Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

DEFF Research Database (Denmark)

Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

2017-01-01

) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

DEFF Research Database (Denmark)

Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48......: Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......, the incidence of emergency ambulance service patients, the proportion of women, elderly, and non-specific diagnoses increased. The level of comorbidity increased substantially, whereas the 1-day and 30-day mortality decreased....

Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

Science.gov (United States)

Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

2017-05-12

Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest.

Science.gov (United States)

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

2018-06-01

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.

Paramedic identification of acute pulmonary edema in a metropolitan ambulance service.

Science.gov (United States)

Williams, Teresa A; Finn, Judith; Celenza, Antonio; Teng, Tiew-Hwa; Jacobs, Ian G

2013-01-01

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

Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study.

Science.gov (United States)

Liman, Thomas G; Winter, Benjamin; Waldschmidt, Carolin; Zerbe, Norman; Hufnagl, Peter; Audebert, Heinrich J; Endres, Matthias

2012-08-01

Pre- and intrahospital time delays are major concerns in acute stroke care. Telemedicine-equipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting. Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation. In 18 of 30 scenarios, National Institutes of Health Stroke Scale assessment could not be performed due to absence or loss of audio-video signal. In the remaining 12 completed scenarios, interrater agreement of National Institutes of Health Stroke Scale examination between ambulance and hospital and ambulance and "a posteriori" video evaluation was moderate to good with weighted κ values of 0.69 (95% CI, 0.51-0.87) and 0.79 (95% CI, 0.59-0.98), respectively. Prehospital telestroke examination was not at an acceptable level for clinical use, at least on the basis of the used technology. Further technical development is needed before telestroke is applicable for prehospital stroke management during patient transport.

Is air transport of stroke patients faster than ground transport?

DEFF Research Database (Denmark)

Hesselfeldt, Rasmus; Gyllenborg, Jesper; Steinmetz, Jacob

2014-01-01

BACKGROUND: Helicopters are widely used for interhospital transfers of stroke patients, but the benefit is sparsely documented. We hypothesised that helicopter transport would reduce system delay to thrombolytic treatment at the regional stroke centre. METHODS: In this prospective controlled...... observational study, we included patients referred to a stroke centre if their ground transport time exceeded 30 min, or they were transported by a secondarily dispatched, physician-staffed helicopter. The primary endpoint was time from telephone contact to triaging neurologist to arrival in the stroke centre....... Secondary endpoints included modified Rankin Scale at 3 months, 30-day and 1-year mortality. RESULTS: A total of 330 patients were included; 265 with ground transport and 65 with helicopter, of which 87 (33%) and 22 (34%), received thrombolysis, respectively (p=0.88). Time from contact to triaging...

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study.

Science.gov (United States)

Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F

2016-03-08

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

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

Directory of Open Access Journals (Sweden)

Jonas Aléx

2015-09-01

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.

Energy cost of ambulation in healthy and disabled Filipino children.

Science.gov (United States)

Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A

1988-11-01

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.

Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands

NARCIS (Netherlands)

Ebben, R.H.; Vloet, L.C.M.; Grunsven, P.M. van; Breeman, W.; Goosselink, B.; Lichtveld, R.A.; Groot, J. de; Achterberg, T. van

2015-01-01

OBJECTIVES: Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). METHODS: A

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial.

Science.gov (United States)

Lundgren, Peter; Henriksson, Otto; Naredi, Peter; Björnstig, Ulf

2011-10-21

Prevention and treatment of hypothermia by active warming in prehospital trauma care is recommended but scientific 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. 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. 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 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. ClinicalTrials.gov: NCT01400152.

A new vibration isolation bed stage with magnetorheological dampers for ambulance vehicles

International Nuclear Information System (INIS)

Chae, Hee Dong; Choi, Seung-Bok

2015-01-01

The vibration experienced in an ambulance can lead to secondary injury to a patient and discourage a paramedic from providing emergency care. In this study, with the goal of resolving this problem, a new vibration isolation bed stage associated with magnetorheological (MR) dampers is proposed to ensure ride quality as well as better care for the patient while he/she is being transported. The bed stage proposed in this work can isolate vibrations in the vertical, rolling and pitching directions to reflect the reality that occurs in the ambulance. Firstly, an appropriate-sized MR damper is designed based on the field-dependent rheological properties of MR fluid, and the damping force characteristics of a MR damper are evaluated as a function of the current. A mechanical model of the proposed vibration isolation bed stage is then established to derive the governing equations of motion. Subsequently, a sliding mode controller is formulated to control the vibrations caused from the imposed excitation signals; those signals are directly measured using a real ambulance subjected to bump-and-curve road conditions. Using the controller based on the dynamic motion of the bed stage, the vibration control performance is evaluated in both the vertical and pitch directions. It is demonstrated that the magnitude of the vibration in the patient compartment of the ambulance can be significantly reduced by applying an input current to the MR dampers installed for the new bed stage. (technical note)

25 CFR 39.703 - What ground transportation costs are covered for students traveling by commercial transportation?

Science.gov (United States)

2010-04-01

... for Funds § 39.703 What ground transportation costs are covered for students traveling by commercial... 25 Indians 1 2010-04-01 2010-04-01 false What ground transportation costs are covered for students traveling by commercial transportation? 39.703 Section 39.703 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT...

