Thies, Sebastian; Gerss, Joachim; Van Aken, Hugo; Lemke, Hans; Schniedermeier, Udo; Bohn, Andreas
High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. The survey was conducted in the German cities Dortmund and Münster. Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.
Lijovic, M; Bernard, S; Nehme, Z; Walker, T; Smith, K
To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.
Full Text Available Taibi Kahler wrote in 1974 a theory about five main drivers that could explain people’s motivation and a series of positive and negative behavior patterns: Be Strong, Be Perfect, Hurry Up, Try Hard and Please People. Of course, we consider there is no absolute positive or negative behavior, since (1 everything needs to be analyzed by taking into account the context and (2 any behavior pattern can mean a series of advantages as long as people understand their own values, beliefs, attitudes and behaviors. It would be interesting to link Kahler’s drivers to the educational process, in order to be able to adapt our courses and our teaching styles to students’ requirements and also to the requirements in the labor market. Our paper is built on literature review and a questionnaire applied to a sample of 607 students in Bucharest University of Economic Studies, Romania. Information was processed with Microsoft Excel 2013, in order to look at the main working styles our students have, at the main explanations for the differences between them and in order to test a series of hypotheses. We were interested to look at the main traits of the current generation of students in our university: dominant drivers, roles of managers and specialists, the attractiveness of the entrepreneurial career path, etc. and at a series of patterns (i.e. gender-related differences. We consider results of this study are useful both for teaching and research purposes. In terms of teaching, we plan to adapt our educational methods in order to improve the educational process.
Arnold, W.; Bowen, S.; Fine, K.; Kaplan, D.; Kolm, M.; Kolm, H.; Newman, J.; Oneill, G. K.; Snow, W.
A mass driver is an electrical device used to accelerate payloads of any material to a high velocity. Small vehicles (called buckets) containing superconducting coils carry the payloads. These buckets are accelerated by pulsed magnetic fields, timed by information on their position, and are guided by induced magnetic fields set up in a surrounding guideway. Upon reaching the correct velocity, the buckets release their payloads, then they are slowed for recirculation to be reused. A rationale is presented that leads to a relatively simple and near-optimum design, as well as basic programs for calculating acceleration. The transverse oscillation frequencies are found to be invariant to guideway transverse dimensions.
Oneill, G. K.
In the past eight months a new mass driver concept has been explored through calculation and inductance model verification. It retains the linear synchronous principle and freedom from arcs, plasmas or physical contact between the accelerated bucket and accelerator. However, it discards passive magnetic flight and obtains transverse focussing from strong off-axis restoring forces produced by drive coils operating in a pull-only mode. This paper gives the reasoning on which the new concept is based, and applies the concept to a lunar catapult design.
Sigurdardottir, Sigrun Birna
by bicycle were related to positive cycling experience, willingness to accept car restrictions, negative attitudes towards cars, and bicycle-oriented future vision, but are negatively related to car ownership norms. Attitudinal constructs are related to individual characteristics, such as gender, residential...... the semantic content of the data, to create a data driven conceptual model. Three segments of pre-drivers were identified: car enthusiasts, who would like to be early car users, car pragmatists, who would like to have the license at an early stage and a car at a later stage, and car sceptics, who are late...
Piezoelectric actuator drive aims to enable reliable motor performance in strong magnetic fields for magnetic res- onance imaging and computed tomography treatment tables. There are technical limitations in operation of these motors and drive systems related to magnetic interference. Piezoelectric...... actuators. Therefore, piezoelectric transformer-based power converters are used for driving piezoelectric actuator drive motor in the presence of high electromagnetic field....... actuator drive is the only form-fit continuous drive solution currently available for the development of high performance nonmagnetic motors. In this research focus will be on the non magnetic compact high efficiency driver for the piezo actuators and on employing energy recovery from the capacitive...
Adachi, Kazumasa; Yamamto, Nozomi; Yamamoto, Osami; Nakano, Tomoaki; Yamamoto, Shin
We have developed a car driver monitoring system for measuring drivers' consciousness, with which we aim to reduce car accidents caused by drowsiness of drivers. The system consists of the following three subsystems: an image capturing system with a pulsed infrared CCD camera, a system for detecting blinking waveform by the images using a neural network with which we can extract images of face and eye areas, and a system for measuring drivers' consciousness analyzing the waveform with a fuzzy inference technique and others. The third subsystem extracts three factors from the waveform first, and analyzed them with a statistical method, while our previous system used only one factor. Our experiments showed that the three-factor method we used this time was more effective to measure drivers' consciousness than the one-factor method we described in the previous paper. Moreover, the method is more suitable for fitting parameters of the system to each individual driver.
Snow, W. R.; Dunbar, R. S.; Kubby, J. A.; Oneill, G. K.
The current status of Mass Driver Two, a linear synchronous motor for accelerating payloads or reaction mass, is discussed. Mass Driver Two combines all the essential elements of an operational mass driver with the exception of bucket recirculation and payload handling. These essential elements include: magnetic flight, vacuum environment, superconducting bucket coils, high acceleration (nominally 500 g's), optical position sensing and electronic triggering, power circuitry similar to that of a flight article, and regenerative braking. Mass Driver Two is operated on a single shot basis.
This research primarily deals with truck driver stress and its nature, stressors, and their mutual relationship. During the : study, the different demands of driving that are related to roads, vehicle, traffic conditions, driver predisposition to : s...
Prasad, R S; Hunter, J; Hanley, J
To study the influence of non-standard controls on return to driving after disability, including prevalence of accidents/retraining difficulties. Postal questionnaires sent within two years of assessment to 972 disabled drivers seen over a three-year period. Scottish Driving Assessment Service. All patients considered capable of driving after assessment during the study period. Five hundred and eighty-nine people (61 %) replied who were representative of the total population (mean age 55 years, range 19-87); 73% were male and 70% were disabled for up to two years. Overall 79% respondents had returned to driving (highest reported success with standard manual car (86%) and lowest using left foot to accelerate and brake (66%) (chi2 = 16.6, P = 0.005)). A significantly higher proportion of the 30 patients (6.5%) admitting to accidents and 25 (5.4%) to problems with retraining were using non-standard driving techniques, especially the use of hand controls. Disabled drivers returning to drive using non-familiar controls had lower success and a higher proportion of accidents and/or problems with retraining than people using conventional controls. If confirmed in larger studies this may have implications for policy-makers as well as specialist practitioners.
Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.
Full Text Available So far, Brain-Machine Interfaces (BMIs have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals. To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training and one movement-free condition (BMI motor imagery task are compared to perform this study.Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions.
Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M.
So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601
Czerniecki, Joseph M; Morgenroth, David C
Amputation results in reduced mobility and contributes to reduced quality of life. The increased metabolic cost of ambulation has been suggested as an important contributor to reduced mobility in this population. Current research on the metabolic energy expenditure of ambulation will be critically reviewed from the perspectives of ecological validity of the research methods and the relative contribution to functional improvement in amputees. Recommendations will be made regarding possible future directions for research and their potential clinical utility. Narrative review. The methods used to quantify metabolic energy expenditure of amputee ambulation do not emulate typical mobility conditions that amputees experience. Amputee mobility is characterized by short bouts of activity with starting, stopping and changes of direction. This is opposed to the typical metabolic testing protocol that requires at least 5 min of steady state linear walking on a treadmill. These studies, therefore, have limitations in ecological validity and therefore limitations in the extent to which they accurately reflect the effect of amputation level, amputation etiology and prosthetic components on energy consumption during walking. Further, the broader perspective on outcomes after dysvascular amputation and sports participation limitations, raises questions about the relative importance of improving metabolic costs and its potential effect on improving mobility in amputees. The greatest potential clinical impact of future research requires methods with improved ecological validity, and the ability to translate metabolic energy expenditure outcomes into functional terms that are meaningful to both clinicians and patients. Implications for Rehabilitation The search for objective measurements to define the effects of amputation on outcome and the consequences of prosthetic components on mobility has focused in part on the use of study designs incorporating metabolic measurement. However
Anund, A.; Ihlström, J.; Fors, C.; Kecklund, L.G.; Filtness, A.J.
Driver fatigue has received increased attention during recent years and is now considered to be a major contributor to approximately 15-30% of all crashes. However, little is known about fatigue in city bus drivers. It is hypothesized that city bus drivers suffer from sleepiness, which is due to a
Full Text Available Nowadays, anger while driving on the road is a crucial issue in Malaysia. The anger of driver may lead to traffic crashes. Road accident issue is an important agenda in every country. Driver behaviour and attitude such as impatience, hasty and hot-tempered on the road has become one of the causes in road accidents. Uncontrolled anger will affect the behavior of oneself during driving and could cause an individual to display aggressive attitude. Therefore, this study is aimed to identify contributing factor in anger of drivers and evaluate the Driver Anger Scale (DAS in Batu Pahat, Johor. In addition, this study also analyzes the relationship between driver anger and the factor of DAS. Cross sectional study method was conducted in this study by distributing 250 questionnaires to car drivers. The data collectied was analyzed by descriptive, chi-square test, correlation and regression analysis using Statistical Package for Social Sciences (SPSS version 20.0. The findings show that the discourtesy was reported as the most dominant factor contributing to driver anger. As a recommendation, to overcome driver anger issue, the authorities should prepare an action plan, promote and nurture public to practice good driving behaviour. Moreover, curriculum and driver training lesson should be improved to create better attitude among drivers. Drivers also should change their driving attitude by becoming safe drivers and exhibiting defensive driving skills on the road.
Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca
The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.
Otimização da localização das bases de ambulâncias e do dimensionamento das suas regiões de cobertura em rodovias Optimizing the location of ambulance bases and the districting of their covering regions on highways
Ana Paula Iannoni
Full Text Available Neste artigo combinamos extensões do modelo hipercubo de filas com algoritmos genéticos para otimizar a configuração e operação de sistemas médicos emergenciais em rodovias. Inicialmente apresentamos um método para localizar as bases de ambulâncias ao longo da rodovia, de forma a otimizar as principais medidas de desempenho do sistema. Em seguida estendemos a abordagem para apoiar duas decisões combinadas: a localização das bases de ambulâncias e o dimensionamento das regiões de cobertura de cada base na rodovia. Por exemplo, a abordagem permite determinar os locais para posicionar as bases de ambulâncias e dimensionar os tamanhos das suas áreas de atuação, tais que minimizem o tempo médio de resposta aos usuários e/ou o desbalanceamento das cargas de trabalho das ambulâncias do sistema. Para ilustrar a aplicação dos métodos propostos, analisamos os resultados de dois estudos de caso em rodovias brasileiras.In this paper we combine extensions of the hypercube queueing model with genetic algorithms to optimize the configuration and operation of emergency medical systems on highways. Initially we present a method to locate the ambulance bases along the highway so that the main system performance measures are optimized. Then we extend the approach to support combined decisions: the location of ambulance bases and the districting of the covering regions of each base on the highway. For instance, the approach can search for locals to place the ambulance bases and determine the sizes of their operation areas, such that the mean user response time and/or the ambulance workload imbalance are minimized. To illustrate the application of the proposed methods, we analyze the results of two case studies of Brazilian highways.
Oberscheider, Marco; Hirsch, Patrick
Efficient transport of non-emergency patients is crucial for ambulance service providers to cope with increased demand resulting from aging Western societies. This paper deals with the optimization of the patient transport operations of the Red Cross of Lower Austria, which is the main provider in this state. Different quality levels of the provided service - expressed by time windows, feasible maximum ride times and exclusive transports - are tested and analyzed on real-life instances to show daily impacts on the provider's resources. Comparisons of the developed solution approach to the recorded manual schedule prove its advantages. In contrast to previous work in this field, non-static service times that depend on the combination of patients, their transport mode, the vehicle type as well as the pickup or delivery locations are used. These service times are based on statistical analyses that have been performed on an anonymized dataset with more than 600,000 requests. To solve the given problem, a matheuristic solution approach was developed that deals with the exact optimization of combinations of requests as a first stage. Subsequently, the identified combinations are used as an input into a Tabu Search strategy, where the vehicle routing is optimized. Three representative days of the year 2012 were chosen for the four regions of Lower Austria to test five different service levels and the quality of the solution method. For the standard scenario, the operation time of the manual schedule is reduced in the range from 14.1 % to 19.8 % for all tested instances. Even in the best service scenario, the matheuristic computes better results than the manual schedule. The service level has a high impact on the operation time of providers. The relative savings that are achieved by the algorithm are significantly lowered by introducing higher quality standards. The main reason is that less feasible combinations of patients can be generated. This leads to diminished
The problem of driver scheduling involves the construction of a legal set of shifts, including allowance : of overtime, which cover the blocks in a particular vehicle schedule. A shift is the work scheduled to be performed by : a driver in one day, w...
This paper summarizes an evaluation of the Driver Assist System (DAS) used by the Minnesota Valley Transit Authority (MTVA) for bus shoulder operations. The DAS is a GPS-based technology suite that provides lane-position feedback to the driver via a ...
Successful school bus drivers bring much more than mechanical know-how to the job. They develop good rapport with students while acting to bring undesirable student behavior under control. Drivers must also show an interest in students' welfare and have a good sense of humor. (MLH)
BMW, Daimler, Audi, Citroen, Lexus, VW, Opel, Peugeot, Renault, Chevrolet, Saab and Bosch. Both the contributions of research work concerning driving behavior analysis and driver assistance systems have to be aligned with a permanently updated interaction within the system of driver, vehicle and road traffic environment.
Wallace, Bilby J.
Tool combines impact driver with sliding dead-blow hammer. Used for any purpose for which ordinary impact driver used; tightening fasteners or driving starter holes for drill. Tool protects user from accidental injury and surrounding equipment from damage that might occur from ordinary arm-wielded hammer. Especially useful in underwater work.
Geer, S.; /Fermilab
In 2004 the Fermilab Long Range Planning Committee identified a new high intensity Proton Driver as an attractive option for the future, primarily motivated by the recent exciting developments in neutrino physics. Over the last few months a physics study has developed the physics case for the Fermilab Proton Driver. The potential physics opportunities are discussed.
... 49 Transportation 2 2010-10-01 2010-10-01 false Driver training. 177.816 Section 177.816... Information and Regulations § 177.816 Driver training. (a) In addition to the training requirements of § 177... employee who will operate a motor vehicle has been trained in the applicable requirements of 49 CFR parts...
The Driver/Carrier Relationship Project was commissioned to address three issues. The first was to determine if drivers of commercial motor vehicles get tickets at a different rate, depending on the carrier that they are working for. The second issue...
The percentage of drivers text-messaging or visibly manipulating : hand-held devices increased from 1.5 percent in : 2012 to 1.7 percent in 2013; however, this was not a statistically : significant increase. Driver hand-held cell phone : use decrease...
Wollina, Uwe; Tchernev, Georgi; Lotti, Torello
Frictional hypermelanosis is an uncommon finding in Caucasians. We report the unusual case of 56-year-old male courier driver who developed linear and patchy hypermelanosis of the back caused by the driver's seat. Histology has included other pathologies. Treatment of the asymptomatic hyper pigmentation was not warranted.
Lobanova, Yuliya I.; Glushko, Kirill V.
The article points at the importance of studying the human factor as a cause of accidents of drivers, especially in loosely structured traffic situations. The description of the experiment on the measurement of driver's accidental abilities is given. Under accidental ability is meant the capability to ensure the security of driving as a behavior…
This processor has been designed for very fast data acquisition and date pre-processing. The dataway and branch highway speeds have been optimized for approximately 1.5 mu sec. The internal processor cycle is approximately 0.8 mu sec. The standard version contains the following functions (slots): crate controller type A1; branch highway driver including terminator; serial I/O port (TTY, VDU); 24 bit ALU and 24 bit program counter; 16 bit memory address counter and 4 word stack; 4k bit memory for program and/or data; battery backup for the memory; CNAFD and crate LAM display; request/grant logic for time- sharing operation of several BDCs. The free slots can be equipped with e.g. extra RAM, computer interfaces, hardware multiplier/dividers, etc. (0 refs).
Jensen, Kristine Engemann
, and these results highlight that even large-scale vegetation patterns can be influenced by climate change and anthropogenic pressures. In Paper III we investigate how sampling bias in botanical dataset can influence patterns of species richness and parameter estimation from statistical analyses. We test...... moredistinct. Climate change, forest fires, and forest loss were identified as the most important drivers of forest alpha and beta diversity change over time. In Paper VI we utilize a new concept in community ecology, dark diversity, to quantify the effect of present and historical environmental factors...... on species diversity in the European Alps using monitoring data from the Alps Vegetation Database. We identified grassland and rocky habitats to have the highest dark diversity intensified by high human influence. We conclude that dark diversity is a valuable conservation tool that can guide conservation...
Oneill, G. K.; Kolm, H. H.
High-acceleration mass drivers are discussed including the MD2 model of axial geometry, with individually powered drive coils of 13.1 cm diameter. Timing is derived through the interruption of light beams by the moving armature (bucket). Electric power is provided by the resonant discharge of sector capacitor banks through silicon-controlled rectifiers in a two-phase, quadrature circuit. The bucket flies in vacuum, guided by passive dynamic eddy-current magnetic forces, those currents flowing in strip conductors lining the inside of a nonconducting vacuum pipe. Quantitative measurements are obtained with a solid bucket carrying two superconducting coils with a current density of 25 kA/sq cm. A cryogenic station for cooling the bucket to liquid helium temperature is connected to the vacuum pipe.
Kim, A. A.; Mazarakis, M. G.; Sinebryukhov, V. A.; Volkov, S. N.; Kondratiev, S. S.; Alexeenko, V. M.; Bayol, F.; Demol, G.; Stygar, W. A.
The linear transformer driver (LTD) technological approach can result in relatively compact devices that can deliver fast, high current, and high-voltage pulses straight out of the LTD cavity without any complicated pulse forming and pulse compression network. Through multistage inductively insulated voltage adders, the output pulse, increased in voltage amplitude, can be applied directly to the load. The usual LTD architecture [A. A. Kim, M. G. Mazarakis, V. A. Sinebryukhov, B. M. Kovalchuk, V. A. Vizir, S. N Volkov, F. Bayol, A. N. Bastrikov, V. G. Durakov, S. V. Frolov, V. M. Alexeenko, D. H. McDaniel, W. E. Fowler, K. LeCheen, C. Olson, W. A. Stygar, K. W. Struve, J. Porter, and R. M. Gilgenbach, Phys. Rev. ST Accel. Beams 12, 050402 (2009)PRABFM1098-440210.1103/PhysRevSTAB.12.050402; M. G. Mazarakis, W. E. Fowler, A. A. Kim, V. A. Sinebryukhov, S. T. Rogowski, R. A. Sharpe, D. H. McDaniel, C. L. Olson, J. L. Porter, K. W. Struve, W. A. Stygar, and J. R. Woodworth, Phys. Rev. ST Accel. Beams 12, 050401 (2009)PRABFM1098-440210.1103/PhysRevSTAB.12.050401] provides sine shaped output pulses that may not be well suited for some applications like z-pinch drivers, flash radiography, high power microwaves, etc. A more suitable power pulse would have a flat or trapezoidal (rising or falling) top. In this paper, we present the design and first test results of an LTD cavity that generates such a type of output pulse by including within its circular array a number of third harmonic bricks in addition to the main bricks. A voltage adder made out of a square pulse cavity linear array will produce the same shape output pulses provided that the timing of each cavity is synchronized with the propagation of the electromagnetic pulse.