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study.

Science.gov (United States)

Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

2015-01-01

Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, pthermal comfort and may prevent the negative consequences of cold stress.

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care--an intervention study.

Science.gov (United States)

Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

2015-01-01

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. 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. 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%, pthermal comfort and may prevent the negative consequences of cold stress.

High-speed ground transportation development outside United States

Energy Technology Data Exchange (ETDEWEB)

Eastham, T.R. [Queen`s Univ., Kingston, Ontario (United Kingdom)

1995-09-01

This paper surveys the state of high-speed (in excess of 200 km/h) ground-transportation developments outside the United States. Both high-speed rail and Maglev systems are covered. Many vehicle systems capable of providing intercity service in the speed range 200--500 km/h are or will soon be available. The current state of various technologies, their implementation, and the near-term plans of countries that are most active in high-speed ground transportation development are reported.

A correction factor for estimating statewide agricultural injuries from ambulance reports.

Science.gov (United States)

Scott, Erika E; Earle-Richardson, Giulia; Krupa, Nicole; Jenkins, Paul

2011-10-01

Agriculture ranks as one of the most hazardous industries in the nation. Agricultural injury surveillance is critical to identifying and reducing major injury hazards. Currently, there is no comprehensive system of identifying and characterizing fatal and serious non-fatal agricultural injuries. Researchers sought to calculate a multiplier for estimating the number of agricultural injury cases based on the number of times the farm box indicator was checked on the ambulance report. Farm injuries from 2007 that used ambulance transport were ascertained for 10 New York counties using two methods: (1) ambulance reports including hand-entered free text; and (2) community surveillance. The resulting multiplier that was developed from contrasting these two methods was then applied to the statewide Emergency Medical Services database to estimate the total number of agricultural injuries for New York state. There were 25,735 unique ambulance runs due to injuries in the 10 counties in 2007. Among these, the farm box was checked a total of 90 times. Of these 90, 63 (70%) were determined to be agricultural. Among injury runs where the farm box was not checked, an additional 59 cases were identified from the free text. Among these 122 cases (63 + 59), four were duplicates. Twenty-four additional unique cases were identified from the community surveillance for a total of 142. This yielded a multiplier of 142/90 = 1.578 for estimating all agricultural injuries from the farm box indicator. Sensitivity and specificity of the ambulance report method were 53.4% and 99.9%, respectively. This method provides a cost-effective way to estimate the total number of agricultural injuries for the state. However, it would not eliminate the more labor intensive methods that are required to identify of the actual individual case records. Incorporating an independent source of case ascertainment (community surveillance) increased the multiplier by 17%. Copyright © 2011 Elsevier Inc. All rights

Electrocardiogram interpretation skills among ambulance nurses.

Science.gov (United States)

Werner, Kristoffer; Kander, Kristofer; Axelsson, Christer

2016-06-01

To describe ambulance nurses' practical electrocardiogram (ECG) interpretation skills and to measure the correlation between these skills and factors that may impact on the level of knowledge. This study was conducted using a prospective quantitative survey with questionnaires and a knowledge test. A convenience sample collection was conducted among ambulance nurses in three different districts in western Sweden. The knowledge test consisted of nine different ECGs. The score of the ECG test were correlated against the questions in the questionnaire regarding both general ECG interpretation skill and ability to identify acute myocardial infarction using Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation. On average, the respondents had 54% correct answers on the test and identified 46% of the ECGs indicating acute myocardial infarction. The median total score was 9 of 16 (interquartile range 7-11) and 1 of 3 (IQR 1-2) in infarction points. No correlation between ECG interpretation skill and factors such as education and professional experience was found, except that coronary care unit experience was associated with better results on the ECG test. Ambulance nurses have deficiencies in their ECG interpretation skills. This also applies to conditions where the ambulance crew has great potential to improve the outcome of the patient's health, such as myocardial infarction and cardiac arrest. Neither education, extensive experience in ambulance service nor in nursing contributed to an improved result. The only factor of importance for higher ECG interpretation knowledge was prior experience of working in a coronary care unit. © The European Society of Cardiology 2014.

CERN'S Fire and Rescue Group Gets New Ambulance

CERN Multimedia

2000-01-01

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 CERN’s 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 ...

Ambulating radiography

International Nuclear Information System (INIS)

Magnusson, K.

1989-01-01

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.)

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.

Science.gov (United States)

Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald

2010-01-01

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), ptime. Applied work was less in the feedback group compared to controls (373+/-448 cm x compression; ptime automated 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.

CERN'S Fire and Rescue Group Gets New Ambulance

CERN Multimedia

2000-01-01

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.

Ambulation in adults with myelomeningocele. Is it possible to predict the level of ambulation in early life?

DEFF Research Database (Denmark)

Seitzberg, A.; Lind, M.; Biering-Sørensen, Fin

2008-01-01

OBJECTIVE: The objective of this study was to evaluate the prediction of ambulation in adults with myelomeningocele from muscle strength testing and ambulation in early life. MATERIALS AND METHODS: Fifty-two myelomeningocele (MMC) individuals at the age 18-37 years at follow-up were studied....... Information on muscle strength and ambulatory function in early life was retrieved from medical records. The motor levels determined by the muscle strength were used to predict ambulatory function later in life. At follow-up, a clinical examination was performed. RESULTS: Of 20 MMC individuals assessed...... life than predicted. Good strength in quadriceps muscles gave significant better prospect for adult walking. Of the 52 participants, 41 retained their ambulation status from 5-8 years of age. CONCLUSION: For MMC individuals with motor levels L3-L5, adult ambulatory function cannot be determined from...

42 CFR 414.620 - Publication of the ambulance fee schedule.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Publication of the ambulance fee schedule. 414.620... SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...

Self- and peer-assessments of ambulance drivers' driving performance

Directory of Open Access Journals (Sweden)

Anna Sundström

2012-07-01

Full Text Available The aim of the present study was to develop and examine the quality of the Ambulance Driver Self-assessment Questionnaire (ADSQ and the Ambulance Driver Peer-assessment Questionnaire (ADPQ measuring aspects of, driving performance, driving style and driving competence. In addition the ADSQ measures self-reflection and safety-attitudes. The aim of the study was also to examine ambulance drivers' self- and peer-assessments as well as to examine the accuracy of self-assessments by comparing self-assessed and peer-assessed driving performance, driving style and competence. 76 ambulance drivers employed at two ambulance stations in northern Sweden completed ADSQ and ADPQ. Item analyses were conducted to examine the psychometric properties of the items, and based on the results some revisions were made to improve the questionnaires. The revised questionnaires were functioning rather well, although some subscale demonstrated low internal consistency. Subscale inter-correlations provided support for construct validity. Self- and peer-assessments indicated safe driving performance and good driver competence, which is positive from a traffic safety perspective. A comparison of mean self- and peer-assessment ratings, controlling for age, gender and driving experience showed no significant differences, except for the subscale overtaking. This indicates that ambulance drivers' self-assessments are realistic in most areas.

Managing the impact of growing low-acuity demand on ambulance services

OpenAIRE

KATHRYN JEAN EASTWOOD

2018-01-01

Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...

42 CFR 410.40 - Coverage of ambulance services.

Science.gov (United States)

2010-10-01

..., 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...

THE MOSCOW AMBULANCE STATION. FROM THE SOURSE TO THE PRESENT

Directory of Open Access Journals (Sweden)

N. F. Plavunov

2017-01-01

Full Text Available This article is devoted to 130th anniversary and publication of academic writings of Alexander Puchkov — Doctor of Med. Sci., Honored Doctor of Russian Soviet Federative Socialist Republic. He was permanent leader of Moscow Ambulance Station from 1923 to 1952. Data presented in Puchkov’s articles were used to compare performance of work of Moscow ambulance in it’s formative period and our days. This article shows specificities, characteristics and environment of Moscow ambulance in 1926 and 2016. For example, the number of brigades had increased by 67,9 times (from 15 in 1926 to 1018 in 2016. Average time of arrival to accident is 10-12 minutes is same for 1926 and 2016. The proportion of pediatric interventions (from birth to 15 years old had increased. Analysis of indicators allows to look at development of Moscow ambulance station from it’s formative period to our days. Fundamental principles laid down by A. Puchkov last in many cases in work of Moscow Ambulance in our days. Ambulance doctors continue to provide medical assistance promptly in the framework spelt out more than 90 years ago.

Ground-water solute transport modeling using a three-dimensional scaled model

International Nuclear Information System (INIS)

Crider, S.S.

1987-01-01

Scaled models are used extensively in current hydraulic research on sediment transport and solute dispersion in free surface flows (rivers, estuaries), but are neglected in current ground-water model research. Thus, an investigation was conducted to test the efficacy of a three-dimensional scaled model of solute transport in ground water. No previous results from such a model have been reported. Experiments performed on uniform scaled models indicated that some historical problems (e.g., construction and scaling difficulties; disproportionate capillary rise in model) were partly overcome by using simple model materials (sand, cement and water), by restricting model application to selective classes of problems, and by physically controlling the effect of the model capillary zone. Results from these tests were compared with mathematical models. Model scaling laws were derived for ground-water solute transport and used to build a three-dimensional scaled model of a ground-water tritium plume in a prototype aquifer on the Savannah River Plant near Aiken, South Carolina. Model results compared favorably with field data and with a numerical model. Scaled models are recommended as a useful additional tool for prediction of ground-water solute transport

Basic life support and automated external defibrillator skills among ambulance personnel

DEFF Research Database (Denmark)

Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

2012-01-01

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.......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....

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke: Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project.

Science.gov (United States)

Valenzuela Espinoza, Alexis; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Fernandez Tellez, Helio; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital. © 2016 S. Karger AG, Basel.

Energy expenditure during ambulation with ortho crutches and axillary crutches.