Allen, R. W.
In steering an automobile, the driver must basically control the direction of the car's trajectory (heading angle) and the lateral deviation of the car relative to a delineated pathway. A previously published linear control model of driver steering behavior which is analyzed from a stability point of view is considered. A simple approximate expression for a stability parameter, phase margin, is derived in terms of various driver and vehicle control parameters, and boundaries for stability are discussed. A field test study is reviewed that includes the measurement of driver steering control parameters. Phase margins derived for a range of vehicle characteristics are found to be generally consistent with known adaptive properties of the human operator. The implications of these results are discussed in terms of driver adaptive behavior.
Hansen, Claus D; Rasmussen, Kurt; Kyed, Morten
Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance......,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self...... with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands....
Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Campodonico, Francesca
Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts. © The Author(s) 2016.
Full Text Available South Africa has one of the highest incidences of road accidents in the world. Most accidents are avoidable and are caused by driver behaviour and errors. The purpose of this article was to identify the riskiest driver behaviours in commercial fleets in South Africa, to determine the business impact of such behaviour, to establish a framework for the management of risky driver behaviour and to test the framework by applying a leading commercial driver behaviour management system as a case study. The case study comprised three South African commercial fleets. Using data from these fleets, critical incident triangles were used to determine the ratio data of risky driver behaviour to near-collisions and collisions. Based on managing the riskiest driver behaviours as causes of more serious incidents and accidents, the results indicated that through the implementation of an effective driver risk management system, risky incidents were significantly reduced.
Andreeva, Elena O.; Aarabi, Parham; Philiastides, Marios G.; Mohajer, Keyvan; Emami, Majid
This paper proposes a multi-modal sensor fusion algorithm for the estimation of driver drowsiness. Driver sleepiness is believed to be responsible for more than 30% of passenger car accidents and for 4% of all accident fatalities. In commercial vehicles, drowsiness is blamed for 58% of single truck accidents and 31% of commercial truck driver fatalities. This work proposes an innovative automatic sleep-onset detection system. Using multiple sensors, the driver"s body is studied as a mechanical structure of springs and dampeners. The sleep-detection system consists of highly sensitive triple-axial accelerometers to monitor the driver"s upper body in 3-D. The subject is modeled as a linear time-variant (LTV) system. An LMS adaptive filter estimation algorithm generates the transfer function (i.e. weight coefficients) for this LTV system. Separate coefficients are generated for the awake and asleep states of the subject. These coefficients are then used to train a neural network. Once trained, the neural network classifies the condition of the driver as either awake or asleep. The system has been tested on a total of 8 subjects. The tests were conducted on sleep-deprived individuals for the sleep state and on fully awake individuals for the awake state. When trained and tested on the same subject, the system detected sleep and awake states of the driver with a success rate of 95%. When the system was trained on three subjects and then retested on a fourth "unseen" subject, the classification rate dropped to 90%. Furthermore, it was attempted to correlate driver posture and sleepiness by observing how car vibrations propagate through a person"s body. Eight additional subjects were studied for this purpose. The results obtained in this experiment proved inconclusive which was attributed to significant differences in the individual habitual postures.
An evaluation of the Parent-Taught Driver Education (PTDE) program in Texas was conducted using three different research techniques: (1) focus groups with driver education instructors, teen drivers, and their parents; (2) statewide mail survey of you...
Jaldell, Henrik; Lebnak, Prachaksvich; Amornpetchsathaporn, Anurak
To calculate the monetary value of the time factor per minute and per year for emergency services. The monetary values for ambulance emergency services were calculated for two different time factors, response time, which is the time from when a call is received by the emergency medical service call-taking center until the response team arrives at the emergency scene, and operational time, which includes the time to the hospital. The study was performed in two steps. First, marginal effects of reduced fatalities and injuries for a 1-minute change in the time factors were calculated. Second, the marginal effects and the monetary values were put together to find a value per minute. The values were found to be 5.5 million Thai bath/min for fatality and 326,000 baht/min for severe injury. The total monetary value for a 1-minute improvement for each dispatch, summarized over 1 year, was 1.6 billion Thai baht using response time. The calculated values could be used in a cost-benefit analysis of an investment reducing the response time. The results from similar studies could for example be compared to the cost of moving an ambulance station or investing in a new alarm system. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Joseph H. Schwab
Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.
Sommers, Juultje; Wieferink, Denise C; Dongelmans, Dave A; Nollet, Frans; Engelbert, Raoul H H; van der Schaaf, Marike
Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in critically ill patients in the ICU. A custom build bedside Body Weight-Supported Treadmill was used and evaluated in medical and surgical patients in the ICU. Feasibility was evaluated according to eligibility, successful number of BWSTT, number of staff needed, adverse events, number of patients that could not have walked without BWSTT, patient satisfaction and anxiety. Twenty participants, underwent 54 sessions BWSTT. Two staff members executed the BWSTT and no adverse events occurred. Medical equipment did not have to be disconnected during all treatment sessions. In 74% of the sessions, the participants would not have been able to walk without the BWSTT. Patient satisfaction with BWSTT was high and anxiety low. This proof of concept study demonstrated that BWSTT is safe, reduces staff resource, and facilitates the first time to ambulation in critically ill patients with severe muscle weakness in the ICU. Copyright © 2017 Elsevier Inc. All rights reserved.
Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.
A. A. Kim
Full Text Available The linear transformer driver (LTD technological approach can result in relatively compact devices that can deliver fast, high current, and high-voltage pulses straight out of the LTD cavity without any complicated pulse forming and pulse compression network. Through multistage inductively insulated voltage adders, the output pulse, increased in voltage amplitude, can be applied directly to the load. The usual LTD architecture [A. A. Kim, M. G. Mazarakis, V. A. Sinebryukhov, B. M. Kovalchuk, V. A. Vizir, S. N Volkov, F. Bayol, A. N. Bastrikov, V. G. Durakov, S. V. Frolov, V. M. Alexeenko, D. H. McDaniel, W. E. Fowler, K. LeCheen, C. Olson, W. A. Stygar, K. W. Struve, J. Porter, and R. M. Gilgenbach, Phys. Rev. ST Accel. Beams 12, 050402 (2009PRABFM1098-440210.1103/PhysRevSTAB.12.050402; M. G. Mazarakis, W. E. Fowler, A. A. Kim, V. A. Sinebryukhov, S. T. Rogowski, R. A. Sharpe, D. H. McDaniel, C. L. Olson, J. L. Porter, K. W. Struve, W. A. Stygar, and J. R. Woodworth, Phys. Rev. ST Accel. Beams 12, 050401 (2009PRABFM1098-440210.1103/PhysRevSTAB.12.050401] provides sine shaped output pulses that may not be well suited for some applications like z-pinch drivers, flash radiography, high power microwaves, etc. A more suitable power pulse would have a flat or trapezoidal (rising or falling top. In this paper, we present the design and first test results of an LTD cavity that generates such a type of output pulse by including within its circular array a number of third harmonic bricks in addition to the main bricks. A voltage adder made out of a square pulse cavity linear array will produce the same shape output pulses provided that the timing of each cavity is synchronized with the propagation of the electromagnetic pulse.
Full Text Available The paper deals with the issue of fatigue and sleepiness behind the wheel, which for a long time has been of vital importance for the research in the area of driver-car interaction safety. Numerous experiments on car simulators with diverse measurements to observe human behavior have been performed at the laboratories of the faculty of the authors. The paper provides analysis and an overview and assessment of the subjective (self-rating and observer rating methods for observation of driver behavior and the detection of critical behavior in sleep deprived drivers using the developed subjective rating scales.
Agerholm, Niels; Tradisauskas, Nerius; Juhl, Jens
and warning, the ISA had an incentive in the form of rewards for speeding avoidance and social control - the latter, however, did not work sufficiently. When a key ID was used, the proportion of speeding was low while driving with ISA. Without key ID there was virtually no change in driving behaviour...... regardless of ISA. Also, a statistical model showed that drivers sensitive to ISA sped significantly less in baseline than insensitive dri- vers. Moreover, on the basis of questionnaires it was found that drivers could be categorised as either green drivers (not positive to speeding) or red (more positive...
Andersen, Thomas Timm
In this report I will examine both the current and the possible performance of one of the most popular robotics platforms in research, the Universal Robot manipulator. I will solely focus on the ROS based approaches and show how the current driver can be improved. I will look at performance...... improvement both in terms of faster reaction as well as making it possible to control the robot using either ros_control or ordinary joint speed commands, which is required for many types of sensory based control like visual servoing. The developed driver is compared to the drivers already existing in the ROS...
In recent years, camera-based driver assistance systems have taken an important step: from laboratory setup to series production. This tutorial gives a brief overview on the technology behind driver assistance systems, presents the most significant functionalities and focuses on the processes of developing camera-based systems for series production. We highlight the critical points which need to be addressed when camera-based driver assistance systems are sold in their thousands, worldwide - and the benefit in terms of safety which results from it.
Lawall, Julia Laetitia; Muller, Gilles; Urunuela, Richard
The Linux operating system is undergoing continual evolution. Evolution in the kernel and generic driver modules often triggers the need for corresponding evolutions in specific device drivers. Such collateral evolutions are tedious, because of the large number of device drivers, and error......-prone, because of the complexity of the code modifications involved. We propose an automatic tool, Tarantula, to aid in this process. In this paper, we examine some recent evolutions in Linux and the collateral evolutions they trigger, and assess the corresponding requirements on Tarantula....
Martinussen, Laila Marianne; Møller, Mette; Prato, Carlo Giacomo
by frequency of aberrant driving behaviors and level of driving skills), as well as to test whether the sub-groups differ in characteristics such as age, gender, annual mileage and accident involvement. Furthermore, the joint analysis of the two instruments was used to test drivers’ assessment of their own...... self-reported driving skills and whether the reported skill level was reflected in the reported aberrant driving behaviors. 3908 drivers aged 18–84 participated in the survey. K-means cluster analysis revealed four distinct sub-groups that differed in driving skills and frequency of aberrant driving......The Driver Behavior Questionnaire and the Driver Skill Inventory are two of the most frequently used measures of self-reported driving style and driving skill. The motivation behind the present study was to identify sub-groups of drivers that potentially act dangerously in traffic (as measured...
Maasalo, Ida; Lehtonen, Esko; Pekkanen, Jami; Summala, Heikki
Studies based on accident statistics generally suggest that the presence of a passenger reduces adult drivers' accident risk. However, passengers have been reported to be a source of distraction in a remarkable portion of distraction-related crashes. Although the effect of passengers on driving performance has been studied extensively, few studies have focused on how a child passenger affects the driver. A child in a car is a potential distractor for parents, especially for mothers of small children, who often suffer from sleep deficit. The aim of this study was to examine how the presence of child passengers of different ages is associated with a higher driver culpability, which was expected due to child-related distraction and fatigue. The analysis was based on the comprehensive data of fatal crashes studied in-depth by multidisciplinary road accident investigation teams in Finland during 1988-2012. Teams determine the primary party who had the most crucial effect on the origin of the event. We define the primary party as culpable and the others involved as nonculpable drivers. The culpability rate was defined as the percentage of culpable drivers and rates were compared for drivers with a child/teen passenger aged 0-17 years (N = 348), with an adult passenger without children (N = 324), and when driving alone (N = 579), grouped by child age and driver gender. Drivers with specific risk-related behavior (substantial speeding, driving when intoxicated, unbelted, or without a license) were excluded from the analyses, in order to make the drivers with and without children comparable. Only drivers 26-47 years old were included, representing parents with children 0-9 years of age. Male drivers were less often culpable with 0- to 17-year-old passengers in the car than alone or with adults. This was not the case with female drivers. The gender difference in culpability was most marked with small children age 0-4 years. Female drivers' culpability rate with a 0
Bieri, R.; Meier, W.
Parametric studies to optimize heavy-ion driver designs are described and an optimized 5 MJ driver design is described. Parametric studies are done on driver parameters including driver energy, number of beams, type of superconductor used in focusing magnets, maximum magnetic field allowed at the superconducting windings, axial quadrupole field packing fraction, ion mass, and ion charge state. All modeled drivers use the maximum beam currents allowed by the Maschke limits; driver scaling is described in a companion paper. The optimized driver described is conservative and cost effective. The base driver direct costs are only $120/Joule, and the base driver uses no recirculation, beam combination, or beam separation. The low driver cost achieved is due, in part, to the use of compact Nb 3 Sn quadrupole arrays, but results primarily from optimization over the large, multi-dimensional, parameter space available for heavy-ion drivers
National Aeronautics and Space Administration — The program leverages on our extensive expertise in developing high-performance driver ASICs for deformable mirror systems and seeks to expand the capacities of the...
National Aeronautics and Space Administration — Explore a variant of the linear transformer driver (LTD) concept being developed by Sandia Laboratories and University of Michigan, with the following differences:...
While data focusing on the danger of driving under the influence : of alcohol is readily available and often cited, less is : known or discussed about drivers under the influence of : other drugs. The Fatality Analysis Reporting System (FARS), : a ce...
Full Text Available Sight is the basic sense for drivers. Condition of the eye determines correct, comfortable and safe performance of the work as drivers. This article presents various factors influencing the sight condition. There are two groups of factors, external (environment, the kind and time of work, stress caused by work and internal (systemic and local disorders. All these factors can reduce significantly visual functions, such as visual acuity, field of vision, color vision, strereoscopic vision, twilight vision and glare sensitivity. There are also presented actual requirements for drivers and causes of the car accidents in various age groups. Impairments in vision functions can be dangerous for both the driver and other road users. Med Pr 2013;64(3:419–425
Huffman, Warren J.; Thompson, Adelbert F.
Several arguments for and against driver education and safety programs in the schools are summarized. The validity of the statistics used by opponents is questioned and evidence in support of such programs are outlined. (JMF)
Bus transit agencies are required to hire extraboard (i.e. back-up) operators to account for unexpected absences. Incorrect sizing of extra driver workforce is problematic for a number of reasons. Overestimating the appropriate number of extraboard o...
This project evaluated the effectiveness of symbol traffic signs for young, middle-aged and elderly drivers. Daytime legibility distance and comprehension of 85 symbols in the Manual on Uniform Traffic Control Devices (MUTCD) were measured. Legibilit...
Padioleau, Yoann; Lawall, Julia Laetitia; Muller, Gilles
, as any changes in the interfaces exported by the kernel and driver support libraries can trigger a large number of adjustments in dependent drivers. These adjustments, which we refer to as collateral evolutions, may be complex, entailing substantial code reorganizations. As to our knowledge there exist...... no tools to help in this process, collateral evolution is thus time consuming and error prone.In this paper, we present a qualitative and quantitative assessment of collateral evolution in Linux device driver code. We provide a taxonomy of evolutions and collateral evolutions, and use an automated patch......-analysis tool that we have developed to measure the number of evolutions and collateral evolutions that affect device drivers between Linux versions 2.2 and 2.6. In particular, we find that from one version of Linux to the next, collateral evolutions can account for up to 35% of the lines modified in such code....
In April of 1980, a joint decision between Research Council personnel and representatives of the Department of Education was reached, and a project was undertaken by the Research Council to provide a software system to process the annual Driver Educa...
In light of Delawares growing population age 60 and older (60+), it is important to plan for the : states projected increase in older drivers. Information from the United States Census Bureau : (2005) indicates that Delaware is projected to hav...
In theory, the designated-driver concept holds great promise for reducing the incidences of drunk driving. It is simple, inexpensive, almost universally recognized, and generally positively regarded by the U.S. population as a means for avoiding drun...
Palmer, Fred; Denvir, Kerry; Allen, Steven
A driver circuit for a light source including one or more solid state light sources, a luminaire including the same, and a method of so driving the solid state light sources are provided. The driver circuit includes a rectifier circuit that receives an alternating current (AC) input voltage and provides a rectified AC voltage. The driver circuit also includes a switching converter circuit coupled to the light source. The switching converter circuit provides a direct current (DC) output to the light source in response to the rectified AC voltage. The driver circuit also includes a mixing circuit, coupled to the light source, to switch current through at least one solid state light source of the light source in response to each of a plurality of consecutive half-waves of the rectified AC voltage.
Littenberg, Benjamin; Lubetkin, Derek
Objectives:?Driver?s license records in the United States typically contain age, sex, height, weight, and home address. By combining the body mass index (calculated from the reported height and weight) and address information, researchers can explore and quantify the relationships between obesity and specific environmental features surrounding the place of residence. We report here our experience obtaining those data and the current state of driver?s license data as an epidemiological resourc...
Full Text Available Drivers typically are less susceptible to motion sickness than passengers. The influence of vehicle control has theoretical implications for the etiology of motion sickness, and has practical implications for the design of virtual environments. In the present study, participants either controlled or did not control a nonvehicular virtual avatar (i.e., an ambulatory character in a console video game. We examined the incidence of motion sickness and patterns of movement of the head and torso as participants either played or watched the game. Motion sickness incidence was lower when controlling the virutal avatar than when watching an avatar that was controlled by someone else. Patterns of head and torso movement differed between particpants who did and did not control the avatar. Indepenently, patterns of movement differed between participants who reported motion sickness and those who did not. The results suggest that motion sickness is influenced by control of stimulus motion, whether that motion arises from a vehicle or from any other source. We consider implications for the design of humancomputer interfaces.
Linda Hui Shi; J Chris White; Shaoming Zou; S Tamer Cavusgil
Global account management (GAM) has become a vital part of many multinational enterprises’ global marketing. Yet little is known about successful GAM strategies. In this study, we conceptualize GAM strategies, and develop and empirically test an integrated theoretical model that links GAM strategies to their drivers and outcomes. We find that: (1) global strategic priority and globalization are significant drivers of four GAM strategies – inter-country coordination, inter-organizational coord...
Ghoneim, Youssef A.
This paper discusses a concept for enhanced active safety by introducing a driver warning system based on vehicle dynamics that predicts a potential loss of control condition prior to stability control activation. This real-time warning algorithm builds on available technologies such as the Electronic Stability Control (ESC). The driver warning system computes several indices based on yaw rate, side-slip velocity, and vehicle understeer using ESC sensor suite. An arbitrator block arbitrates b...
Cohen, R.H., E-mail: firstname.lastname@example.org [Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, CA 94550 (United States); Heavy Ion Fusion Science Virtual National Laboratory (United States)
We review some previous results on electron-cloud dynamics and accumulation and the impact of electron clouds on ion beam dynamics, and assess these in the context of a magnetic-quadrupole-based heavy-ion fusion driver. We present a new analysis which exploits analytic solution of linearized envelope equations between accelerating gaps to derive a set of mapping equations which we use to extrapolate from previously obtained particle-simulation results for a beam transport system to an HIF driver.
Skurtveit, Svetlana; Abotnes, Bjørg; Christophersen, Asbjørg S
Norwegian drugged drivers with benzodiazepine (BZD) detections have been studied with regard to drug use pattern and rearrest rate. During 1995, 3343 drivers were apprehended by the police in Norway due to the suspicion of influence by drugs. Blood samples from all drivers were sent to the National Institute of Forensic Toxicology (NIFT). The samples were analysed using a standard program covering the most commonly abused drugs on the marked in Norway. BZDs, representing some of the most frequently detected drugs, were found in approximately 30% (n = 1051) of the cases, represented by 14% (n = 150) female and 86% (n = 901) male drivers. In 8% of the cases, one BZD only was detected, half of these cases with one BZD could reflect therapeutic use. One or more BZDs were combined with illegal drug(s) (73%), other prescribed drugs (10%), and/or alcohol (24%). 62% of the drivers with BZD detections, had earlier been arrested for the same offence, or six cases per rearrested driver. The frequency of earlier arrests were lower for female (34%) than for male (67%) drivers. Alcohol was most frequently found for those arrested for the first time before 1992, while BZD or illegal drugs were most frequently found for those with their first arrest during 1992-1995. Our study shows that apprehended drivers using BZD are mainly represented by drug abusers due to frequent multi-drug use, blood concentrations representing doses above therapeutic levels and high rearrest rate for the same offence. A treatment program or other reactions, are thus necessary in addition to fines, prison penalty and suspension of driving licence.
In 2004, motivated by the recent exciting developments in neutrino physics, the Fermilab Long Range Planning Committee identified a new high intensity Proton Driver as an attractive option for the future. At the end of 2004 the APS ``Study on the Physics of Neutrinos'' concluded that the future U.S. neutrino program should have, as one of its components, ``A proton driver in the megawatt class or above and neutrino superbeam with an appropriate very large detector capable of observing CP viol...
Vles, G.F.; Soudant, D.L.; Hoving, M.A.; Vermeulen, R.J.; Bonouvrié, L.A.; van Oostenbrugge, R.J.; Vles, J.S.
Background: Little is known about the long-term effects of Continuous intrathecal Baclofen (CITB) therapy in non-ambulant children with intractable spastic Cerebral Palsy (CP). Aim: To determine whether short-term beneficial effects of CITB therapy are present at the long-term, and whether
Paul, Serene S; Harvey, Lara; Carroll, Therese; Li, Qiang; Boufous, Soufiane; Priddis, Annabel; Tiedemann, Anne; Clemson, Lindy; Lord, Stephen R; Muecke, Sandy; Close, Jacqueline Ct; Lo, Serigne; Sherrington, Catherine
Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Retrospective population-based descriptive study. Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.
Serene S Paul
Full Text Available Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW, Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Study type: Retrospective population-based descriptive study. Methods: Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. Results: There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753 were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%. Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively. Conclusions: Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.
Full Text Available Abstract Background We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. Results In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Conclusions Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent. Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob
In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), pMobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Bolster, E.A.M.; van Schie, P.E.M.; Becher, J.G.; van Ouwerkerk, W.J.R.; Strijers, R.L.M.; Vermeulen, R.J.
Aim: The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles. Method: The study used a prospective cohort design and participants
Armstrong, Stephanie; Langlois, Adele; Laparidou, Despina; Dixon, Mark; Appleton, Jason P; Bath, Philip M; Snooks, Helen; Siriwardena, A Niroshan
We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent). Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.
This project evaluates the effectiveness of a multistage driver education program for Montanas young : drivers. A total of 347 teenaged drivers who had completed high school driver education agreed to participate. : These drivers were randomly spl...
From 1 July 2012, any driver of a motorised road vehicle, excluding two- or three-wheeled vehicles whose engine capacity does not exceed 50cm3, must be in possession of a breathalyser in full working order. With effect from 1 November 2012*, drivers failing to produce a breathalyser run the risk of being served with an 11 euro fine. A breathalyser is used to measure the alcohol content in the motorist's breath. The permissible level of alcohol for drivers is less than 0.5 g of alcohol per litre of blood, or 0.25 mg of alcohol per litre of air exhaled. The obligation to have a breathalyser on board the vehicle also applies to all drivers on the French part of the CERN site. All vehicles belonging to or leased by the Organization must also carry a breathalyser together with all the requisite documentation (cf. Operational Circular No. 4). Drivers of privately owned vehicles can obtain breathalysers from car accessory dealers, service stations or pharmacies, etc. Drivers of vehicles belonging to or l...
Stasolla, Fabrizio; Caffò, Alessandro O; Perilli, Viviana; Boccasini, Adele; Stella, Anna; Damiani, Rita; Albano, Vincenza; Damato, Concetta
We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid. © 2017 Society for the Experimental Analysis of Behavior.
The Emergency Medical Video Multiplexing Transport System (EMTS) is designed to support prehospital cares by delivering high quality live video streams of patients in an ambulance to emergency doctors in a remote hospital via satellite communications. The important feature is that EMTS divides a patient's live video scene into four pieces and transports the four video streams on four separate network channels. By multiplexing four video streams, EMTS is able to transport high quality videos through low data transmission rate networks such as satellite communications and cellular phone networks. In order to transport live video streams constantly, EMTS adopts Real-time Transport Protocol/Real-time Control Protocol as a network protocol and video stream data are compressed by Moving Picture Experts Group 4 format. As EMTS combines four video streams with checking video frame numbers, it uses a refresh packet that initializes server's frame numbers to synchronize the four video streams.
The purpose of this study was to evaluate the knowledge of normal tyre pressures and tyre care among motor vehicle drivers in Benin City. Three hundred and one drivers were interviewed consisting of 273 males and 28 females. There were 100 private and 201 commercial drivers. Of the 100 private drivers 67 use brand ...
Olson, C.C. [Sandia National Labs., Albuquerque, NM (United States); Lee, E. [Lawrence Berkeley Lab., CA (United States); Langdon, B. [Lawrence Livermore National Lab., CA (United States)
This report contains research in the following areas related to beam transport for a common ion driver: multi-gap acceleration; neutralization with electrons; gas neutralization; self-pinched transport; HIF and LIF transport, and relevance to common ion driver; LIF and HIF reactor concepts and relevance to common ion driver; atomic physics for common ion driver; code capabilities and needed improvement.
The ages of drivers, service period of vehicles, and pavement conditions were also obtained by interviewing the drivers. A model of cumul-ative response times of driver-vehicle-road interaction developed indicated that TMT was contributed by the interactions of driver perception-reaction time, steering time and vehicle ...
Francinaldo do Monte Pinto
Full Text Available Objetivo: analisar a atividade dos motoristas de ambulância do Serviço Móvel de Urgência (SAMU. Métodos: foi empregada a perspectiva ergológica, que se opera a partir da concepção de vida-saúde-doença postulada por George Canguilhem, e a Ergonomia da Atividade. Foram realizadas onze entrevistas dialógicas com motoristas da Unidade de Terapia Intensiva Móvel, em 2010, no estado da Paraíba. Resultados: os motoristas atribuem as principais dificuldades para realizar o trabalho ao modo de organização prescrita do trabalho no SAMU, à gestão temporal da atividade, à atividade no trânsito, à relação com a população usuária e ao risco de contrair doenças. Em contraposição, os motoristas adquirem sentido no trabalho ao salvarem vidas, em uma conjunção de valores – solidariedade, confiança e cooperação – em relação aos socorridos e aos seus acompanhantes. Quando essa possibilidade não se concretiza, o coletivo de trabalho serve de apoio para que permaneçam na profissão, apesar das frustrações. Conclusão: evidenciou-se que, mesmo diante das variabilidades cotidianas da atividade de trabalho, os motoristas de ambulâncias produzem modos operatórios para dar conta das situações de trabalho, cooperando para solução dos problemas e/ou manejando as imprevisibilidades no trabalho em equipe.
Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F
The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue. Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance. The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states. Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Sinclair, Neil; Swinton, Paul A; Donald, Michael; Curatolo, Lisa; Lindle, Peter; Jones, Steph; Corfield, Alasdair R
Trauma remains the fourth leading cause of death in western countries and is the leading cause of death in the first four decades of life. NICE guidance in 2016 advocated the attendance of pre-hospital critical care trauma team (PHCCT) in the pre-hospital stage of the care of patients with major trauma. Previous publications support dispatch by clinicians who are also actively involved in the delivery of the PHCCT service; however there is a lack of objective outcome measures across the current reviewed evidence base. In this study, we aimed to assess the accuracy of PHCCT clinician led dispatch, when measured by Injury Severity Score (ISS). A retrospective cohort study over a 2 year period pre and post implementation of a PHCCT clinician led dispatch of PHCCT for potential major trauma patients, using national ambulance data combined with national trauma registry data. A total of 99,702 trauma related calls were made to SAS including 495 major trauma patients with an ISS >15, and a total of 454 dispatches of a PHCCT. Following the introduction of a PHCCT clinician staffed trauma desk, the sensitivity for major trauma was increased from 11.3% to 25.9%. The difference in sensitivity between the pre and post trauma desk group was significant at 14.6% (95% CI 7.4%-21.4%, p < .001). The results from the study support the results from other studies recommending that a PHCCT clinician should be located in ambulance control to identify major trauma patients as early as possible and co-ordinate the response. Copyright © 2018. Published by Elsevier Ltd.
Shaw, T A; De Risio, L; Laws, E J; Rose, J H; Harcourt-Brown, T R; Granger, N
Limited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4-S3 segments. Previous research suggests that L4-S3 SCI does not have a worse prognosis than T3-L3 SCI. To elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4-S3 SCI and compare prognosis to T3-L3 SCI. A retrospective study on 61 nonambulatory dogs with L4-S3 SCI, matched to dogs with T3-L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or dogs regained continence compared to T3-L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4-S3 SCI dogs, fewer dogs regained continence with loss of CPP (P Dogs with L4-S3 SCI have a poorer short-term prognosis than do dogs with T3-L3 SCI. Dogs with L4-S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small-breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision-making in L4-S3 SCI. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Olia, P M; Mollica, T V; Querci, A
The aim of the present study was to analyse the types of calls attended by the authors in their ambulance, assigned to one sector of the urban area of Prato. We analysed 1060 consecutive calls carried out by our ambulance; 33 calls (3.1%), cancelled for various reasons, were excluded from statistical analysis. The calls regarded 1027 patients, 549 (53.5%) males and 478 (46.5%) females. 46% of calls concerned non trauma cases, 17% trauma cases and 7.2% transfers between hospitals. Calls in the non trauma group were for dyspnea (16.7%), unconsciousness (16.6%), chest pain (11.8%), cerebrovascular pathology (7.7%), mental disorders (7.1%), abdominal pain (5.1%), use of psychotropic substances (4%) and convulsions (3.2%). Support to patients with terminal cancer accounted for 2.3% of cases, metabolic disorders 2.2%, hypertensive events 2.1%, tachycardia 1.9%, vertigo 1.9%, allergies 1%, obstetric pathology 0.5% and cardiorespiratory resuscitation 2,2%. Thirteen point seven percent were miscellaneous, including poisonings, migraines, haemorrhages and flu syndromes. Trauma cases included road accidents (62.6%), falls (27%), aggression (6.9%), work-related accidents (3.5%). The percentage of trauma cases (17%) was similar to that reported for a Swedish urban area (20%). Cases of cardiorespiratory resuscitation were 1.65% of our calls, compared to 1.73% and 1.8% reported in Northeastern Germany and Taiwan. Although prehospital emergency medical services are organised differently in different countries, our data suggest that emergency medical services in our area have a percentage distribution of case types similar to services in other countries.
Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson
To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Chemperek, Ewa; Mikuła, Agnieszka; Goniewicz, Mariusz; Krawczyk, Wojciech
The major causes of deaths all over the world are circulatory system diseases, neoplasms and injuries. Each man can become a participant of the event which results in life-threatening emergencies and the most immediate possible actions are essential. The period of time for starting efficient life-restoration actions is very short, estimated at 4-5 minutes. Ambulance Service is a medical organization created to apply aid in life-threatening emergencies. The standards of the developed western countries determine the arrival time at 7-10 minutes from the call time. Both first-aid applied by the accident witnesses and efficient actions of ambulance service have significance for effective pre-hospital aid and increasing the chances of survival of people in need. The study analysed emergency records of the ambulance cars of the Regional Unit of Ambulance Service - Sródmieście Station in Lublin in the year 2000. 3,723 calls were recorded. In 142 cases complete resuscitation actions were carried out due to circulatory and respiratory arrest. The records selected this way went through a detailed analysis. In 3.8% of the interventions of emergency teams the necessity of applying advanced life support was observed. The time of arrival at the scene, transport of the patient to the admission room as well as efficiency of resuscitation comply with the European standards. The efficiency of resuscitation actions estimated at 51.4% depended on the age of the patient, the cause of circulatory and respiratory arrest and ambulance arrival time. Taking up basic life support by witnesses of the event was observed in 2.8% of cases, in 8.5% aid was applied by the medical staff members who happened to be at the scene.
Shen, Sijun; Neyens, David M
With the increase in automated driver support systems, drivers are shifting from operating their vehicles to supervising their automation. As a result, it is important to understand how drivers interact with these automated systems and evaluate their effect on driver responses to safety critical events. This study aimed to identify how drivers responded when experiencing a safety critical event in automated vehicles while also engaged in non-driving tasks. In total 48 participants were included in this driving simulator study with two levels of automated driving: (a) driving with no automation and (b) driving with adaptive cruise control (ACC) and lane keeping (LK) systems engaged; and also two levels of a non-driving task (a) watching a movie or (b) no non-driving task. In addition to driving performance measures, non-driving task performance and the mean glance duration for the non-driving task were compared between the two levels of automated driving. Drivers using the automated systems responded worse than those manually driving in terms of reaction time, lane departure duration, and maximum steering wheel angle to an induced lane departure event. These results also found that non-driving tasks further impaired driver responses to a safety critical event in the automated system condition. In the automated driving condition, driver responses to the safety critical events were slower, especially when engaged in a non-driving task. Traditional driver performance variables may not necessarily effectively and accurately evaluate driver responses to events when supervising autonomous vehicle systems. Thus, it is important to develop and use appropriate variables to quantify drivers' performance under these conditions. Copyright © 2017 Elsevier Ltd and National Safety Council. All rights reserved.
Mardi Safitri, Dian; Azmi, Nora; Singh, Gurbinder; Astuti, Pudji
Ergonomic risk at work stations with type Seated Work Control was one of the problems faced by Transjakarta bus driver. Currently “Trisakti” type bus, one type of bus that is used by Transjakarta in corridor 9, serving route Pinang Ranti - Pluit, gained many complaints from drivers. From the results of Nordic Body Map questionnaires given to 30 drivers, it was known that drivers feel pain in the neck, arms, hips, and buttocks. Allegedly this was due to the seat position and the button/panel bus has a considerable distance range (1 meter) to be achieved by drivers. In addition, preliminary results of the questionnaire using Workstation Checklist identified their complaints about uncomfortable cushion, driver's seat backrest, and the exact position of the AC is above the driver head. To reduce the risk level of ergonomics, then did research to design the cabin by using a generic approach to designing products. The risk analysis driver posture before the design was done by using Rapid Upper Limb Assessment (RULA), Rapid Entire Body Assessment (REBA), and Quick Exposure Checklist (QEC), while the calculation of the moment the body is done by using software Mannequin Pro V10.2. Furthermore, the design of generic products was done through the stages: need metric-matrix, house of quality, anthropometric data collection, classification tree concept, concept screening, scoring concept, design and manufacture of products in the form of two-dimensional. While the design after design risk analysis driver posture was done by using RULA, REBA, and calculation of moments body as well as the design visualized using software 3DMax. From the results of analysis before the draft design improvements cabin RULA obtained scores of 6, REBA 9, and the result amounted to 57.38% QEC and moment forces on the back is 247.3 LbF.inch and on the right hip is 72.9 LbF.in. While the results of the proposed improvements cabin design RULA obtained scores of 3, REBA 4, and the moment of force on
Zhou, Wenhui; Gu, Guizhen; Wu, Hui; Yu, Shanfa
To analyze the status of occupational stress in different types of train drivers. By using cluster sampling method, a cross-sectional study was conducted in 1 339 train drivers (including 289 passenger train drivers, 637 freight trains drivers, 339 passenger shunting train drivers, and 74 high speed rail drivers) from a Railway Bureau depot. The survey included individual factors, occupational stress factors, stress response factors and stress mitigating factors. The occupational stress factors, stress response factors and mitigating factors were measured by the revised effort-reward imbalance (ERI) model questionnaires and occupational stress measurement scale. By using the method of covariance analysized the difference of occupational stress factors of all types train drivers, the method of Stepwise regression was used to analyze the effection (R(2)) of occupational stress factors and stress mitigating factors on stress response factors. Covariance analysis as covariates in age, education level, length of service and marital status showed that the scores of ERI (1.58 ± 0.05), extrinsic effort (19.88 ± 0.44), rewards (23.43 ± 0.43), intrinsic effort (17.86 ± 0.36), physical environment (5.70 ± 0.22), social support (30.51 ± 0.88) and daily tension (10.27 ± 0.38 ) of high speed rail drivers were higher than other drivers (F values were 6.06, 11.32, 7.05, 13.25, 5.20, 9.48 and 6.14 respectively, P train drivers were higher than other drivers (F values were 4.33 and 5.50 respectively, P train drivers was high speed rail drivers (R(2) = 0.64), passenger train drivers (R(2) = 0.44), passenger shunting train drivers (R(2) = 0.39), freight trains drivers (R(2) = 0.38); job satisfaction of train drivers was high speed rail drivers (R(2) = 0.68), passenger train drivers (R(2) = 0.62), freight trains drivers (R(2) = 0.43), passenger shunting train drivers(R(2) = 0.38); to daily tension of train drivers was high speed rail drivers (R(2) = 0.54), passenger train
Farmer, R; Tranah, T; O'Donnell, I; Catalan, J
People have jumped (or fallen) in front of trains on the London Underground system in increasing numbers throughout the twentieth century. During the past decade there have been about 100 such incidents each year, of which around 90 would involve the train driver witnessing his train strike the person on the track. Most are suicides or attempts at suicide. They represent major unexpected and violent events in the lives of the train drivers and it might be expected that some of them would respond by developing a post-traumatic stress reaction of the type identified by Horowitz (1976) or other adverse psychological reactions or both. The research reported in this paper was designed to characterize the range of responses of drivers to the experiences of killing or injuring members of the public during the course of their daily work. It was found that 16.3% of the drivers involved in incidents did develop post-traumatic stress disorder and that other diagnoses, e.g. depression and phobic states, were present in 39.5% of drivers when interviewed one month after the incident.
Haliza, Am; Md Muziman Syah, Mms; Norliza, Mf
The objective of this study was to determine the prevalence of poor visual acuity, colour blindness and visual field defect of new Malaysian drivers. A total of 3717 new drivers (50.2% males and 49.8% females) age 19±6 years, voluntarily participated in this study. Standard optometric apparatus such as LogMAR Charts, Ishihara plates and HandHeld Bernell Perimeter were used and standard procedures were applied. The visual examination showed 6.7% (n=250) of subjects achieved less than 0.3 LogMAR with better eye whilst 2.2% (n=83) had failed the Ishihara Test (2.1% males and 0.1% females). Most of the affected drivers were deutranopia. Only 2094 subjects had their visual field using a mobile Handheld Bernell Perimeter. 1.72% (n=36) subjects have less than 120 degrees of peripheral field of vision. The visual status among new Malaysian drivers needs to be taken seriously to ensure safe driving. Other factors such as colour vision and visual field screening have to be considered seriously when evaluating the visual performance of a driver. Good visual performance is indispensible for safe driving.
Full Text Available In this study, we propose a hierarchical fuzzy system for human in a driver-vehicle-environment system to model takeover by different drivers. The driver's behavior is affected by the environment. The climate, road and car conditions are included in fuzzy modeling. For obtaining fuzzy rules, experts' opinions are benefited by means of questionnaires on effects of parameters such as climate, road and car conditions on driving capabilities. Also the precision, age and driving individuality are used to model the driver's behavior. Three different positions are considered for driving and decision making. A fuzzy model called Model I is presented for modeling the change of steering angle and speed control by considering time distances with existing cars in these three positions, the information about the speed and direction of car, and the steering angle of car. Also we obtained two other models based on fuzzy rules called Model II and Model III by using Sugeno fuzzy inference. Model II and Model III have less linguistic terms than Model I for the steering angle and direction of car. The results of three models are compared for a driver who drives based on driving laws.