Science.gov (United States)

Hinton, C A; Cullen, K E

1982-06-01

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.

Patients' experiences of cold exposure during ambulance care.

Science.gov (United States)

Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger

2013-06-06

Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

Patients’ experiences of cold exposure during ambulance care

Science.gov (United States)

2013-01-01

Background Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients’ experiences of cold exposure and to identify related factors. Method During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients’ finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. Results In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from −22.3°C to 8.4°C. Conclusion Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons. PMID:23742143

Large Payload Ground Transportation and Test Considerations

Science.gov (United States)

Rucker, Michelle A.

2016-01-01

Many spacecraft concepts under consideration by the National Aeronautics and Space Administration’s (NASA’s) Evolvable Mars Campaign take advantage of a Space Launch System payload shroud that may be 8 to 10 meters in diameter. Large payloads can theoretically save cost by reducing the number of launches needed--but only if it is possible to build, test, and transport a large payload to the launch site in the first place. Analysis performed previously for the Altair project identified several transportation and test issues with an 8.973 meters diameter payload. Although the entire Constellation Program—including Altair—has since been canceled, these issues serve as important lessons learned for spacecraft designers and program managers considering large payloads for future programs. A transportation feasibility study found that, even broken up into an Ascent and Descent Module, the Altair spacecraft would not fit inside available aircraft. Ground transportation of such large payloads over extended distances is not generally permitted, so overland transportation alone would not be an option. Limited ground transportation to the nearest waterway may be possible, but water transportation could take as long as 67 days per production unit, depending on point of origin and acceptance test facility; transportation from the western United States would require transit through the Panama Canal to access the Kennedy Space Center launch site. Large payloads also pose acceptance test and ground processing challenges. Although propulsion, mechanical vibration, and reverberant acoustic test facilities at NASA’s Plum Brook Station have been designed to accommodate large spacecraft, special handling and test work-arounds may be necessary, which could increase cost, schedule, and technical risk. Once at the launch site, there are no facilities currently capable of accommodating the combination of large payload size and hazardous processing such as hypergolic fuels

Availability of Life Support Equipment and its Utilization by Ambulance Drivers.

Science.gov (United States)

Acharya, Rija; Badhu, Angur; Shah, Tara; Shrestha, Sharmila

2017-09-08

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.

The effect of active warming in prehospital trauma care during road and air ambulance transportation - a clinical randomized trial

Directory of Open Access Journals (Sweden)

Naredi Peter

2011-10-01

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

Modelling of the reactive transport of organic pollutants in ground water; Modellierung des reaktiven Transports organischer Schadstoffe im Grundwasser

Energy Technology Data Exchange (ETDEWEB)

Schaefer, W [Heidelberg Univ. (Germany). Inst. fuer Umweltphysik

1999-07-01

The book describes reactive transport of organic pollutants in ground water and its quantitative monitoring by means of numerical reaction transport models. A brief introduction dealing with the importance of and hazards to ground water and opportunities for making use of ground water models is followed by a more detailed chapter on organic pollutants in ground water. Here the focus is on organochlorine compounds and mineral oil products. Described are propagation mechanisms for these substances in the ground and, especially, their degradability in ground water. A separate chapter is dedicated to possibilities for cleaning up polluted ground water aquifers. The most important decontamination techniques are presented, with special emphasis on in-situ processes with hydraulic components. Moreover, this chapter discusses the self-cleaning capability of aquifers and the benefits of the application of models to ground water cleanup. In the fourth chapter the individual components of reaction transport models are indicated. Here it is, inter alia, differences in the formulation of reaction models as to their complexity, and coupling between suspended matter transport and reaction processes that are dealt with. This chapter ends with a comprehensive survey of literature regarding the application of suspended matter transport models to real ground water accidents. Chapter 5 consists of a description of the capability and principle of function of the reaction transport model TBC (transport biochemism/chemism). This model is used in the two described applications to the reactive transport of organic pollutants in ground water. (orig.) [German] Inhalt des vorliegenden Buches ist die Darstellung des reaktiven Transports organischer Schadstoffe im Grundwasser und dessen quantitative Erfassung mithilfe numerischer Reaktions-Transportmodelle. Auf eine kurze Einleitung zur Bedeutung und Gefaehrdung von Grundwasser und zu den Einsatzmoeglichkeiten von Grundwassermodellen folgt ein

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre.

Science.gov (United States)

Hannay, R Scott; Wyrzykowski, Amy D; Ball, Chad G; Laupland, Kevin; Feliciano, David V

2014-02-01

Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.

Community ambulation: influences on therapists and clients reasoning and decision making.

Science.gov (United States)

Corrigan, Rosemary; McBurney, Helen

2008-01-01

Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapist's or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a client's decision to return to walking in their community are unclear. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence client's decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapist's decision making about preparing a clients to return to walking in the community. An individual's participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a person's decision to return to walking in their community

Speciation and transport of radionuclides in ground water

International Nuclear Information System (INIS)

Robertson, D.E.; Toste, A.P.; Abel, K.H.; Cowan, C.E.; Jenne, E.A.; Thomas, C.W.