Semenza, Jan C; Lindgren, Elisabet; Balkanyi, Laszlo; Espinosa, Laura; Almqvist, My S; Penttinen, Pasi; Rocklöv, Joacim
Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008-2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.
Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F
In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0
Kim, Alexander A; Mazarakis, Michael G; Sinebryukhov, Vadim A; Volkov, Sergey N; Kondratiev, Sergey S; Alexeenko, Vitaly M; Bayol, Frederic; Demol, Gauthier; Stygar, William A
A linear transformer driver includes at least one ferrite ring positioned to accept a load. The linear transformer driver also includes a first power delivery module that includes a first charge storage devices and a first switch. The first power delivery module sends a first energy in the form of a first pulse to the load. The linear transformer driver also includes a second power delivery module including a second charge storage device and a second switch. The second power delivery module sends a second energy in the form of a second pulse to the load. The second pulse has a frequency that is approximately three times the frequency of the first pulse. The at least one ferrite ring is positioned to force the first pulse and the second pulse to the load by temporarily isolating the first pulse and the second pulse from an electrical ground.
Kaeppler, W. D.
Mathematical models describing vehicle dynamics as well as human behavior may be useful in evaluating driver performance and in establishing design criteria for vehicles more compatible with man. In 1977, a two level model of driver steering behavior was developed, but its parameters were identified for clear visibility conditions only. Since driver performance degrades under conditions of reduced visibility, e.g., fog, the two level model should be investigated to determine its applicability to such conditions. The data analysis of a recently performed driving simulation experiment showed that the model still performed reasonably well under fog conditions, although there was a degradation in its predictive capacity during fog. Some additional parameters affecting anticipation and lag time may improve the model's performance for reduced visibility conditions.
Full Text Available Purpose: Reports of business failure elicit various reactions, while research in this domain often appears to be limited by a lack of access to information about failure and by the negativity that surrounds it. Those who have experienced failure do not readily talk about it, or they disappear from the radar screen of researchers. Yet failure is preceded by decline which, when focused on strategically, can reduce eventual failures if early action is taken. The main purpose of this study is to develop a conceptual framework or typology of the drivers and moderators of business decline. Design/methodology/approach: After applying the "grounded theory" approach to the academic literature on decline and failure, a conceptual framework for the variables that drive and moderate business decline is proposed. Findings: The study proposes that decline has three core drivers, three peripheral drivers and four moderators. The core drivers identified are: resource munificence; leadership as origin; and causality (strategic versus operational origin of decline. The three peripheral drivers are: unique preconditions; continuous decisions impact; and extremes dichotomy. The study describes four moderators of the drivers: life cycle stage; stakeholder perspective; quantitative versus qualitative nature of signs and causes; and finally the age and size effects. Research limitations/implications: The proposed conceptual framework is based on literature only, although it has found support during discussions with practitioners. It is proposed to readers of this journal for scrutiny and validation. Practical implications: Strategists need to understand what drives decline in order to act timeously; practitioners who have an insight into the moderators with their impacts could make better decisions in response to decline in organisations and possibly avoid business failure. Originality/Value: Understanding business decline is still a huge theoretical challenge, which
Fynbo, Lars; Järvinen, Margaretha Maria
The paper analyses risk behaviour as described by a group of convicted drink-drivers. Risk assessment is seen as a part of a complicated process reflecting moral values in specific socio-cultural settings and within a specific framework of time. The respondents’ retrospective accounts of their dr......The paper analyses risk behaviour as described by a group of convicted drink-drivers. Risk assessment is seen as a part of a complicated process reflecting moral values in specific socio-cultural settings and within a specific framework of time. The respondents’ retrospective accounts...
Haliza, AM; Md Muziman Syah, MMS; Norliza, MF
Purpose: The objective of this study was to determine the prevalence of poor visual acuity, colour blindness and visual field defect of new Malaysian drivers. Methods: A total of 3717 new drivers (50.2% males and 49.8% females) age 19±6 years, voluntarily participated in this study. Standard optometric apparatus such as LogMAR Charts, Ishihara plates and HandHeld Bernell Perimeter were used and standard procedures were applied. Results: The visual examination showed 6.7% (n=250) of subjects a...
Kyung, Gyouhyung; Nussbaum, Maury A; Babski-Reeves, Kari L
Driver workspace design and evaluation is, in part, based on assumed driving postures of users and determines several ergonomic aspects of a vehicle, such as reach, visibility and postural comfort. Accurately predicting and specifying standard driving postures, hence, are necessary to improve the ergonomic quality of the driver workspace. In this study, a statistical clustering approach was employed to reduce driving posture simulation/prediction errors, assuming that drivers use several distinct postural strategies when interacting with automobiles. 2-D driving postures, described by 16 joint angles, were obtained from 38 participants with diverse demographics (age, gender) and anthropometrics (stature, body mass) and in two vehicle classes (sedans and SUVs). Based on the proximity of joint angle sets, cluster analysis yielded three predominant postural strategies in each vehicle class (i.e. 'lower limb flexed', 'upper limb flexed' and 'extended'). Mean angular differences between clusters ranged from 3.8 to 52.4 degrees for the majority of joints, supporting the practical relevance of the distinct clusters. The existence of such postural strategies should be considered when utilising digital human models (DHMs) to enhance and evaluate driver workspace design ergonomically and proactively. STATEMENT OF RELEVANCE: This study identified drivers' distinct postural strategies, based on actual drivers' behaviours. Such strategies can facilitate accurate positioning of DHMs and hence help design ergonomic driver workspaces.
Frengopoulos, Courtney; Payne, Michael W C; Holmes, Jeffrey D; Viana, Ricardo; Hunter, Susan W
Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm. To investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations. Cross-sectional study. Outpatient and inpatient amputee clinics at an academic rehabilitation hospital. Sixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas). Not applicable. Time to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs. Gait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many
Zhang, Qian; Jiang, Zuhua; Zheng, Dongpeng; Wang, Yifan; Man, Dong
Carless young drivers refers to those drivers aged between 18 and 25 years who have a driver's license but seldom have opportunities to practice their driving skills because they do not have their own cars. Due to China's lower private car ownership, many young drivers turn into carless young drivers after licensure, and the safety issue associated with them has become a matter of great concern in China. Because few studies have examined the driving behaviors of these drivers, this study aims to utilize the Driver Behavior Questionnaire (DBQ) to investigate the self-reported driving behaviors of Chinese carless young drivers. A total of 523 Chinese carless young drivers (214 females, 309 males) with an average age of 21.91 years completed a questionnaire including the 27-item DBQ and demographics. The data were first randomized into 2 subsamples for factor analysis and then combined together for the following analyses. Both an exploratory factor analysis (EFA, n = 174) and a confirmatory factor analysis (CFA, n = 349) were performed to investigate the factor structure of the DBQ. Correlation analysis was conducted to examine the relationships between the demographics and the DBQ scales' variables. Multivariate linear regression and logistic regression were performed to investigate the prediction of the DBQ scales and crash involvement in the previous year. The EFA produced a 4-factor structure identified as errors, violations, attention lapses, and memory lapses, and the CFA revealed a good model fit after the removal of one item with a low factor loading and the permission of the error covariance between some items. The Chinese carless young drivers reported a comparatively low level of aberrant driving behaviors. The 3 most frequently reported behaviors were all lapses and the 3 least were all violations. Gender was the only significant predictor of the 2 lapses scales and lifetime mileage was the only significant predictor of the violations scale. Only the
Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Ass...
The TMACS Software Project Test Procedures translate the project's acceptance criteria into test steps. Software releases are certified when the affected Test Procedures are successfully performed and the customers authorize installation of these changes. This Test Procedure tests the TMACS Acromag Software Driver (Bridge Code)
...'. At the present time, no such comprehensive model exists. This report discusses a conceptual framework designed to encompass the relationships, conditions, and constraints related to direct, indirect, and remote modes of driving and thus provides a guide or 'road map' for the construction and creation of a comprehensive driver performance model.
Driving on roads that are covered with ice or snow is hazardous for all drivers, but there may be : disproportionally high risks for certain age groups on certain road types and different winter : maintenance practices may also have a greater influen...
Hernandez-Pacheco, Raisa; Steiner, Ulrich K
Heterogeneity in life courses among individuals of a population influences the speed of adaptive evolutionary processes, but it is less clear how biotic and abiotic environmental fluctuations influence such heterogeneity. We investigate principal drivers of variability in sequence of stages durin...
Simbolotti, G.; Zampaglione, V.; Ferrari, M.; Gallina, M.; Mazzone, G.; Nardi, C.; Petrizzi, L.; Rado, V.; Violante, V.; Daenner, W.; Lorenzetto, P.; Gierszewski, P.; Grattarola, M.; Rosatelli, F.; Secolo, F.; Zacchia, F.; Caira, M.; Sorabella, L.
Depending on the final decision on the operation time of ITER (International Thermonuclear Experimental Reactor), the Driver Blanket might become a basic component of the machine with the main function of producing a significant fraction (close to 0.8) of the tritium required for the ITER operation, the remaining fraction being available from external supplies. The Driver Blanket is not required to provide reactor relevant performance in terms of tritium self-sufficiency. However, reactor relevant reliability and safety are mandatory requirements for this component in order not to significantly afftect the overall plant availability and to allow the ITER experimental program to be safely and successfully carried out. With the framework of the ITER Conceptual Design Activities (CDA, 1988-1990), a conceptual design of the ITER Driver Blanket has been carried out by ENEA Fusion Dept., in collaboration with ANSALDO S.p.A. and SRS S.r.l., and in close consultation with the NET Team and CFFTP (Canadian Fusion Fuels Technology Project). Such a design has been selected as EC (European Community) reference design for the ITER Driver Blanket. The status of the design at the end of CDA is reported in the present paper. (orig.)
Trento, Stefano; Götzen, Amalia De; Serafin, Stefania
A prototype of Human Machine Interface (HMI) used to de- liver information to the driver in cars is described in this paper. The de- livery of information is based on the Informative Interruptive Cue (IIC) approach. The interface is a matrix of 4 x 3 vibrating motors, controlled through a real-ti...
Fortuin, F.T.J.M.; Omta, S.W.F.
Purpose - The food processing industry, confronted with increased global competition and more stringent customer demands, is pressurized to improve the pace and quality of its innovation processes. This paper aims to find out what factors constitute the main drivers and barriers to innovation and to
Li, J.; van Zuylen, H.J.; van der Horst, E.
Driver behavior in China shows remarkable differences from that in western countries. In this study, six focus groups were organized to investigate Chinese drivers’ attitudes, expectations, intended actions, their preferences, and habits in different situations in urban areas. The outcomes show that
S.J.A. Hessels (Jolanda); A.M. van Gelderen (Marco); A.R. Thurik (Roy)
textabstractSeveral drivers of entrepreneurial aspirations and entrepreneurial motivations are investigated using country-level data from the Global Entrepreneurship Monitor (GEM) for the years 2005 and 2006. We estimate a two-equation model explaining aspirations using motivations and socioeconomic
Hessels, J.; van Gelderen, M.W.; Thurik, A.R.
Several drivers of entrepreneurial aspirations and entrepreneurial motivations are investigated using country-level data from the Global Entrepreneurship Monitor (GEM) for the years 2005 and 2006. We estimate a two-equation model explaining aspirations using motivations and socioeconomic variables,
Proposed rules by the U.S. Department of Transportation (DOT) for drug and alcohol testing of school bus drivers are expected to be implemented by early 1994. DOT regulations are very specific. School districts need to decide whether to establish their own program or contract with a full-service drug-testing firm. Explains the seven major elements…
Ohio State Univ., Columbus. National Center for Research in Vocational Education.
This booklet is intended to help mainstreamed mentally retarded, emotionally disturbed, or learning disabled high school students acquire a basic understanding of the responsibilities and working conditions of taxi drivers and to practice basic math skills necessary in the occupation. The first section provides a brief introduction to the…
Illinois State Board of Education, Springfield.
Four units are provided for formal classroom instruction in advanced competencies for school bus drivers in Illinois. Units cover passenger control, accidents and emergencies, detecting hazards, and first aid. Each unit contains some or all of the following components: table of contents; a list of objectives; informative material, including an…
Council, Forrest M.; And Others
A three-year pilot project was conducted to evaluate the feasibility of implementing a statewide off-road motorcycle training program for beginning drivers in North Carolina. The first year of the program involved approximately 422 students from five locations, the second year involved seven sites across the State. The three basic criteria for the…
... interstate or foreign commerce, because, in the case of an accident or other emergency and in other respects... accidents occur, they help the driver in obtaining aid and protect the vehicle from oncoming traffic. (c) In... commerce within the meaning of the Motor Carrier Act. (Ispass v. Pyramid Motor Freight Corp., 152 F. (2d...
De Pedro, I.; Ackermann, B.
The goal of this master thesis is to develop new drive and contrololutions, for creating white light from mixing the light of different-color LEDs, aiming at a reduced component count resulting in less space required by the electronics and lower cost. It evaluates the LED driver concept proposed in
Deregulation and Macroeconomic Drivers Of Foreign Direct Investment In Nigerian Agriculture (1970 -2009): An Econometric Analysis. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more ...
Full Text Available It’s a real problem to visit a low-level device driver from a high-level application based on the .NET platform managed code in software developing practice .This paper concerns how to solve it by a runtime interoperation services provided by Microsoft .NET Common Language Runtime (CLR .A real world example is given in the end.
People 65 and older are the fastest growing demographic : group in the United States. This is cause for concern given : that the youngest and oldest drivers have the highest crash : rates per unit of distance traveled, with rates increasing for : old...
The 2008 hand-held cell phone use rate translates into 812,000 vehicles being driven by someone using a hand-held cell phone at any given daylight moment.1 It also translates into an estimated 11 percent of the vehicles whose drivers were using some ...
Perreault, J R; Geigle, P R; Gorman, P H; Scott, W H
To measure body mass index (BMI) and ambulation changes for a morbidly obese, 47-year-old man with chronic motor-incomplete tetraplegia after gastric sleeve surgery. A morbidly obese man, BMI=44 kg m(-)(2), with chronic C5 AIS D tetraplegia underwent elective gastric sleeve surgery. Assessment of BMI and function via the 6-minute walk test (6MWT), 10-meter walk test (10MWT) and ambulation parameters (CIR Systems/GAITRite, Franklin, NJ, USA) was performed preoperatively and at 12, 24, 36 and 52 weeks postoperatively, and additionally after 3 weeks of both a prescribed coached (3 × /week facility based) and a non-coached (3 × /week home based) walking program initiated at 52 weeks. A step activity monitor assessed daily ambulation preoperatively, prior to and during the third and sixth week of the walking program. Results included a 34.3% peak BMI decrease at 52 weeks post surgery and a peak increase in 6MWT distance of 58% at 52 weeks post surgery, 10MWT preferred speed of 56% at 55 weeks and step activity monitor of 82% at 58 weeks post surgery. At 58 weeks, gait data demonstrated a decrease in double limb stance of 38% and decrease in base of support of 72%. This empirical case assessment of BMI and functional mobility before and after gastric sleeve surgery may encourage further investigation into mobility and general health effects post gastric procedures for people with chronic motor-incomplete spinal cord injury.
Bååth, Carina; Engström, Maria; Gunningberg, Lena; Muntlin Athlin, Åsa
The aim was to investigate the effect of an early intervention, a heel suspension device boot, on the incidence of heel pressure ulcers among older patients (aged 70+). Pressure ulcers are a global healthcare issue; furthermore, the heel is an exposed location. Research indicates that preventive nursing interventions starting during the ambulance care and used across the acute care delivery chain are seldom used. A multi-centre randomized control study design was used. Five ambulance stations, two emergency departments and 16 wards at two Swedish hospitals participated. Altogether, 183 patients were transferred by ambulance to the emergency department and were thereafter admitted to one of the participating wards. Significantly fewer patients in the intervention group (n=15 of 103; 14.6%) than the control group (n=24 of 80; 30%) developed heel pressure ulcers during their hospital stay (p=0.017). Pressure ulcer prevention should start early in the acute care delivery chain to increase patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.
Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark
This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Resumo: A configuração de redes logísticas para serviços de emergência é questão estratégica de imensa importância, visto que pequenas variações no tempo de resposta podem implicar na morte do solicitante. Partindo dessa premissa, o trabalho propõe novas alternativas de posicionamento para as ambulâncias do sistema SAMU na cidade de Duque de Caxias, RJ, capazes de reduzir o tempo de resposta do serviço. Essas propostas de reposicionamento das ambulâncias foram construídas em duas etapas: na primeira, dois modelos de Programação Inteira foram aplicados para se obter soluções que provejam maior cobertura à população. Posteriormente, o Modelo do Hipercubo foi empregado para avaliar a disponibilidade dos servidores, dentre outros indicadores de desempenho relevantes, como o tempo médio de resposta e a taxa de ocupação das ambulâncias.
Byrne, Eamonn; Bury, Gerard
Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy. To identify, investigate and document the barriers to medication error reporting within the NAS. An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis. Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological. Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.
To examine the effects of "Comfort upon Rising" care (CUR) as a new type of early morning care. This was a quasi-experimental study using a convenience sampling and non-random assignment of 80 orthopedic postoperative inpatients needing ambulation assistance. The intervention group of 40 inpatients was given CUR designed to support the patients' needs. The control group of 40 inpatients was given conventional early morning care (CMC). Floor nurses conducted either CMC or CUR for subjects beginning the morning after surgery and continuing for 3 days. Mood was measured by the Wake-up Questionnaire (question I) and Profile of Mood States (POMS). Morning activities, which were daily living activities, breakfast behaviors including breakfast intake rate, were measured by Wake-up Questionnaire (question IV) and observation. Completing the study were 36 patients from the control group and 36 patients from the intervention group. Mood and activities in the morning were improved in the CUR group. CUR is a patient-centered care based on patients' individual needs and promotes self-care. CUR is more effective than CMC in promoting natural recovery after an operation. © 2013 The Author. Japan Journal of Nursing Science © 2013 Japan Academy of Nursing Science.
Full Text Available Abstract Background Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientifical evidence of its effectiveness in a clinical setting is scarce. The objective of this study was to evaluate the effect of additional active warming during road or air ambulance transportation of trauma patients. Methods Patients were assigned to either passive warming with blankets or passive warming with blankets with the addition of an active warming intervention using a large chemical heat pad applied to the upper torso. Ear canal temperature, subjective sensation of cold discomfort and vital signs were monitored. Results Mean core temperatures increased from 35.1°C (95% CI; 34.7-35.5°C to 36.0°C (95% CI; 35.7-36.3°C (p Conclusions In mildly hypothermic trauma patients, with preserved shivering capacity, adequate passive warming is an effective treatment to establish a slow rewarming rate and to reduce cold discomfort during prehospital transportation. However, the addition of active warming using a chemical heat pad applied to the torso will significantly improve thermal comfort even further and might also reduce the cold induced stress response. Trial Registration ClinicalTrials.gov: NCT01400152
Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S
Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed. © 2013 Blackwell Publishing Ltd.
Statistics show that young drivers have higher motor vehicle crash rates compared to other age groups. This study investigated : characteristics, contributory causes, and factors which increase injury severity of young driver crashes in Kansas by com...
A UNIX device driver for a TransLink II Transputer board is described. A complete listing of the code is presented. The device driver allows a transputer array to be used with the A/UX operating system
As autonomous vehicles enter the fleet, there will be a long period when these vehicles will have to interact with : human drivers. One of the challenges for autonomous vehicles is that human drivers do not communicate their : decisions well. However...
... applications. The notices of applications stated in detail the qualifications, experience, and medical... Federal Motor Carrier Safety Administration Qualification of Drivers; Exemption Applications; Vision... annual medical certification to the employer for retention in the driver's qualification file and retains...
... of applications stated in detail the qualifications, experience, and medical condition of each... Federal Motor Carrier Safety Administration Qualification of Drivers; Exemption Applications; Vision... the employer for retention in the driver's qualification file and retains a copy of the certification...
... applications. The notices of applications stated in detail the qualifications, experience, and medical...; FMCSA- 25246] Qualification of Drivers; Exemption Applications; Vision AGENCY: Federal Motor Carrier... annual medical certification to the employer for retention in the driver's qualification file and retains...
.... The notices of applications stated in detail the qualifications, experience, and medical condition of... Federal Motor Carrier Safety Administration Qualification of Drivers; Exemption Applications; Vision... annual medical certification to the employer for retention in the driver's qualification file and retains...
National Aeronautics and Space Administration — The overall goal of the SBIR program is to develop a new Application Specified Integrated Circuit (ASIC) driver to be used in driver electronics of a deformable...
A number of studies have shown that passengers substantially : increase the risk of crashes for young, novice drivers. : This increased risk may result from distractions that young : passengers create for drivers. Alternatively, the presence : of pas...
A number of studies have shown that passengers substantially increase the risk of crashes for young, novice drivers. This increased risk may result from distractions that young passengers create for drivers. Alternatively, the presence of passengers ...
In the United States, teenage drivers are more at risk of being involved in crashes than : any other age group. Statistics reveal a clear need for improving teenagers driving : skills, judgment and behavior. Driver education programs are a crucial...
...-0192] Qualification of Drivers; Exemption Applications; Diabetes Mellitus AGENCY: Federal Motor Carrier... insulin- treated diabetes mellitus (ITDM) operating commercial motor vehicles (CMVs) in interstate... individual assessment of drivers with diabetes mellitus, and be consistent with the criteria described in...
...-0348] Qualification of Drivers; Exemption Applications; Diabetes Mellitus AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Notice of applications for exemption from the diabetes... revision must provide for individual assessment of drivers with diabetes mellitus, and be consistent with...
... interstate commerce, if he is granted an exemption. Zachary Rietz Mr. Reitz holds a driver's license from the... commerce, if granted an exemption. Bryon Smith Mr. Smith holds a driver's license from the state of...
Teen drivers have the highest crash rate per mile driven of any : age group (Williams, Ferguson, & Wells, 2005). Immaturity and : inexperience are two explanations for why novice teen drivers : have such a high crash risk (Arnett, 1992; Mayhew, Simps...
In 2009, the Oregon Legislature passed House Bill 2489, requiring the Oregon Driver and Motor Vehicle (DMV) Services Division and the Department of Corrections (DOC) to enter into agreements and adopt rules to assist offenders in obtaining a driver l...
This Research Note summarizes selected results from the 2007 MVOSS. It focuses primarily on information collected regarding driver education and GDL. This was a new module introduced in 2007. The data are weighted to yield national estimates.
Elshatarat, Rami Azmi; Burgel, Barbara J
In the United States (U.S.), cardiovascular disease (CVD) is a major leading cause of death. Despite the high mortality rate related to CVD, little is known about CVD risk factors among urban taxi drivers in the U.S. A cross-sectional design was used to identify the predictors of high cardiovascular risk factors among taxi drivers. Convenience sampling method was used to recruit 130 taxi drivers. A structured questionnaire was used to obtain the data. The sample was male (94 %), age mean (45 ± 10.75) years, married (54 %), born outside of the USA (55 %), had some college or below (61.5 %), night drivers (50.8 %), and driving on average 9.7 years and 41 h/week. About 79 % of them were eligible for CVD prevention, and 35.4 % had high CVD risk factors (4-9 risk factors). A CVD high-risk profile had a significant relationship with the subjects who were ≥55 years old; had hypertension, diabetes, or hyperlipidemia; were drinking alcohol ≥2 times/week; and had insufficient physical activity. Subjects who worked as a taxi driver for more than 10 years (OR 4.37; 95 % CI 1.82, 10.50) and had mental exertion from cab driving >5 out of 10 (OR 2.63; 95 % CI 1.05, 6.57) were more likely to have a CVD high-risk profile. As a conclusion, system-level or worksite interventions include offering healthy food at taxi dispatching locations, creating a work culture of frequent walking breaks, and interventions focusing on smoking, physical activity, and weight management. Improving health insurance coverage for this group of workers is recommended.
Llerena, Luis E; Aronow, Kathy V; Macleod, Jana; Bard, Michael; Salzman, Steven; Greene, Wendy; Haider, Adil; Schupper, Alex
Cell phone use and texting are prevalent within society and have thus pervaded the driving population. This technology is a growing concern within the confines of distracted driving, as all diversions from attention to the road have been shown to increase the risk of crashes. Adolescent, inexperienced drivers, who have the greatest prevalence of texting while driving, are at a particularly higher risk of crashes because of distraction. Members of the Injury Control Violence Prevention Committee of the Eastern Association for the Surgery of Trauma performed a PubMed search of articles related to distracted driving and cell phone use as a distractor of driving between 2000 and 2013. A total of 19 articles were found to merit inclusion as evidence in the evidence-based review. These articles provided evidence regarding the relationship between distracted driving and crashes, cell phone use contributing to automobile accidents, and/or the relationship between driver experience and automobile accidents. (Adjust methods/results sections to the number of articles that correctly corresponds to the number of references, as well as the methodology for reference inclusion.) Based on the evidence reviewed, we can recommend the following. All drivers should minimize all in-vehicle distractions while on the road. All drivers should not text or use any touch messaging system (including the use of social media sites such as Facebook and Twitter) while driving. Younger, inexperienced drivers should especially not use cell phones, texting, or any touch messaging system while driving because they pose an increased risk for death and injury caused by distractions while driving.
Weiss, Eve; Fisher Thiel, Megan; Sultana, Nahida; Hannan, Chloe; Seacrist, Thomas
From the advent of airbags to electronic stability control, technological advances introduced into automobile design have significantly reduced injury and death from motor vehicle crashes. These advances are especially pertinent among teen drivers, a population whose leading cause of death is motor vehicle crashes. Recently developed advanced driver assistance systems (ADAS) have the potential to compensate for skill deficits and reduce overall crash risk. Yet, ADAS is only effective if drivers are willing to use it. Limited research has been conducted on the suitability of ADAS for teen drivers. The goal of this study is to identify teen drivers' perceived need for ADAS, receptiveness to in-vehicle technology, and intervention preferences. The long-term goal is to understand public perceptions and barriers to ADAS use and to help determine how these systems must evolve to meet the needs of the riskiest driving populations. Three focus groups (N = 24) were conducted with licensed teen drivers aged 16-19 years and 2 focus groups with parents of teen drivers (N = 12). Discussion topics included views on how ADAS might influence driving skills and behaviors; trust in technology; and data privacy. Discussions were transcribed; the team used conventional content analysis and open coding methods to identify 12 coding domains and code transcripts with NVivo 10. Interrater reliability testing showed moderate to high kappa scores. Overall, participants recognized potential benefits of ADAS, including improved safety and crash reduction. Teens suggested that ADAS is still developing and therefore has potential to malfunction. Many teens reported a greater trust in their own driving ability over vehicle technology. They expressed that novice drivers should learn to drive on non-ADAS-equipped cars and that ADAS should be considered a supplemental aid. Many teens felt that overreliance on ADAS may increase distracted driving or risky behaviors among teens. Parents also
Required elements of an inertial confinement fusion power plant are modeled and discussed. A detailed analysis of two critical elements of candidate drivers is done, and new component designs are proposed to increase the credibility and feasibility of each driver system. An analysis of neutron damage to the final elements of a laser focusing system is presented, and multilayer -- dielectric mirrors are shown to have damage lifetimes which axe too short to be useful in a commercial power plant. A new final-focusing system using grazing incidence metal mirrors to protect sensitive laser optics is designed and shown to be effective in extending the lifetime of the final focusing system. The reflectivities and damage limits of grazing incidence metal mirrors are examined in detail, and the required mirror sizes are shown to be compatible with the beam sizes and illumination geometries currently envisioned for laser drivers. A detailed design and analysis is also done for compact arrays of superconducting magnetic quadrupoles, which are needed in a multi-beam heavy-ion driver. The new array model is developed in more detail than some previous conceptual designs and models arrays which are more compact than arrays scaled from existing single -- quadrupole designs. The improved integrated model for compact arrays is used to compare the effects of various quadrupole array design choices on the size and cost of a heavy-ion driver. Array design choices which significantly affect the cost of a heavy-ion driver include the choice of superconducting material and the thickness of the collar used to support the winding stresses. The effect of these array design choices on driver size and cost is examined and the array model is used to estimate driver cost savings and performance improvements attainable with aggressive quadrupole array designs with high-performance superconductors
Maasalo, Ida; Lehtonen, Esko; Pekkanen, Jami; Summala, Heikki
AbstractObjective: Studies based on accident statistics generally suggest that the presence of a passenger reduces adult drivers' accident risk. However, passengers have been reported to be a source of distraction in a remarkable portion of distraction related crashes. Although the effect of passengers on driving performance has been studied extensively, few studies have focused on how a child passenger affects the driver. A child in a car is a potential distractor for parents, especially for...
Research was undertaken to determine vehicle size parameters influencing driver fatality odds, independent of mass, in two-vehicle collisions. Forty vehicle parameters were evaluated for 1,500 vehicle groupings. Logistic regression analyses show driver factors (belt use, age, drinking) collectively contribute more to fatality odds than vehicle factors, and that mass is the most important vehicular parameter influencing fatality odds for all crash configurations. In car crashes, other vehicle ...
Peláez Coronado, Gustavo Adolfo
Driver supervision is crucial in safety systems for the driver. It is important to monitor the driver to understand his necessities, patterns of movements and behaviour under determined circumstances. The availability of an accurate tool to supervise the driver’s behaviour allows multiple objectives to be achieved such as the detection of drowsiness (analysing the head movements and blinking pattern) and distraction (estimating where the driver is looking by studying the head and eyes positio...
Zhang, Wei; He, Ruichun; Ma, Changxi; Gao, Mingxia
For the problem of taxi carpooling detour, this paper studies driver strategy choice with carpooling detour. The model of taxi driver strategy evolution with carpooling detour is built based on prospect theory and evolution game theory. Driver stable strategies are analyzed under the conditions of complaint mechanism and absence of mechanism, respectively. The results show that passenger’s complaint mechanism can effectively decrease the phenomenon of driver refusing passengers with carpoolin...
Full Text Available Integration of multi-omics data of cancer can help people to explore cancers comprehensively. However, with a large volume of different omics and functional data being generated, there is a major challenge to distinguish functional driver genes from a sea of inconsequential passenger genes that accrue stochastically but do not contribute to cancer development. In this paper, we present a gene length-based network method, named DriverFinder, to identify driver genes by integrating somatic mutations, copy number variations, gene-gene interaction network, tumor expression, and normal expression data. To illustrate the performance of DriverFinder, it is applied to four cancer types from The Cancer Genome Atlas including breast cancer, head and neck squamous cell carcinoma, thyroid carcinoma, and kidney renal clear cell carcinoma. Compared with some conventional methods, the results demonstrate that the proposed method is effective. Moreover, it can decrease the influence of gene length in identifying driver genes and identify some rare mutated driver genes.
A van Niekerk
Full Text Available In South Africa (SA, the school transport industry provides millions of children with a means of travelling to and from school. The industry has, however, been reported to be plagued by widespread safety concerns. The consequent road traffic incidents have often been attributed to driver factors, including driving in excess of legal speeds or at inappropriate speeds; driving while under the influence of alcohol, while sleepy or fatigued; or driving without using protective equipment for vehicle occupants. There are currently very few SA interventions that specifically target this important industry role-player. The Safe Travel to School Programme was recently implemented by a national child safety agency, with a focus on driver road safety awareness, defensive driver training, eye- testing, vehicle roadworthy inspections with selected upgrades, incentives for safe performance, and implementation of a vehicle telematics tracking system with regular, individual driving behaviour information updates. This quasi-experimental study offers an evaluation of the initial impact on safety performance of this telematics-based driver and vehicle safety intervention in terms of speeding, acceleration, braking, cornering, and time-of-day driving, and compares the school transport driver performance with that of general motorists. Despite concerns that some school transport vehicles are used for multiple purposes outside of school transport duties, at night, and for longer distances, overall these vehicles recorded lower percentages of speeding, lower harsh braking, and lower average harsh cornering and acceleration than general drivers.
...-28480] Commercial Driver's License (CDL) Standards: Exemption AGENCY: Federal Motor Carrier Safety... commercial driver's license (CDL) as required by current regulations. FMCSA reviewed NAAA's application for... demonstrate alternatives its members would employ to ensure that their commercial motor vehicle (CMV) drivers...
Non-planar driver's side rearview mirrors: A survey of mirror types and european driver experience and a driver behavior study on the influence of experience and driver age on gap acceptance and vehicle detection (final report)
Vos, A.P. de
Some European drivers have been using different types of convex, driver-side rear-view mirrors which provide a wider field-of-view than flat mirrors, but produce a minified image. With a minified image, some drivers may have difficulty judging distances and approach speeds. To assess the potential
Full Text Available and the age and experience of the drivers considered before a Professional Drivers Permit (PrDP) license issued to the driver. Formal institutions such as Further Education and Training (FET) colleges needs to, in future play a bigger role in the issuing...
Aim: To ascertain the prevalence and nature of psychoactive drug use amongst taxi drivers in Nigeria. Materials and Method: A total of 192 taxi drivers in Enugu, South East Nigeria was studied using a questionnaire. Information obtained from the questionnaire included socio-demographic characteristics of the drivers, ...
The fatality rate (fatalities per distance travelled) of young drivers (18- to 24-year-olds) is more than five times higher than that of drivers between the ages of 30 and 59 years. The fatality rate of young males is even as much as ten times higher. The high risk of young drivers is due to both
Potvin, Louise; And Others
1983 legislation making driver training courses mandatory for any person in Quebec seeking a first driver's license had no effect on the risk of accident or the mortality/morbidity rate for newly licensed drivers over 18. However, since 1983 more women under 18 are becoming licensed, and their risks may be increased. (Author/BJV)
Preventive safety system of vehicle is highlighted to reduce the number of traffic accidents. Driver's state adaptive driving safety system may be one of candidates of the safety system. Identifying driver's psychosomatic states is indispensable to establish those safety systems. Anger of driver state is often seen in traffic ...
There were 38.4 million licensed older drivers in 2014a 31% : increase from 10 years earlier (2005). Furthermore, older drivers as : a percentage of all licensed drivers increased from 15% in 2005 to : 18% in 2014 (National Center for Statistics a...
Important drivers of woody cover in African savannas are rainfall, soil and nutrients, and disturbance factors, such as fire and herbivory. However, very little is known about how these drivers influence woody cover at specific height classes. The main aim of this study was to identify which of these drivers are the best ...
Objective: To determine the pattern of eye diseases among commercial intercity vehicle drivers (CIVDs) in Ilorin, Nigeria. Design: A cross-sectional descriptive study. Methodology: Out of the estimated 450 drivers operating in the five major motor parks for CIVDs in Ilorin, 399 consecutive drivers participated in the study.
This book describes high frequency power MOSFET gate driver technologies, including gate drivers for GaN HEMTs, which have great potential in the next generation of switching power converters. Gate drivers serve as a critical role between control and power devices.
Waller, Patricia F.
Driver licensing, the only state program with the opportunity for routine personal contact with every driver, has unmatched potential for both general and specific countermeasures to the problem of drunk driving. General countermeasures apply to large groups of drivers prior to the occurrence of any infraction. They may be considered basically…
Traffic safety is a widespread social concern. Tackling the problem requires understanding the people : who are driving. This includes information about driver behavior, but also about perceptions these drivers : hold regarding their driving. North D...
Morgan, Prue E; Soh, Sze-Ee; McGinley, Jennifer L
Despite an increasing number of studies examining the profile of falls and mobility decline in adults with cerebral palsy (CP), little is known about its impact on an individual's life quality. The aim of this preliminary study was to assess the wellbeing and health status aspects of health-related quality of life (HRQOL) in ambulant adults with CP and explore the relationship of falls and mobility decline with HRQOL. Ambulant adults with CP completed postal surveys which sought demographic data, mobility (Gross Motor Function Classification System; GMFCS-E&R), presence of mobility decline, falls history, and HRQOL (Personal Wellbeing Index (PWI), Short Form-36 Health Survey (SF-36)). Thirty-four community-dwelling ambulant adults with CP with a mean age of 44.2 years (SD; 8.6; range 26-65) participated. Twenty-eight (82%) participants reported mobility decline since reaching adulthood, and a similar proportion of individuals (82%) reported having had more than two falls in the previous year. The health status and wellbeing of this sample of ambulant adults with CP were generally lower compared with the Australian normative population. Mobility decline was found by univariate regression analysis to be associated with mental health status (β = 0.52; p = 0.002), but not when other predictor variables were included in the multivariate model (β = 0.27; p = 0.072). In contrast, self-reported history of falls was found to be a significant contributing factor for both physical health status (β = -0.55; p = 0.002) and personal wellbeing (β = -0.43; p = 0.006). This sample of ambulant adults with CP perceived their HRQOL to be poor, with some health status and wellbeing domains below that of population wide comparisons. A majority of these individuals also experienced a fall in the last year and a decline in their mobility since reaching adulthood. While further research is required, this preliminary study has highlighted the potential implications of falls and mobility
Full Text Available This paper proposes a new concept of elderly driver assistance systems, which performs the assistance by cooperative driving between two vehicles, and describes some experiments with elderly drivers. The assistance consists of one vehicle driven by an elderly driver called a guest vehicle and the other driven by a assisting driver called a host vehicle, and the host vehicle assists or escorts the guest vehicle through the inter-vehicle communications. The functions of the systems installed on a single-seat electric vehicle are highly evaluated by subjects of elderly drivers in virtual streets on a test track.
Tarpey, Patrick S; Behjati, Sam; Young, Matthew D; Martincorena, Inigo; Alexandrov, Ludmil B; Farndon, Sarah J; Guzzo, Charlotte; Hardy, Claire; Latimer, Calli; Butler, Adam P; Teague, Jon W; Shlien, Adam; Futreal, P Andrew; Shah, Sohrab; Bashashati, Ali; Jamshidi, Farzad; Nielsen, Torsten O; Huntsman, David; Baumhoer, Daniel; Brandner, Sebastian; Wunder, Jay; Dickson, Brendan; Cogswell, Patricia; Sommer, Josh; Phillips, Joanna J; Amary, M Fernanda; Tirabosco, Roberto; Pillay, Nischalan; Yip, Stephen; Stratton, Michael R; Flanagan, Adrienne M; Campbell, Peter J
Chordoma is a malignant, often incurable bone tumour showing notochordal differentiation. Here, we defined the somatic driver landscape of 104 cases of sporadic chordoma. We reveal somatic duplications of the notochordal transcription factor brachyury (T) in up to 27% of cases. These variants recapitulate the rearrangement architecture of the pathogenic germline duplications of T that underlie familial chordoma. In addition, we find potentially clinically actionable PI3K signalling mutations in 16% of cases. Intriguingly, one of the most frequently altered genes, mutated exclusively by inactivating mutation, was LYST (10%), which may represent a novel cancer gene in chordoma.Chordoma is a rare often incurable malignant bone tumour. Here, the authors investigate driver mutations of sporadic chordoma in 104 cases, revealing duplications in notochordal transcription factor brachyury (T), PI3K signalling mutations, and mutations in LYST, a potential novel cancer gene in chordoma.