1984-01-01

Studies of the chemical speciation of a number of radionuclides migrating in a slightly contaminated ground water plume are identifying the most mobile species and providing an opportunity to test and/or validate geochemical models of radionuclide transport in ground waters. Results to date have shown that most of the migrating radionuclides are present in anionic or nonionic forms. These include anionic forms of 55 Fe, 60 Co, /sup 99m/Tc, 106 Ru, 131 I, and nonionic forms of 63 Ni and 125 Sb. Strontium-70 and a small fraction of the mobile 60 Co are the only cationic radionuclides which have been detected moving in the ground water plume beyond 30 meters from the source. A comparison of the observed chemical forms with the predicted species calculated from modeling thermodynamic data and ground water chemical parameters has indicated a good agreement for most of the radioelements in the system, including Tc, Np, Cs, Sr, Ce, Ru, Sb, Zn, and Mn. The discrepancies between observed and calculated solutions species were noted for Fe, Co, Ni and I. Traces of Fe, Co, and Ni were observed to migrate in anionic or nonionic forms which the calculations failed to predict. These anionic/nonionic species may be organic complexes having enhanced mobility in ground waters. The radioiodine, for example, was shown to behave totally as an anion but further investigation revealed that 49-57% of this anionic iodine was organically bound. The ground water and aqueous extracts of trench sediments contain a wide variety of organic compounds, some of which could serve as complexing agents for the radionuclides. These results indicate the need for further research at a variety of field sites in defining precisely the chemical forms of the mobile radionuclide species, and in better understanding the role of dissolved organic materials in ground water transport of radionuclides

Microbial air quality and bacterial surface contamination in ambulances during patient services.

Science.gov (United States)

Luksamijarulkul, Pipat; Pipitsangjan, Sirikun

2015-03-01

We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson's correlation coefficient with a p-value of less than 0.050 considered significant. The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m(3) and 522±581cfu/m(3), respectively. Bacterial counts during patient services were 468±607cfu/m(3) and fungal counts were 656±612cfu/m(3). Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm(2) and 1.3±1.1cfu/cm(2), respectively (pair samples and bacterial counts on medical instruments and allocated areas. This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce

Efficacy and safety of intravenous fentanyl administered by ambulance personnel

DEFF Research Database (Denmark)

Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias

2016-01-01

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...... patients (1.3%) and hypotension observed in 71 patients (3.0%). CONCLUSION: Intravenous fentanyl caused clinically meaningful pain reduction in most patients and was safe in the hands of ambulance personnel. Many patients had moderate to severe pain at hospital arrival. As the protocol allowed higher doses...

Predicting Ambulance Time of Arrival to the Emergency Department Using Global Positioning System and Google Maps

Science.gov (United States)

Fleischman, Ross J.; Lundquist, Mark; Jui, Jonathan; Newgard, Craig D.; Warden, Craig

2014-01-01

Objective To derive and validate a model that accurately predicts ambulance arrival time that could be implemented as a Google Maps web application. Methods This was a retrospective study of all scene transports in Multnomah County, Oregon, from January 1 through December 31, 2008. Scene and destination hospital addresses were converted to coordinates. ArcGIS Network Analyst was used to estimate transport times based on street network speed limits. We then created a linear regression model to improve the accuracy of these street network estimates using weather, patient characteristics, use of lights and sirens, daylight, and rush-hour intervals. The model was derived from a 50% sample and validated on the remainder. Significance of the covariates was determined by p times recorded by computer-aided dispatch. We then built a Google Maps-based web application to demonstrate application in real-world EMS operations. Results There were 48,308 included transports. Street network estimates of transport time were accurate within 5 minutes of actual transport time less than 16% of the time. Actual transport times were longer during daylight and rush-hour intervals and shorter with use of lights and sirens. Age under 18 years, gender, wet weather, and trauma system entry were not significant predictors of transport time. Our model predicted arrival time within 5 minutes 73% of the time. For lights and sirens transports, accuracy was within 5 minutes 77% of the time. Accuracy was identical in the validation dataset. Lights and sirens saved an average of 3.1 minutes for transports under 8.8 minutes, and 5.3 minutes for longer transports. Conclusions An estimate of transport time based only on a street network significantly underestimated transport times. A simple model incorporating few variables can predict ambulance time of arrival to the emergency department with good accuracy. This model could be linked to global positioning system data and an automated Google Maps web

Patients' perception of the ambulance services at Hospital Universiti Sains Malaysia.

Science.gov (United States)

Anisah, A; Chew, K S; Mohd Shaharuddin Shah, C H; Nik Hisamuddin, N A R

2008-08-01

Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia. A six-month prospective cross-sectional study to look at patients' perception of Hospital Universiti Sains Malaysia's (HUSM) ambulance service was conducted from February 2006 to July 2006. Upon arrival at the hospital, patients or their relatives (who used our hospital's ambulances) were interviewed with a set of questions regarding their perception of the ambulance services and were asked to rate the perception on a Likert Scale from 1 to 10. A convenient sampling method was applied. A total of 87 samples were obtained. Despite the many problems faced by the ambulance service in HUSM, the mean score for each of the questions on patient's perception ranged from 9.33 to 9.70 out of 10. The questions with the highest mean score, which were both 9.70 each, were related to staff attentiveness and staff gentleness. Patients' perceptions can be very subjective, but until further similar studies could be carried out in other parts of Malaysia, this set of data merely represents a numerical measure of public perception of the ambulance services from HUSM.