Raphael, Benjamin J; Dobson, Jason R; Oesper, Layla
High-throughput DNA sequencing is revolutionizing the study of cancer and enabling the measurement of the somatic mutations that drive cancer development. However, the resulting sequencing datasets are large and complex, obscuring the clinically important mutations in a background of errors, noise......, and random mutations. Here, we review computational approaches to identify somatic mutations in cancer genome sequences and to distinguish the driver mutations that are responsible for cancer from random, passenger mutations. First, we describe approaches to detect somatic mutations from high-throughput DNA...... sequencing data, particularly for tumor samples that comprise heterogeneous populations of cells. Next, we review computational approaches that aim to predict driver mutations according to their frequency of occurrence in a cohort of samples, or according to their predicted functional impact on protein...
Carmona, Juan; García, Fernando; Martín, David; Escalera, Arturo de la; Armingol, José María
A driver behaviour analysis tool is presented. The proposal offers a novel contribution based on low-cost hardware and advanced software capabilities based on data fusion. The device takes advantage of the information provided by the in-vehicle sensors using Controller Area Network Bus (CAN-BUS), an Inertial Measurement Unit (IMU) and a GPS. By fusing this information, the system can infer the behaviour of the driver, providing aggressive behaviour detection. By means of accurate GPS-based localization, the system is able to add context information, such as digital map information, speed limits, etc. Several parameters and signals are taken into account, both in the temporal and frequency domains, to provide real time behaviour detection. The system was tested in urban, interurban and highways scenarios.
Christiansen, John K.; Varnes, Claus J.
the relationship between the uses of structured rule-based approaches to manage product development, but little is known about what makes these rules change. This is the first study to uncover the multitude of drivers that stimulate change in product development rules and to suggest sets of moderators......Purpose: - The purpose of this research is to investigate the drivers that induce companies to change their rules for managing product development. Most companies use a form of rule-based management approach, but surprisingly little is known about what makes companies change these rules...... 10 years based on three rounds of interviews with 40 managers. Findings: - Previous research has assumed that the dynamics of product development rules are based on internal learning processes, and that increasingly competent management will stimulate the implementation of newer and more complex rule...
Kolm, H.; Fine, K.; Mongeau, P.; Williams, F.
Mass drivers can serve to propel massive objects by expelling any available material as reaction mass, however, mass driver engines have several limitations such as relatively large payload size and dynamic stability problems. A number of alternative acceleration mechanisms exist which offer advantages for certain applications, such as higher acceleration at a sacrifice in efficiency, smaller possible size and decreased complexity at a sacrifice in service life, etc. The alternative concepts include several variants of the railgun, a family of superconducting slingshot oscillators, a momentum transformer, an impulse induction motor, and a family of hybrid synchronous accelerators. A potential application of considerable interest is the earth-based launching of space cargo or nuclear waste by using off-peak generating capacity to accelerate one ton cargo cylinders at intervals of several minutes.
Bolia, Pratiksh; Weiskircher, Thomas; Müller, Steffen
In this paper, a two level preview driver steering control model for the use in numerical vehicle dynamics simulation is introduced. The proposed model is composed of cascaded control loops: The outer loop is the path following layer based on potential field framework. The inner loop tries to capture the driver's physical behaviour. The proposed driver model allows easy implementation of different driving situations to simulate a wide range of different driver types, moods and vehicle types. The expediency of the proposed driver model is shown with the help of developed driver steering assist (DSA) function integrated with a conventional series production (Electric Power steering System with rack assist servo unit) system. With the help of the DSA assist function, the driver is prevented from over saturating the front tyre forces and loss of stability and controllability during cornering. The simulation results show different driver reactions caused by the change in the parameters or properties of the proposed driver model if the DSA assist function is activated. Thus, the proposed driver model is useful for the advanced driver steering and vehicle stability assist function evaluation in the early stage of vehicle dynamics handling and stability evaluation.
Ichikawa, Masao; Nakahara, Shinji; Taniguchi, Ayako
In aging societies, increasing numbers of older drivers are involved in motor vehicle collisions (MVCs), and preserving their safety is a growing concern. In this study, we focused on whether older drivers were more likely to cause MVCs and injuries than drivers in other age groups. To do so we compared at-fault MVC incidence and resulting injury risks by drivers' ages, using data from Japan, a country with a rapidly aging population. The at-fault MVC incidence was calculated based on distance traveled made for non-commercial purposes, and the injury risks posed to at-fault drivers and other road users per at-fault MVCs. We used MVC data for 2010 from the National Police Agency of Japan and driving exposure data from the Nationwide Person Trip Survey conducted by a Japanese governmental ministry in 2010. The at-fault MVC incidence showed a U-shaped curve across the drivers' ages, where teenage and the oldest drivers appeared to be the highest risk groups in terms of causing MVCs, and the incidence was higher for female drivers after age 25. The injury risk older drivers posed to other vehicle occupants because of their at-fault MVCs was lower than for drivers in other age groups, while their own injury risk appeared much higher. As the number of older drivers is increasing, efforts to reduce their at-fault MVCs appear justified. Copyright © 2015 Elsevier Ltd. All rights reserved.
Crowdfunding combines social networking with microfinance in a method of financing new ventures that has become increasingly popular. Crowdfunding offers entrepreneurs an opportunity to find a large number of investors for projects, but many campaigns tend to remain unfunded. This study’s main objective was to access the main success drivers of crowdfunded projects, focusing, in particular, on sports projects. The dataset comprised 4,952 donationand rewards-based projects launched in three pl...
Calza, Elisa; Goedhuys, Micheline; Trifkovic, Neda
innovation (product and process) and other variables related to technological capabilities, international standards are still conducive to higher productivity, through improved management practices associated with their adoption. In line with the requirement of continuous improvement implied by most......Using a rich panel dataset of SMEs active in the manufacturing sector in Viet Nam, this paper investigates the drivers of firm productivity, focusing on the role played by international management standards certification. We develop and test the hypothesis that, controlling for technological...
Stranden, Ole; Fjeldsgård, Espen
Master thesis Business Administration - University of Agder 2016 Corruption has existed since the beginning of time, and the first documented case of corruption related to sport took place 388 years BC. Several previous studies and research conclude that corruption appears in sport, and that it is a major problem. However, there are relatively few studies emphasising the main actors, mechanisms and drivers and that seek to find feasible solutions on how to prevent and decrease corruption i...
Ziebinski, Adam; Cupek, Rafal; Grzechca, Damian; Chruszczyk, Lukas
New cars can be equipped with many advanced safety solutions. Airbags, seatbelts and all of the essential passive safety parts are standard equipment. Now cars are often equipped with new advanced active safety systems that can prevent accidents. The functions of the Advanced Driver Assistance Systems are still growing. A review of the most popular available technologies used in ADAS and descriptions of their application areas are discussed in this paper.
Kaiser, Josef; Lacroix, Jean.
This branch driver allows in association with the FIFO memories of the microcomputer Micral, very fast exchanges with the 7 crates of a CAMAC branch. A CAMAC programm (command, test, read, write) is loaded in the 1K FIFO buffer of the Micral before execution time and executed in sequence at a rate of 1,5μs per CAMAC command. After programm execution, data may be transferred directly on a magnetic tape [fr
Steinvall, Ove; Sandberg, Stig; Hörberg, Ulf; Persson, Rolf; Berglund, Folke; Karslsson, Kjell; Öhgren, Johan; Yu, Zhaohua; Söderberg, Per
A growing problem for the Police and Security Forces has been to prevent potentially hostile individuals to pass a checkpoint, without using lethatl violence. Therefore the question has been if there is a laser or any other strong light source that could be used as a warning and dazzling device, without lethal or long term effects. To investigate the possibilities a field trial has been performed at a motor-racing track. A green CW laser with an irradiance on the eye of maximum 0.5 MPE, as defined by ICNIRP  and the ANZI standard , was used as a dazzle source. Ten drivers have been driving with dipped headlights through a course of three lines with orange cones. In every line there has been only one gate wide enough to pass without hitting the cones. The time through the course, the choice of gates and the number of cones hit have been measured. For every second trial drive through the track, the driver was exposed to the laser dazzler. The background illuminances ranged from a thousand lux in daylight to about ten millilux in darkness. The protective effect of the sun-visor of the car was investigated. The drives visual system was carefully examined before and after experimental driving and a few weeks after the experimental driving to verify that no pathological effects, that could potentially be induced by the laser exposure, pre-existed or occurred after the laser exposure. An analysis of variance for a within subjects design has been used for evaluation. It was found that green laser light can have an obvious warning effect in daylight. Dazzling does reduce the drivers ability to make judgments and manouver the car in twilight and darkness. A sun-visor can reduce the glare and give the driver an improved control, but that perception can be unjustified. No damage to the visual system was observed.
Full Text Available Circadian rhythm influences the physiology of the cardiovascular system, inducing diurnal variation of blood pressure. We investigated the association between daily emergency ambulance calls (EACs for elevated arterial blood pressure during the time intervals of 8:00–13:59, 14:00–21:59, and 22:00–7:59 and weekly fluctuations of air temperature (T, barometric pressure, relative humidity, wind speed, geomagnetic activity (GMA, and high-speed solar wind (HSSW. We used the Poisson regression to explore the association between the risk of EACs and weather variables, adjusting for seasonality and exposure to CO, PM10, and ozone. An increase of 10 °C when T > 1 °C on the day of the call was associated with a decrease in the risk of EACs during the time periods of 14:00–21:59 (RR (rate ratio = 0.78; p < 0.001 and 22:00–7:59 (RR = 0.88; p = 0.35. During the time period of 8:00–13:59, the risk of EACs was positively associated with T above 1 °C with a lag of 5–7 days (RR = 1.18; p = 0.03. An elevated risk was associated during 8:00–13:59 with active-stormy GMA (RR = 1.22; p = 0.003; during 14:00–21:59 with very low GMA (RR = 1.07; p = 0.008 and HSSW (RR = 1.17; p = 0.014; and during 22:00–7:59 with HSSW occurring after active-stormy days (RR = 1.32; p = 0.019. The associations of environmental variables with the exacerbation of essential hypertension may be analyzed depending on the time of the event.
Plat, M J; Frings-Dresen, M H W; Sluiter, J K
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health surveillance (WHS) activities and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs. The search strategy systematically searched the PubMed, PsycINFO and OSH-update databases. The search strategy consisted of several synonyms of the job titles of interest, combined with synonyms for workers' health surveillance. The methodological quality was checked. At least one study was found for each of the following occupations fire fighters, ambulance personnel, police personnel and military personnel. For the first objective, 24 studies described several job-specific WHS activities aimed at aspects of psychological, 'physical' (energetic, biomechanical and balance), sense-related, environmental exposure or cardiovascular requirements. The seven studies found for the second objective measured different outcomes related to work functioning. The methodological quality of the interventions varied, but with the exception of one study, all scored over 55% of the maximum score. Six studies showed effectiveness on at least some of the defined outcomes. The studies described several job-specific interventions: a trauma resilience training, healthy lifestyle promotion, physical readiness training, respiratory muscle training, endurance and resistance training, a physical exercise programme and comparing vaccines. Several examples of job-specific WHS activities were found for the four occupations. Compared to studies focusing on physical tasks, a few studies were found that focus on psychological tasks. Effectiveness studies for job-specific WHS interventions were scarce, although their results were promising. We recommend studying
Floegel, Theresa A; Dickinson, Jared M; DerAnanian, Cheryl; McCarthy, Marianne; Hooker, Steven P; Buman, Matthew P
The aim of this work was to investigate the predictive value of in-hospital posture and ambulatory activity for 30 days following discharge on functional status in older patients with heart failure. We undertook a prospective observational pilot study of 27 patients (78 ± 9.8 y, 51.8% female) admitted with heart failure. Participants wore 2 inclinometric accelerometers to record posture in-hospital and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed on the day after discharge (Timed Up and Go [TUG], Short Physical Performance Battery [SPPB], hand grip strength) and 30 days after discharge. Length of stay was 5.1 ± 3.9 days. Participants spent 63.0 ± 19.2% of their hospital time lying down, 30.2 ± 18.7% sitting, 5.3 ± 4.2% standing, and 1.9 ± 8.6% ambulating. Thirty-day mean post-discharge stepping was 4890 ± 2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7 s longer TUG time (95% confidence interval [CI] 0.2-1.9) at 30 days. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI 0.1-1.0) at 30 days. Handgrip strength was unchanged. Older patients with heart failure were sedentary during hospitalization, which may contribute to decreased functional performance. Physical activity after discharge may minimize this negative effect. Copyright © 2018 Elsevier Inc. All rights reserved.
Lovach-Chepujnoska, Margarita; Nojkov, Jordan; Joshevska-Jovanovska, Slagjana; Domazetov, Robert
The advantages of patient-controlled epidural analgesia (PCEA) for delivery compared with continuous epidural analgesia (CEA) have been a point of interest in research obstetric anaesthesia for more than two decades. The aim of this single blind randomized controlled study was to evaluate the incidence of motor block and ability to perform partial knee flexion in women who received CEA or PCEA. Fifty-one healthy nulliparous women were included in this study. After an initial dose and established sensory block at Th 10, parturients were randomized into two groups: group CEA (10 ml/h), and group PCEA (bolus - 5 ml, lockout interval - 15 minutes, basal rate - 0 ml) with bupivacaine 0.08% and fentanyl 2 µg/ml. The motor function of the lower limbs was evaluated by modified Bromage scale at regular hourly intervals until full cervical dilatation. The quality of analgesia was assessed using a visual analogue pain scale (VAPS) and maternal satisfaction. Mode of delivery, the total number of additional rescue boluses, foetal and neonatal outcomes were recorded. Motor block was significantly lower in the third (33.3% vs. 4.35%; p = 0.008), fourth (57.9% vs. 6.3%; p = 0.003) and fifth hour (75.0% vs. 18.2%; p = 0.001) in the PCEA group. Ambulation occurred in 18% in the CEA and 46% in the PCEA group (p = 0.036). VAPS was with borderline significance in the second (p = 0.076) and significantly lower in the fourth hour (p = 0.034). Compared with CEA, PCEA provided less motor block and better first-stage analgesia, which leads to the conclusion that patient-controlled analgesia techniques are the preferred model in obstetric anesthesia.
Labruyère, Rob; van Hedel, Hubertus J
To investigate whether a figure-of-8-shaped walking test can estimate various domains of walking in subjects with incomplete spinal cord injury (iSCI) better than the 10-meter walk test (10MWT), and to explore similarities and differences between the 2 tests and between subjects with iSCI and age-matched, healthy controls. Case-control study. Spinal cord injury center of a university hospital. A convenience sample of subjects with iSCI (n=15; mean age, 50y; 40% women; neurologic level from C3 to L5; median time since injury, 5mo) was compared with an age-matched control group (47% women). Not applicable. The figure-of-8 test (FET) included 6 conditions to test the subjects' ability to adapt their gait to several circumstances. These conditions covered normal and maximal walking speed, constrained vision, obstacles, foamed soles, and a dual task. Additionally, subjects were tested for lower extremity muscle strength, gait capacity (10MWT) and balance, independence, and fear of falling. (1) Preferred straight-walking speed correlated with the different FET conditions in both groups; (2) if normalized to preferred straight-walking speed, FET conditions showed significant differences between both groups; (3) if normalized to preferred curve-walking speed, these differences seemed to disappear; and (4) the 10MWT appeared superior to the different conditions of the FET in estimating various walking-related functions. Subjects with iSCI seem to have difficulties with curve walking compared with straight walking. We therefore recommend the implementation of curve walking into rehabilitation training programs. However, the FET did not provide a better estimate of functional ambulation performance after an iSCI compared with the 10MWT. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Youssef A. Ghoneim
Full Text Available This paper discusses a concept for enhanced active safety by introducing a driver warning system based on vehicle dynamics that predicts a potential loss of control condition prior to stability control activation. This real-time warning algorithm builds on available technologies such as the Electronic Stability Control (ESC. The driver warning system computes several indices based on yaw rate, side-slip velocity, and vehicle understeer using ESC sensor suite. An arbitrator block arbitrates between the different indices and determines the status index of the driving vehicle. The status index is compared to predetermined stability levels which correspond to high and low stability levels. If the index exceeds the high stability level, a warning signal (haptic, acoustic, or visual is issued to alert the driver of a potential loss of control and ESC activation. This alert will remain in effect until the index is less than the low stability level at which time the warning signal will be terminated. A vehicle speed advisory algorithm is integrated with the warning algorithm to provide a desired vehicle speed of a vehicle traveling on a curve. Simulation results and vehicle tests were conducted to illustrate the effectiveness of the warning algorithm.
Kato, Yoshiaki; Nakai, Sadao; Yamanaka, Chiyoe.
The energy driver development at the Institute of Laser Engineering (ILE), Osaka University, comprises three fields; glass, laser, carbon dioxide laser, and relativistic electron beam. The development of reliable glass lasers has been the main program at ILE. The GEKKO 12 module program was carried out in the fiscal years from 1977 to 1979 in order to develop various laser components and subsystems which are necessary to construct a 20 kJ GEKKO 12 glass laser. The measured gain coefficient of the 200 mm disk amplifier was 0.10/cm corresponding to the αD product of 4.0. The expected peak output power of the system was 2 TW at 0.1 ns and 0.9 kJ at 1 ns. The recent advances in coating techniques will enable to operate this system over 1.3 kJ per beam at 3 ns. Carbon dioxide lasers have been developed as efficient high energy lasers to study the wave length scaling of implosion process. The design and construction of the 10 kJ LEKKO 8 laser system are in progress. Relativistic electron beam machines, being the most cost-effective driver, have been studied to control pulsed power and to investigate electron beam plasma interaction. As the future plans of ILE, the construction of a 100 kJ energy driver from 1958 to 1987 for scientific break-even experiments is considered. (Kato, T.)
Snenghi, Rossella; Forza, Giovanni; Favretto, Donata; Sartore, Daniela; Rodinis, Silvia; Terranova, Claudio; Nalesso, Alessandro; Montisci, Massimo; Ferrara, Santo Davide
The aim of this study was to investigate polydrug use in drunk drivers. The experimental study was conducted on 2,072 drunk drivers undergoing a driving license reissue protocol at the Department of Legal Medicine of Padova University Hospital in the period between January 2011 and December 2012. The study protocol involved anamnesis, clinical examination, toxicological history, and toxicological analyses on multiple biological samples. One thousand eight hundred seventy-seven subjects (90.6%) were assessed as fit to drive, and 195 (9.5%) were declared unfit. Among those unfit, 32 subjects (1.6%) were declared unfit due to recent use of an illicit drug (time span drive after completeness of the protocol was established in 1.2% of cases for alcohol disorders and in 5.7% of cases for illicit drug abuse; only one subject was included in both subgroups. Cocaine was the most widely used substance, followed by cannabis, opiates, and psychotropic pharmaceutical drugs. The application of the protocol presented in this study allowed the identification of underlying polydrug use in drunk drivers. The study led to the identification of 6.8% unfit subjects on the basis of alcohol disorders and/or drug abuse, compared to 1.2% of identifiable unfitness if the protocol were limited to the mere assessment of alcohol consumption. The frequent association of alcohol and cocaine is different from other patterns of use in North Europe countries.
Agimi, Yll; Albert, Steven M; Youk, Ada O; Documet, Patricia I; Steiner, Claudia A
In a number of states, physicians are mandated by state law to report at-risk drivers to licensing authorities. Often these patients are older adult drivers who may exhibit unsafe driving behaviors, have functional/cognitive impairments, or are diagnosed with conditions such as Alzheimer's disease and/or seizure disorders. The hypothesis that mandatory physician reporting laws reduce the rate of crash-related hospitalizations among older adult drivers was tested. Using retrospective data (2004-2009), this study identified 176,066 older driver crash-related hospitalizations, from the State Inpatient Databases. Three age-specific negative binomial generalized estimating equation models were used to estimate the effect of physician reporting laws on state's incidence rate of crash-related hospitalizations among older drivers. No evidence was found for an independent association between mandatory physician reporting laws and a lower crash hospitalization rate among any of the age groups examined. The main predictor of interest, mandatory physician reporting, failed to explain any significant variation in crash hospitalization rates, when adjusting for other state-specific laws and characteristics. Vision testing at in-person license renewal was a significant predictor of lower crash hospitalization rate, ranging from incidence rate ratio of 0.77 (95% confidence interval 0.62-0.94) among 60- to 64-year olds to 0.83 (95% confidence interval 0.67-0.97) among 80- to 84-year olds. Physician reporting laws and age-based licensing requirements are often at odds with older driver's need to maintain independence. This study examines this balance and finds no evidence of the benefits of mandatory physician reporting requirements on driver crash hospitalizations, suggesting that physician mandates do not yet yield significant older driver safety benefits, possibly to the detriment of older driver's well-being and independence. © The Author 2017. Published by Oxford University
Hawkins, A N; Filtness, A J
Driver sleepiness is a major contributor to severe crashes and fatalities on our roads. Many people continue to drive despite being aware of feeling tired. Prevention relies heavily on education campaigns as it is difficult to police driver sleepiness. The video sharing social media site YouTube is extremely popular, particularly with at risk driver demographics. Content and popularity of uploaded videos can provide insight into the quality of publicly accessible driver sleepiness information. The purpose of this research was to answer two questions; firstly, how prevalent are driver sleepiness videos on YouTube? And secondly, what are the general characteristics of driver sleepiness videos in terms of (a) outlook on driver sleepiness, (b) tone, (c) countermeasures to driver sleepiness, and, (d) driver demographics. Using a keywords search, 442 relevant videos were found from a five year period (2nd December 2009-2nd December 2014). Tone, outlook, and countermeasure use were thematically coded. Driver demographic and video popularity data also were recorded. The majority of videos portrayed driver sleepiness as dangerous. However, videos that had an outlook towards driver sleepiness being amusing were viewed more often and had more mean per video comments and likes. Humorous videos regardless of outlook, were most popular. Most information regarding countermeasures to deal with driver sleepiness was accurate. Worryingly, 39.8% of videos with countermeasure information contained some kind of ineffective countermeasure. The use of humour to convey messages about the dangers of driver sleepiness may be a useful approach in educational interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.
Daza, Iván García; Bergasa, Luis Miguel; Bronte, Sebastián; Yebes, Jose Javier; Almazán, Javier; Arroyo, Roberto
This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems) in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS). An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study.
Iván G. Daza
Full Text Available This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS. An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study.
Full Text Available Background: Bus drivers are a special group of professional drivers who are at a very high risk of fatigue. The aim of the study was to examine whether the driver’s subjective assessment of fatigue allows for the determination of its level and identification of its causes. Material and Methods: The study group comprised 45 randomly selected bus drivers (mean age – 43.7±7.9 years, period of employment as drivers – 14.7±8.6 years. Examinations were performed in all subjects four times – before and after work on the “easy” route (outside the city center, small traffic intensity and before and after work on the “difficult” route (city center, heavy traffic. The fatigue test questionnaire, based on the list of symptoms of fatigue prepared by the Japan Research Committee of Fatigue, was used in the study. Results: The rating of fatigue after the work was significantly higher than that before the work. The profile of fatigue after work was not influenced by the type of route, but the assessment of most symptoms of fatigue reached a higher level after the “difficult” routes and the differences were statistically significant for 7 symptoms. Only the ratings of leg fatigue, feeling of heaviness, and the necessity to squint eyes and gaze with effort reached the higher levels after driving the “easy” routes. It has been found that the level of fatigue was significantly correlated with the job characteristics (driving time, the length of the route, number of stops, etc. and with the abundance of food ingested and type of beverage (coffee vs. others drunk prior to driving. Conclusions: The questionnaire used in our study to assess the subjective feeling of fatigue has proved to be a sensitive and useful tool for indicating the level and causes of fatigue. The relationship between the symptoms of fatigue and the characteristics of job and lifestyle shows that actions must be taken by both the employers and employees to prevent fatigue
Wei, Junqing; Dolan, John M.; Litkouhi, Bakhtiar
In this paper, an offline learning mechanism based on the genetic algorithm is proposed for autonomous vehicles to emulate human driver behaviors. The autonomous driving ability is implemented based on a Prediction- and Cost function-Based algorithm (PCB). PCB is designed to emulate a human driver's decision process, which is modeled as traffic scenario prediction and evaluation. This paper focuses on using a learning algorithm to optimize PCB with very limited training data, so that PCB can have the ability to predict and evaluate traffic scenarios similarly to human drivers. 80 seconds of human driving data was collected in low-speed (car-following scenarios. In the low-speed car-following tests, PCB was able to perform more human-like carfollowing after learning. A more general 120 kilometer-long simulation showed that PCB performs robustly even in scenarios that are not part of the training set.
Parekh, V.; Gildfind, D.; Lewis, S.; James, C.
The University of Queensland's X3 facility is a large, free-piston driven expansion tube used for super-orbital and high Mach number scramjet aerothermodynamic studies. During recent development of new scramjet test flow conditions, experimentally measured shock speeds were found to be significantly lower than that predicted by initial driver performance calculations. These calculations were based on ideal, isentropic compression of the driver gas and indicated that loss mechanisms, not accounted for in the preliminary analysis, were significant. The critical determinant of shock speed is peak driver gas sound speed, which for a given gas composition depends on the peak driver gas temperature. This temperature may be inaccurately estimated if an incorrect fill temperature is assumed, or if heat losses during driver gas compression are significant but not accounted for. For this study, the ideal predicted peak temperature was 3750 K, without accounting for losses. However, a much lower driver temperature of 2400 K is suggested based on measured experimental shock speeds. This study aimed to measure initial and peak driver gas temperatures for a representative X3 operating condition. Examination of the transient temperatures of the driver gas and compression tube steel wall during the initial fill process showed that once the filling process was complete, the steady-state driver gas temperature closely matched the tube wall temperature. Therefore, while assuming the gas is initially at the ambient laboratory temperature is not a significant source of error, it can be entirely mitigated by simply monitoring tube wall temperature. Optical emission spectroscopy was used to determine the driver gas spectra after diaphragm rupture; the driver gas emission spectrum exhibited a significant continuum radiation component, with prominent spectral lines attributed to contamination of the gas. A graybody approximation of the continuum suggested a peak driver gas temperature of
Zheng, Hao; Dong, Xiaoshe; Wang, Endong; Chen, Baoke; Zhu, Zhengdong; Liu, Chengzhe
With the advantage of the reusability property of the virtualization technology, users can reuse various types and versions of existing operating systems and drivers in a virtual machine, so as to customize their application environment. In order to prevent users' virtualization environments being impacted by driver faults in virtual machine, Chariot examines the correctness of driver's write operations by the method of combining a driver's write operation capture and a driver's private access control table. However, this method needs to keep the write permission of shadow page table as read-only, so as to capture isolated driver's write operations through page faults, which adversely affect the performance of the driver. Based on delaying setting frequently used shadow pages' write permissions to read-only, this paper proposes an algorithm using shadow page cache to improve the performance of isolated drivers and carefully study the relationship between the performance of drivers and the size of shadow page cache. Experimental results show that, through the shadow page cache, the performance of isolated drivers can be greatly improved without impacting Chariot's reliability too much.
Full Text Available Research Question: Whether long distance truck drivers are at a higher risk of contracting and transmitting STDs including HIV? Objectives: i To study the degree of knowledge of HIV and AIDS among long- distance truck drivers. ii Assess their sexual behaviour including condom use. iii Explore their prevailing social influences and substance abuse patterns. iv Explore their treatment seeking bahaviour as regards STDs. v Deduce their risk of contracting and transmitting STDs including HIV. Study Design: Cross- sectional interview. Setting: Transport Nagar, Indore (M.P Participants: 210 senior drivers (First drivers and 210 junior drivers (Second drivers. Study Variables: Extra-Marital sexual intercourse, condom usage, past and present history of STDs, treatment and counseling, substance abuse, social â€" cultural milieu. Outcome Variables: Risk of contraction of STDs. Statistical Analysis: Univariate analysis. Results: 94% of the drivers were totally ignorant about AIDS. 82.9% and 43.8 % of the senior and junior drivers had a history of extra- marital sex and of these only 2 regularly used condoms. 13.8% and 3.3 % of the senior and junior drivers had a past or present history suggestive of STD infection. Alcohol and Opium were regularly used by them. Conclusion: The studied drivers are at a high risk of contracting and transmitting STDs including HIV.
Halder, P K; Sarker, E
Background. Inappropriate design of sitting furniture and working equipment causes the serious musculoskeletal injuries and various pains as well as reducing working efficiency. Uncomfortable sitting posture in prolonged driving in Bangladesh is an issue to be solved immediately. Therefore, anthropometric databank of user population is significantly essential for the suitable dimensional design for avoiding these remarkable problems. Methods. This study analyses the anthropometric data of the Bangladeshi male vehicle driver aged between 30 and 60 years. A total of 210 Bangladeshi healthy drivers are considered for 15 anthropometric measurements and compared with the similar anthropometrics of other nationalities. Results. The mean stature and sitting height erect of Bangladeshi driver are 1645 mm and 843 mm, respectively. The mean of body mass index (BMI) of the drivers is 26.09 kg/m(2), which indicates that the drivers are overweight. The mean stature of Bangladeshi driver is 17 mm shorter than the driver of Korea and 115 mm shorter than the driver of Iran. Conclusion. There are substantial differences between the body dimensions of Bangladeshi driver and similar dimensions of other countries. In comparison, Bangladeshi driver is found to be the shortest compared with the sample of other nationalities.
Anne-Gaëlle Le Moing
Full Text Available Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD patients (mean age 18.5 ± 5.5 years collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment
Drummer, Olaf H; Kourtis, Irene; Beyer, Jochen; Tayler, Penny; Boorman, Martin; Gerostamoulos, Dimitri
In mid 2009 Victoria introduced compulsory drug testing of blood taken from all injured drivers taken to hospital. Δ(9)-Tetrahydrocannabinol (THC), methylamphetamine (MA) and 3,4-methylenedioxy-methylamphetamine (MDMA) are prohibited and if drivers are positive to any amount an automatic penalty is enforced. Laboratory screens were conducted on preserved blood using ELISA testing for cannabis metabolite and methylamphetamines and a fully validated LC-MS/MS method for 105 drugs including THC, amphetamines, opioids, benzodiazepines, antidepressants and antipsychotics and a number of other psychoactive substances using a minimum of two transitions per drug. Conventional GC-testing for ethanol was used to screen and quantify the presence of alcohol. 1714 drivers were tested and showed alcohol in 29% (≥ 0.01 g/100mL) and drugs in 35%. The positive rate for the three drugs prohibited by legislation was 12.5%. The prevalence of THC, MA and MDMA was 9.8%, 3.1%, and 0.8%, respectively. The range of THC concentrations in blood was 2-42 ng/mL (median 7) of which 70% had a concentration of 10 ng/mL or higher. The range of concentrations for MA and MDMA was 0.02-0.4 and 0.03-0.3mg/L (median for both drugs was 0.05 mg/L). Drugs of any type were detected in 35% of cases. The other drugs were largely prescribed drugs such as the antidepressants (9.3%) and benzodiazepines (8.9%). Neither 6-acetylmorphine nor cocaine (or benzoylecgonine) was detected in these cases. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Siemieniuch, C E; Sinclair, M A; Henshaw, M J deC
This paper briefly explores the expected impact of the 'Global Drivers' (such as population demographics, food security; energy security; community security and safety), and the role of sustainability engineering in mitigating the potential effects of these Global Drivers. The message of the paper is that sustainability requires a significant input from Ergonomics/Human Factors, but the profession needs some expansion in its thinking in order to make this contribution. Creating a future sustainable world in which people experience an acceptable way of life will not happen without a large input from manufacturing industry into all the Global Drivers, both in delivering products that meet sustainability criteria (such as durability, reliability, minimised material requirement and low energy consumption), and in developing sustainable processes to deliver products for sustainability (such as minimum waste, minimum emissions and low energy consumption). Appropriate changes are already being implemented in manufacturing industry, including new business models, new jobs and new skills. Considerable high-level planning around the world is in progress and is bringing about these changes; for example, there is the US 'Advanced Manufacturing National Program' (AMNP)', the German 'Industrie 4.0' plan, the French plan 'la nouvelle France industrielle' and the UK Foresight publications on the 'Future of Manufacturing'. All of these activities recognise the central part that humans will continue to play in the new manufacturing paradigms; however, they do not discuss many of the issues that systems ergonomics professionals acknowledge. This paper discusses a number of these issues, highlighting the need for some new thinking and knowledge capture by systems ergonomics professionals. Among these are ethical issues, job content and skills issues. Towards the end, there is a summary of knowledge extensions considered necessary in order that systems ergonomists can be fully
Dalla Villa, P; Matthews, L R; Alessandrini, B; Messori, S; Migliorati, G
The European region has been, and remains, a global leader in the development of animal welfare policies. The region has a great diversity of cultures and religions, different levels of socio-economic development, and varied legislation, policies and practices. Nevertheless, there are common drivers for animal welfare policy based on a history of animal welfare ethics and obligations to animal users and society in general. A unifying goal of countries in the region is to achieve sustainable compliance with the World Organisation for Animal Health (OIE) standards on animal health and welfare. Ethics isthe overarching driver, supported by the actions of governmental, inter-governmental and non-governmental activities, markets and trade, science and knowledge. Historically, organisations involved in promoting animal welfare have tended to act in isolation. For example, non-governmental organisations (NGOs) have run campaigns to influence retailers and the welfare policies of their farmer suppliers. Increasingly, different organisations with common or complementary goals are working together. For example, competent authorities, inter-governmental bodies and NGOs have combined their efforts to address dog population control across several countries in the region. Also, animal welfare is becoming integrated into the corporate social responsibility targets of private companies. Science and knowledge, as drivers and tools, are assisting with the harmonisation of welfare standards, e.g. by providing a common basis for measuring welfare impacts through animal-based measures and widespread sharing of this information. Current trends suggest that there will be greater collaboration among the organisations driving change, and increasing convergence of animal welfare strategies and welfare assessment tools. The result will be increased harmonisation of animal welfare standards throughout the region.
Dengel, S.; Billesbach, D. P.; Hughes, H.; Humphreys, E.; Lee, J.; Noormets, A.; Verfaillie, J. G.
Since the advancement in CH4 eddy covariance flux measurements, monitoring of CH4 emissions is becoming more widespread. Since CH4 fluxes are not as predictable or as easily interpretable as CO2 fluxes, understanding their emission patterns often still challenging. As these are spatially (ecosystem and latitudinal) and temporal very divers and often event based, a better understanding or interpretation of results is required. An improvement in understanding does also increase the reliability of gap-filling methods as annual greenhouse gas budgets rely on high quality data. There are generalised additive models (Wood 2001) that can easily be applied to sites, models where a relationship between the response variable, in this case CH4 and explanatory variables (drivers) is established. Relevant for CH4flux dynamics are the smoothing function that is applied, where each predictor variable is separated into sections and a polynomial function fitted. On the one hand such models are rarely used as they are difficult to interpret since no parameter values are retuned. On the other hand, such models are very good for prediction and explanatory analysis in estimating the functional nature of a response. Applying such models to CH4 eddy flux data does improve our understanding of the dynamics of CH4 emissions and the respective meteorological drivers. Furthermore, such models combined with tree models (interactions between the explanatory variables), can visualise precise dynamics and easily applied to individual sites. These models are simple tools in understanding of these complex fluxes, as they can include a variety of drivers, and their relevance tested by the model. Model input variables should be as independent as possible (avoiding cross-correlation), avoiding redundant inputs, as models should follow the principle of parsimony of being simple but not too simple. Wood SN (2001). mgcv: GAMs and generalized ridge regression for R. R news.
Freeman, Jennifer; Fox, Esther; Gear, Margaret; Hough, Alan
People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training; 2 Comparing core stability training with standardised physiotherapy exercise; 3 Exploring underlying mechanisms of change associated with this intervention This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before
Full Text Available Abstract Background People with Multiple Sclerosis (MS frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect. This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training 2 Comparing core stability training with standardised physiotherapy exercise 3 Exploring underlying mechanisms of change associated with this intervention Methods This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control. All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12, the Functional Reach (forwards and lateral, a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC Scale. In addition, ultrasound imaging of the
Kressler, Jochen; Thomas, Christine K; Field-Fote, Edelle C; Sanchez, Justin; Widerström-Noga, Eva; Cilien, Deena C; Gant, Katie; Ginnety, Kelly; Gonzalez, Hernan; Martinez, Adriana; Anderson, Kimberley D; Nash, Mark S
To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain. Case series. Academic research center. Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year. OBA 3d/wk for 6 weeks. To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed. With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed, .11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale. OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic
Herlina ABDUL RAHIM
Full Text Available The main purpose of this project is to produce a safety system especially for fatigue car driver so as to prevent from accidents. The statistic on road fatality shows that human error constitute of 64.84 % road accidents fatality and 17.4 % due to technical factors. These systems encompassed the approach of hand pressure applied on the steering wheel. The steering will be installed with pressure sensors. At the same time these sensors can be used to measure gripping force while driving.
Full Text Available Courses à la virtuosité Nombreuses sont les pratiques qui ont généré, parfois en leur cœur et souvent en leurs marges, des programmes acrobatiques. Ces programmes ont généralement des finalités comparables. Il s’agit d’apprécier et d’évaluer l’excellence technique, d’explorer plus ou moins librement les possibilités d’un instrument ou de mettre à l’épreuve ses limites. De la musique à la jonglerie, de la prestidigitation à la voltige aérienne ou encore à la cascade à moto, rares sont les arts...