29 CFR 553.215 - Ambulance and rescue service employees.

Science.gov (United States)

2010-07-01

... activities, the applicable standard is the one which applies to the activity in which the employee spends the majority of work time during the work period. (b) Ambulance and rescue service employees of public agencies... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553...

Complexity, fractal dynamics and determinism in treadmill ambulation: Implications for clinical biomechanists.

Science.gov (United States)

Hollman, John H; Watkins, Molly K; Imhoff, Angela C; Braun, Carly E; Akervik, Kristen A; Ness, Debra K

2016-08-01

Reduced inter-stride complexity during ambulation may represent a pathologic state. Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in a way that mimics pathological states. The purpose of this study was to examine the dynamical system components of gait complexity, fractal dynamics and determinism during treadmill ambulation. Twenty healthy participants aged 23.8 (1.2) years walked at preferred walking speeds for 6min on a motorized treadmill and overground while wearing APDM 6 Opal inertial monitors. Stride times, stride lengths and peak sagittal plane trunk velocities were measured. Mean values and estimates of complexity, fractal dynamics and determinism were calculated for each parameter. Data were compared between overground and treadmill walking conditions. Mean values for each gait parameter were statistically equivalent between overground and treadmill ambulation (P>0.05). Through nonlinear analyses, however, we found that complexity in stride time signals (P<0.001), and long-range correlations in stride time and stride length signals (P=0.005 and P=0.024, respectively), were reduced on the treadmill. Treadmill ambulation induces more predictable inter-stride time dynamics and constrains fluctuations in stride times and stride lengths, which may alter feedback from destabilizing perturbations normally experienced by the locomotor control system during overground ambulation. Treadmill ambulation, therefore, may provide less opportunity for experiencing the adaptability necessary to successfully ambulate overground. Investigators and clinicians should be aware that treadmill ambulation will alter dynamic gait characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

Willingness to pay for emergency referral transport in a developing setting: a geographically randomized study.

Science.gov (United States)

Bose, Sourav K; Bream, Kent D W; Barg, Frances K; Band, Roger A

2012-07-01

The objective was to identify the correlates of willingness to pay for ambulance transports from a rural city to a regional hospital in Guatemala. An innovative methodology that utilizes a novel randomization technique and satellite imagery was used to select a sample of homes in Santiago Atitlán, Guatemala. The respondents were surveyed at these homes about their willingness to pay for ambulance transport to a regional hospital. A price ladder was used to elicit respondents' willingness to pay for ambulance transport, depending on the level of severity of three types of emergencies: life-threatening emergencies, disability-causing emergencies, and simple emergencies. Simple and multiple linear regression modeling was used to identify the social and economic correlates of respondents' willingness to pay for ambulance transport and to predict demand for ambulance transport at a variety of price levels. Beta coefficients (β) expressed as percentages with 95% confidence intervals (CIs) were estimated. The authors surveyed 134 respondents (response rate=3.3%). In the multivariable regression models, three variables correlated with willingness to pay: household income, location of residence (rural district vs. urban district), and respondents' education levels. Correlates for ambulance transport in life-threatening emergencies included greater household daily income (β=1.32%, 95% CI=0.63% to 2.56%), rural location of residence (β=-37.3%, 95% CI=-51.1% to -137.5%), and higher educational levels (β=4.41%, 95% CI=1.00% to 6.36%). Correlates of willingness to pay in disability-causing emergencies included greater household daily income (β=1.59%, 95% CI=0.81% to 3.19%) and rural location of residence (β=-19.4%, 95% CI=-35.7% to -89.4%). Correlates of willingness to pay in simple emergencies included rural location of residence (β=59.4%, 95% CI=37.9% to 133.7%) and higher educational levels (β=7.96%, 95% CI=1.96% to 11.8%). At all price levels, more individuals were

Dispatch and prehospital transport for acute septic patients

DEFF Research Database (Denmark)

Pedersen, Peter Bank; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren

2017-01-01

ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists. RESULTS: We included 1,713 patients median age 72 years (IQR 57-81), 793 (46.3%) male, 621...

Mixed-μ magnetic levitation for advanced ground transport system

International Nuclear Information System (INIS)

Russell, F.M.

1977-12-01

The possibility of applying the mixed-μ principle for magnetic levitation to ground transport systems is examined. The system is developed specifically for suspension and useful lift to passive weight ratios exceeding 8:1 have been calculated. Application to a hybrid system where conventional wheel drive is used in conjunction with magnetic levitation is explained for urban transport. (author)

Evaluating public ambulance service levels by applying a GIS based ...

African Journals Online (AJOL)

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 ...

Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study.

Science.gov (United States)

Togher, Fiona J; O'Cathain, Alicia; Phung, Viet-Hai; Turner, Janette; Siriwardena, Aloysius Niroshan

2015-12-01

There is an increasing need to assess the performance of emergency ambulance services using measures other than the time taken for an ambulance to arrive on scene. In line with government policy, patients and carers can help to shape new measures of ambulance service performance. To investigate the aspects of emergency ambulance service care valued by users. Qualitative interview study. One of 11 ambulance services in England. Twenty-two users and eight of their spouses (n = 30). Users of the emergency ambulance service, experiencing different types of ambulance service response, valued similar aspects of their pre-hospital care. Users were often extremely anxious about their health, and the outcome they valued was reassurance provided by ambulance service staff that they were receiving appropriate advice, treatment and care. This sense of being reassured was enhanced by the professional behaviour of staff, which instilled confidence in their care; communication; a short wait for help; and continuity during transfers. A timely response was valued in terms of allaying anxiety quickly. The ability of the emergency ambulance service to allay the high levels of fear and anxiety felt by users is crucial to the delivery of a high quality service. Measures developed to assess and monitor the performance of emergency ambulance services should include the proportion of users reporting feeling reassured by the response they obtained. © 2014 John Wiley & Sons Ltd.

Offload zone patient selection criteria to reduce ambulance offload delay

NARCIS (Netherlands)

Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus J.; Carter, Alix J.E.

2016-01-01

Emergency department overcrowding is a widespread problem and often leads to ambulance offload delay. If no bed is available when a patient arrives, the patient has to wait with the ambulance crew. A recent Canadian innovation is the offload zone—an area where multiple patients can wait with a

Ambulance Work : Relationships between occupational demands, individual characteristics and health-related outcomes

OpenAIRE

Aasa, Ulrika

2005-01-01

Although musculoskeletal disorders (MSDs) and other health complaints are an occupational problem for ambulance personnel, there is a lack of knowledge regarding work-related factors associated with MSDs and other health complaints. The overall aim of this thesis was to investigate the relationships between occupational demands, individual characteristics and health-related outcomes among ambulance personnel. A random sample of 234 female and 953 male ambulance personnel participated in a nat...

Simulation-based decision support framework for dynamic ambulance redeployment in Singapore.

Science.gov (United States)

Lam, Sean Shao Wei; Ng, Clarence Boon Liang; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Ong, Marcus Eng Hock

2017-10-01

Dynamic ambulance redeployment policies tend to introduce much more flexibilities in improving ambulance resource allocation by capitalizing on the definite geospatial-temporal variations in ambulance demand patterns over the time-of-the-day and day-of-the-week effects. A novel modelling framework based on the Approximate Dynamic Programming (ADP) approach leveraging on a Discrete Events Simulation (DES) model for dynamic ambulance redeployment in Singapore is proposed in this paper. The study was based on the Singapore's national Emergency Medical Services (EMS) system. Based on a dataset comprising 216,973 valid incidents over a continuous two-years study period from 1 January 2011-31 December 2012, a DES model for the EMS system was developed. An ADP model based on linear value function approximations was then evaluated using the DES model via the temporal difference (TD) learning family of algorithms. The objective of the ADP model is to derive approximate optimal dynamic redeployment policies based on the primary outcome of ambulance coverage. Considering an 8min response time threshold, an estimated 5% reduction in the proportion of calls that cannot be reached within the threshold (equivalent to approximately 8000 dispatches) was observed from the computational experiments. The study also revealed that the redeployment policies which are restricted within the same operational division could potentially result in a more promising response time performance. Furthermore, the best policy involved the combination of redeploying ambulances whenever they are released from service and that of relocating ambulances that are idle in bases. This study demonstrated the successful application of an approximate modelling framework based on ADP that leverages upon a detailed DES model of the Singapore's EMS system to generate approximate optimal dynamic redeployment plans. Various policies and scenarios relevant to the Singapore EMS system were evaluated. Copyright © 2017

Impact of Air Temperature on London Ambulance Call-Out Incidents and Response Times

Directory of Open Access Journals (Sweden)

Marliyyah A. Mahmood

2017-08-01

Full Text Available Ambulance services are in operation around the world and yet, until recently, ambulance data has only been used for operational purposes rather than for assessing public health. Ambulance call-out data offers new and valuable (near real-time information that can be used to assess the impact of environmental conditions, such as temperature, upon human health. A detailed analysis of London ambulance data at a selection of dates between 2003 and 2015 is presented and compared to London temperature data. In London, the speed of ambulance response begins to suffer when the mean daily air temperature drops below 2 °C or rises above 20 °C. This is explained largely by the increased number of calls past these threshold temperatures. The baseline relationships established in this work will inform the prediction of likely changes in ambulance demand (and illness types that may be caused by seasonal temperature changes and the increased frequency and intensity of extreme/severe weather events, exacerbated by climate change, in the future.

Heart rate and leukocytes after air and ground transportation in artificially ventilated neonates: a prospective observational study.