Amano, Shinichi; Roemmich, Ryan T; Skinner, Jared W; Hass, Chris J
Parkinson disease is a progressive neurodegenerative disorder characterized by a variety of motor and nonmotor features. This article reviews the problems of postural instability and gait disturbance in persons with Parkinson disease through the discussion of (1) the neuropathology of parkinsonian motor deficits, (2) behavioral manifestations of gait and postural abnormalities observed in persons with Parkinson disease, and (3) pharmacologic, surgical, and physical therapy-based interventions to combat postural instability and gait disturbance. This article advances the treatment of postural instability and gait disturbance by condensing up-to-date knowledge and making it available to clinicians and rehabilitation professionals. Copyright © 2013 Elsevier Inc. All rights reserved.
Staubach, Maria; Kassner, Astrid; Fricke, Nicola; Schießl, Caroline; Brockmann, Martin; Kuck, Detlef
Nowadays there already exists a large amount of driving-related information displayed in the dashboard and thus additional information concerning ecological driving might enlarge the workload of the driver further. This raises the question whether the presentation of additional ecologic information via the haptic channel is more efficient and comfortable for the driver compared to a visual presentation. Previous studies proved the impact of driver feedback systems on the reduction of fuel con...
Betz, Marian E.; Dickerson, Anne; Coolman, Tyler; Davis, Elin Schold; Jones, Jacqueline; Schwartz, Robert
The objective of this study was to describe the services, referral and reporting practices, and barriers to utilization of driver rehabilitation programs (DRPs) for older drivers. Identified through two national association databases, 204 driver rehabilitation programs completed an online survey. DRP availability varies, with a median of one program per 64,151 older adults (range: 1,006–676,981). The median cost for a complete evaluation was $400; 36% of DRPs reported no third-party reimburse...
Routley, Virginia; Ozanne-Smith, Joan; Qin, Yu; Wu, Ming
To determine and validate patterns of seat belt use and attitudes of taxi drivers on wearing a seat belt following national and provincial seat belt legislation in 2004-2005. Roadside daylight seat belt observation and interview survey methods were used, as well as observations from inside taxis during routine trips and a taxi driver focus group. The setting was Nanjing, Jiangsu Province, PR China in April of 2006 and 2007. Prevalence of seat belt use and attitudes to wearing a seat belt were determined, as were vehicle and driver characteristics, and comparisons with other motor-vehicle driver's seat belt use and attitudes. Taxi drivers interviewed were predominantly male and aged 30-39 years. They spent more hours per week in their vehicles and had more driving experience than other drivers. Over half (56.2%) of taxi drivers interviewed reported that they always wore seat belts, while observation of taxi drivers showed lower wearing rates (i.e., roadside observation was 43.8%, and observation from inside taxis was 36.2%). Belt tampering was a practice of 12-15% of taxi drivers. "Fine avoidance, safety, high speed and long trips" were given as important reasons for wearing and "feeling trapped and uncomfortable" for not wearing. Seat belt reminder signs in taxis were common (82.6% of taxis), but did not appear to impact on driver seat belt use. The four research methods found taxi drivers to have consistently low "correct wearing" rates. As in several other countries, taxi drivers are particularly resistant to seat belt use. Innovative strategies, including occupational health and safety approaches, may be required to achieve increased levels of seat belt use.
Full Text Available Background: The purpose of this article is to draw attention to a significant role of social approval variable in the qustionnairebased diagnosis of drivers' psychological aptitude. Material and Methods: Three questionnaires were used: Formal Characteristics of Behavior - Temperament Inventory (FCB-TI, Eysenck Personality Questionnaire (EPQ-R(S and Impulsiveness Questionnaire (Impulsiveness, Venturesomeness, Empathy - IVE. Three groups of drivers were analyzed: professional "without crashes" (N = 46, nonprofessional "without crashes" (N = 75, and nonprofessional "with crashes" (N = 75. Results: Nonprofessional drivers "without crashes" significantly stood up against other drivers. Their personality profile, indicating a significantly utmost perseveration, emotional reactivity, neuroticism, impulsiveness and the lowest endurance did not fit in to the requirements to be met by drivers. The driver safety profile was characteristic of professional drivers (the lowest level of perseveration, impulsiveness and neuroticism and the highest level of endurance. Similar profile occurred among nonprofessional drivers - the offenders of road crashes. Compared to the nonprofessional "without crashes" group, professional drivers and offenders of road crashes were also characterized by a significantly higher score on the Lie scale, determining the need for social approval. This is likely to result from the study procedure according to which the result of professional drivers testing had an impact on a possible continuity of their job and that of nonprofessional drivers "with crashes" decided about possible recovery of the driving license. Conclusions: The variable of social approval can be a significant artifact in the study of psychological drivers' testing and reduce the reliability of the results of questionnaire methods. Med Pr 2014;65(3:373–385
Dorn, Lisa; Stannard, Jenny
In order to combat the problem of novice bus driver risk, a bus simulator was developed to improve decision-making at hazards that are most often associated with bus crashes. If the simulator is capable of discriminating between novice and experienced bus drivers then it can be argued that it is a valid tool for bus driver training to improve road safety. The purpose of this study then is to investigate whether there are significant differences between experienced and novice bus d...
Oškrdal Václav; Pavlíček Antonín; Jelínková Petra
This article presents an insight to processes, performance drivers and ICT tools in human resources (HR) management area. On the basis of a modern approach to HR management, a set of business processes that are handled by today’s HR managers is defined. Consequently, the concept of ICT-supported performance drivers and their relevance in the area of HR management as well as the relationship between HR business processes, performance drivers and ICT tools are defined. The theoretical outcomes ...
Murray, Kate E; Buul, Abdimalik; Aden, Rasheed; Cavanaugh, Alyson M; Kidane, Luwam; Hussein, Mikaiil; Eastman, Amelia; Checkoway, Harvey
Research has shown that taxi drivers are at risk for numerous health concerns, such as low back and leg pain, linked to their highly sedentary occupation, long work hours and stressors related to the job (e.g. low income, safety threats). The goal of this study was to explore occupational health risks and opportunities for health interventions with taxi drivers using community-based participatory research (CBPR) methods. A mixed methods approach included first a convenience sample of 19 East African taxi drivers participating in focus group discussions. Second, a convenience sample of 75 current taxi drivers (M age = 45.7 years) and 25 non-driver comparison participants (M age = 40.3 years) were recruited to complete a structured self-reported questionnaire and objective measures of health. Health education was provided alongside the research to address common health concerns and to ensure mutual benefit and an action orientation. The focus groups described numerous health concerns that drivers attributed to their occupation, including chronic pain, sleep deprivation, cardiovascular disease, diabetes, kidney disease and eye problems, as the most common. Participants offered ideas for health interventions that include workplace reform and driver education. Quantitative data indicate that 44% of drivers reported their health as 'fair' or 'poor'. Drivers were more likely to report musculoskeletal pain, less sleep, more fatigue and less physical activity as compared to non-drivers. The majority of drivers reported financial and job dissatisfaction. The research provides data to inform targeted health interventions that support the health and safety of taxi drivers. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
van Driel, Cornelie
Mobility is a key factor for modern societies. However, it also brings about problems, such as congestion, accidents and pollution. High expectations rest on in-vehicle systems to contribute to solving these problems. These so-called driver support systems use advanced information and communication
Harrison, D D; Harrison, S O; Croft, A C; Harrison, D E; Troyanovich, S J
Driving has been associated with signs and symptoms caused by vibrations. Sitting causes the pelvis to rotate backwards and the lumbar lordosis to reduce. Lumbar support and armrests reduce disc pressure and electromyographically recorded values. However, the ideal driver's seat and an optimal seated spinal model have not been described. To determine an optimal automobile seat and an ideal spinal model of a driver. Information was obtained from peer-reviewed scientific journals and texts, automotive engineering reports, and the National Library of Medicine. Driving predisposes vehicle operators to low-back pain and degeneration. The optimal seat would have an adjustable seat back incline of 100 degrees from horizontal, a changeable depth of seat back to front edge of seat bottom, adjustable height, an adjustable seat bottom incline, firm (dense) foam in the seat bottom cushion, horizontally and vertically adjustable lumbar support, adjustable bilateral arm rests, adjustable head restraint with lordosis pad, seat shock absorbers to dampen frequencies in the 1 to 20 Hz range, and linear front-back travel of the seat enabling drivers of all sizes to reach the pedals. The lumbar support should be pulsating in depth to reduce static load. The seat back should be damped to reduce rebounding of the torso in rear-end impacts. The optimal driver's spinal model would be the average Harrison model in a 10 degrees posterior inclining seat back angle.
Vadeby, Anna; Wiklund, Mats; Forward, Sonja
As a way to reduce the number of car crashes different in-car safety devices are being introduced. In this paper one such application is being investigated, namely the electronic stability control system (ESC). The study used a survey method, including 2000 private car drivers (1000 driving a car with ESC and 1000 driving a car without ESC). The main objective was to investigate the effect of ESC on driver behaviour. Results show that drivers report that they drive even more carelessly when they believe that they have ESC, than when they do not. Men are more risk prone than women and young drivers more than older drivers. Using the theory of planned behaviour the results show that attitude, subjective norm and perceived control explain between 62% and 67% of driver's variation of intentions to take risks. When descriptive norm was added to the model a small but statistically significant increase was found. The study also shows that more than 35% erroneously believe that their car is equipped with an ESC system. These findings may suggest that driver behaviour could reduce the positive effect ESC has on accidents. It also shows that drivers who purchase a new car are not well informed about what kind of safety devices the car is equipped with. These findings highlight the need for more targeted information to drivers. Copyright © 2010 Elsevier Ltd. All rights reserved.
Amaral, L; Da Silva, S; Mazza, G; Meroli, S; Moreira, P; Rivetti, A; Troska, J; Wyllie, K
A laser driver for data transmission at 5 Gb/s has been developed as a part of the Giga Bit Transceiver (GBT) project. The Giga Bit Laser Driver (GBLD) targets High Energy Physics (HEP) applications for which radiation tolerance is mandatory. The GBLD ASIC can drive both VCSELs and some types of edge emitting lasers. It is essentially composed of two drivers capable of sinking up to 12 mA each from the load at a maximum data rate of 5 Gb/s, and of a current sink for the laser bias current. The laser driver include also pre-emphasis and duty cycle control capabilities.
Meier, W.R.; Logan, B.G.
Previous modeling for HIF drivers concentrated on designs in which 100 or more beams are grouped in an array and accelerated through a common set of induction cores. The total beam energy required by the target is achieved by the combination of final ion energy, current per beam and number of beams. Economic scaling favors a large number of small (∼1 cm dia.) beams. An alternative architecture has now been investigated, which we refer to as a modular driver. In this case, the driver is subdivided into many (>10) independent accelerators with one or many beams each. A key objective of the modular driver approach is to be able to demonstrate all aspects of the driver (source-to-target) by building a single, lower cost module compared to a full-scale, multi-beam driver. We consider and compare several design options for the modular driver including single-beam designs with solenoid instead of quadrupole magnets in order to transport the required current per module in a single beam, solenoid/quad combinations, and multi-beam, all-quad designs. The drivers are designed to meet the requirements of the hybrid target, which can accommodate a larger spot size than the distributed radiator target that was used for the Robust Point Design. We compare the multi-beam and modular driver configuration for a variety and assumptions and identify key technology advances needed for the modular design
Li, Qing; Tay, Richard
Although a proficient knowledge of the road rules is important to safe driving, many drivers do not retain the knowledge acquired after they have obtained their licenses. Hence, more innovative and appealing methods are needed to improve drivers' knowledge of the road rules. This study examines the effect of game based learning on drivers' knowledge acquisition and retention. We find that playing an entertaining game that is designed to impart knowledge of the road rules not only improves players' knowledge but also helps them retain such knowledge. Hence, learning by gaming appears to be a promising learning approach for driver education. Copyright © 2013 Elsevier Ltd. All rights reserved.
...-2011-0367] Qualification of Drivers; Exemption Applications; Diabetes Mellitus AGENCY: Federal Motor... diabetes mellitus (ITDM) from operating commercial motor vehicles (CMVs) in interstate commerce. The...). [[Page 10608
Mitchell, Christopher G B Kit
Driving licence holding in Britain is increasing for older people, particularly older women. Licence holding by men aged 40-69 has saturated at about 90%, and for women aged 30-59 at about 78%. Drivers begin to surrender licences after age 70. By age 90, 38% of women and 25% of men who held a licence at age 70 have surrendered their licences. The paper shows the numbers of car drivers of different ages killed and injured in accidents since 1975 and the fatality and casualty rates per driver and per mile driven. The safety of older drivers is improving faster than that of younger age groups. The number of car driver fatalities aged 70 and over was highest between 1990 and 2004, and has subsequently reduced by almost 40%. For drivers aged 80 and over, the peak was in 2004 and the number has subsequently reduced by almost 50%. The paper uses demographic projections, forecast licence holding and the trends in fatality rates to project the numbers of fatalities for drivers of different ages in Britain. This shows that fatalities among older drivers aged are likely to continue to reduce. Fatality rates for older road users are increased by the fragility of older persons. This disguises the fact that the accident involvement rate for older drivers does not increase with age until after age 75 or 80. Copyright © 2012. Published by Elsevier Ltd.
Kervick, Aoife A; Hogan, Michael J; O'Hora, Denis; Sarma, Kiran M
There is growing interest in the potential value of using phone applications that can monitor driver behaviour (Smartphone Driver Support Systems, 'SDSSs') in mitigating risky driving by young people. However, their value in this regard will only be realised if young people are willing to use this technology. This paper reports the findings of a study in which a novel structural model of willingness to use SDSSs was tested. Grounded in the driver monitoring and Technology Acceptance (TA) research literature, the model incorporates the perceived risks and gains associated with potential SDSS usage and additional social cognitive factors, including perceived usability and social influences. A total of 333 smartphone users, aged 18-24, with full Irish driving licenses completed an online questionnaire examining willingness or Behavioural Intention (BI) to uptake a SDSS. Following exploratory and confirmatory factor analyses, structural equation modelling indicated that perceived gains and social influence factors had significant direct effects on BI. Perceived risks and social influence also had significant indirect effects on BI, as mediated by perceived gains. Overall, this model accounted for 72.5% of the variance in willingness to uptake SDSSs. Multi-group structural models highlighted invariance of effects across gender, high and low risk drivers, and those likely or unlikely to adopt novel phone app technologies. These findings have implications for our understanding of the willingness of young drivers to adopt and use SDSSs, and highlight potential factors that could be targeted in behavioural change interventions seeking to improve usage rates. Copyright © 2015 Elsevier Ltd. All rights reserved.
Stern, Hal S; Blower, Daniel; Cohen, Michael L; Czeisler, Charles A; Dinges, David F; Greenhouse, Joel B; Guo, Feng; Hanowski, Richard J; Hartenbaum, Natalie P; Krueger, Gerald P; Mallis, Melissa M; Pain, Richard F; Rizzo, Matthew; Sinha, Esha; Small, Dylan S; Stuart, Elizabeth A; Wegman, David H
This article summarizes the recommendations on data and methodology issues for studying commercial motor vehicle driver fatigue of a National Academies of Sciences, Engineering, and Medicine study. A framework is provided that identifies the various factors affecting driver fatigue and relating driver fatigue to crash risk and long-term driver health. The relevant factors include characteristics of the driver, vehicle, carrier and environment. Limitations of existing data are considered and potential sources of additional data described. Statistical methods that can be used to improve understanding of the relevant relationships from observational data are also described. The recommendations for enhanced data collection and the use of modern statistical methods for causal inference have the potential to enhance our understanding of the relationship of fatigue to highway safety and to long-term driver health. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
Mabbott, N.; Lloyd, B. [ARRB Group Ltd., Leederville, WA (United States)
Coal Services (Health and Safety Trust) funded ARRB Transport Research Ltd. to investigate fatigue and performance of truck drivers over consecutive shifts. The main questions were to assess: What is the most important contributor to acute fatigue in mining? Is it length of shift or is it time of day? What is the limit of successive day or night shifts before chronic fatigue affects operator performance in open cut mines? The project methodology included utilising ARRB Fatigue Monitoring Devices in eight haul trucks, testing 24 subjects over several weeks. Each subject filled in a Fatigue Risk Questionnaire on lifestyle and health. Operators worked a 14 night, 1 day off, 13 day roster of 12-hour shifts in a fly-in, fly-out operation with excellent opportunities for restorative sleep between shifts. A total of 3,500 hours of real-time data was collected, representing the first set of objective, real-time driver performance data for Australian mining. The major finding within this study is the combined influence of circadian rhythms and individual variability on performance. The lifestyle habits and the health of individuals have a profound effect on operator performance as shown by the strong positive correlation between high fatigue risk scores from the Fatigue Risk Questionnaire and poor performance. An individualistic approach would appear to have the best chance of reducing high potential incidents due to fatigue through successive nightshifts. 9 refs., 14 figs.
Walker, Guy H; Stanton, Neville A; Salmon, Paul M
Incompatibility between different types of road user is a problem that previous research has shown to be resistant to a range of interventions. Cars and motorcycles are particularly prone to this. Insight is provided in this paper by a naturalistic method using concurrent verbal protocols and an automatic, highly reliable semantic network creation tool. The method shows how the same road situation is interpreted differently by car drivers and motorcyclists in ways congruent with wider accident rates. Analysis of the structure and content of the semantic networks reveals a greater degree of cognitive compatibility on faster roads such as motorways, but evidence of more critical incompatibilities on country roads and junctions. Both of these road types are implicated in helping to activate cognitive schema which in turn generate stereotypical behaviors unfavourable to the anticipation of motorcyclists by car drivers. The results are discussed in terms of practical measures such as road signs which warn of events behind as well as in front, cross-mode training and the concept of route driveability. Copyright © 2010 Elsevier Ltd. All rights reserved.
This review is intended to place in perspective our current view of the parameter ranges for induction linac drivers that lead to attractive scenarios for civilian electrical power plants; there is a surprising degree of choice (a factor of 2 or so in most parameters) before any significant impact on the cost of energy results. The progress and goals of the US heavy-ion fusion accelerator research (HIFAR) program are reviewed. The step between the realization of the HIFAR goals and a full-scale driver is seen to be very large indeed and will require one or more significant intermediate steps which can be justified only by a commitment to advance the HIF method towards a true fusion goal. Historial anomalies in the way that fusion programs for both military and civilian applications are administered will need to be resolved; the absence of any presently perceived energy crisis results in little current sense of urgency to develop vigorous long-term energy solutions. (orig.)
Herrmannsfeldt, W.B.; Bangerter, R.O.; Bock, R.; Hogan, W.J.; Lindl, J.D.
The various technical issues of HIF will be briefly reviewed in this paper. It will be seen that there are numerous areas in common in all the approaches to HIF. In the recent International Symposium on Heavy Ion Inertial Fusion, the attendees met in specialized workshop sessions to consider the needs for research in each area. Each of the workshop groups considered the key questions of this report: (1) Is this an appropriate time for international collaboration in HIF? (2) Which problems are most appropriate for such collaboration? (3) Can the sharing of target design information be set aside until other driver and systems issues are better resolved, by which time it might be supposed that there could be a relaxation of classification of target issues? (4) What form(s) of collaboration are most appropriate, e.g., bilateral or multilateral? (5) Can international collaboration be sensibly attempted without significant increases in funding for HIF? The authors of this report share the conviction that collaboration on a broad scale is mandatory for HIF to have the resources, both financial and personnel, to progress to a demonstration experiment. Ultimately it may be possible for a single driver with the energy, power, focusibility, and pulse shape to satisfy the needs of the international community for target physics research. Such a facility could service multiple experimental chambers with a variety of beam geometries and target concepts