Science.gov (United States)

Grosek, Stefan; Mlakar, Gorazd; Vidmar, Ivan; Ihan, Alojz; Primozic, Janez

2009-01-01

To evaluate the effect of interhospital air and ground transportation of artificially ventilated neonates on heart rate and peripheral blood leukocyte counts. Prospective, observational study. Level III multidisciplinary Neonatal and Pediatric Intensive Care Unit. Fifty-eight near-term artificially ventilated transported neonates between May 2006 and April 2007. Day-helicopter, day- and night-ground transportation. Heart rate at retrieval, on admission to the ICU and 1 h later, and peripheral blood leukocyte counts on admission and 1 d later were compared. Fifteen neonates were transported by helicopter during the daytime (D-HEL), 20 by daytime ground and 23 by nighttime ground transportation (D-GROUND, N-GROUND). No differences in delivery mode, birth weight, gestational age, gender, primary diagnoses for transportation, response time and duration of transportation were found between the groups. Similarly, no differences in pH, pCO(2), blood pressure and skin temperature at retrieval and on admission to the ICU were found between the three groups. The mean heart rate at retrieval did not differ significantly, while on arrival in the ICU and 1 h later the D-GROUND group of patients showed a significantly higher mean heart rate compared to the D-HEL and N-GROUND groups. Moreover, leukocyte counts on arrival in the ICU showed significantly higher leukocyte counts in the D-GROUND group of patients compared to the D-HEL group of patients. These results demonstrate that there is an association between daytime ground transportation and higher heart rate and peripheral blood leukocytes.

Ambulance Reasonable Charge Public Use Files

Data.gov (United States)

U.S. Department of Health & Human Services — The Ambulance Reasonable Charge public use files for calendar years (CY) 2003 through 2005 are located in the Downloads section below. These public use files are...

Hydrologic transport of radionuclides from low-level waste burial grounds

International Nuclear Information System (INIS)

Duguid, J.O.

1977-01-01

The physical characteristics of the virgin site and of the disturbed site after burial drastically affect the transport of radionuclides from buried waste. The disturbance of the land surface during the waste burial operation causes changes in the local ground-water regimen. These changes can increase the water table elevation and cause the occurrence of perched water in burial trenches. The combination of these changes may lead to submersion of the waste and to increased radionuclide transport from the burial site in both surface and ground water. Factors such as ion exchange can retard or in some cases, with competing ions, can also mobilize radionuclides and increase their discharge into ground and surface water. Because of complexing agents (organics) contained in the waste, increased mobility of some radionuclides can be expected. The chemical form of radionuclides in the water, the ground-water quality, and the chemistry of the geologic formation in which the waste is buried all influence the movement of radionuclides in the hydrologic system. For the assessment of the environmental impact of low-level waste burial, models capable of simulating both the chemical and the physical factors that affect hydrologic transport must be available. Several models for conducting such simulation are presently available. However,the input parameters used in these models are highly variable, and the accuracy of parameter measurement must be considered in evaluating the reliability of simulated results

Ambulance traffic accidents in Taiwan.

Science.gov (United States)

Chiu, Po-Wei; Lin, Chih-Hao; Wu, Chen-Long; Fang, Pin-Hui; Lu, Chien-Hsin; Hsu, Hsiang-Chin; Chi, Chih-Hsien

2018-04-01

Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations. A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016. Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements. Copyright © 2018. Published by Elsevier B.V.

Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS - A Descriptive Study.

Science.gov (United States)

Mix, Felicia M; Zielinski, Martin D; Myers, Lucas A; Berns, Kathy S; Luke, Anurahda; Stubbs, James R; Zietlow, Scott P; Jenkins, Donald H; Sztajnkrycer, Matthew D

2018-06-01

IntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS). This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90). A total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort. In this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India.

Science.gov (United States)

Singh, Samiksha; Doyle, Pat; Campbell, Oona Mr; Oakley, Laura; Rao, Gv Ramana; Murthy, Gvs

2017-06-09

To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India. A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'. Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT. © Article author(s) (or their employer(s) unless otherwise stated in the text of the

Is the Ability to Ambulate Associated with Better Employment Outcomes in Participants with Traumatic Spinal Cord Injury?

Science.gov (United States)

Krause, James S.

2010-01-01

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…

[The Swedish ambulance services 1935-1936 of Gunnar Agge].

Science.gov (United States)

Gustavsson, Pär; Nilsson, Peter M

2006-01-01

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

Hydrologic transport of radionuclides from low-level waste burial grounds

International Nuclear Information System (INIS)

Duguid, J.O.

1979-01-01

The physical characteristics of the virgin site and of the disturbed site after burial drastically affect the transport of radionuclides from buried waste. The disturbance of the land surface during the waste burial operation causes changes in the local ground-water regimen. These changes can increase the water table elevation and cause the occurrence of perched water in burial trenches. The combination of these changes may lead to submersion of the waste and to increased radionuclide transport from the burial site in both surface and groundwater. Factors such as ion exchange can retard or in some cases, with competing ions, can also mobilize radionuclides and increase their discharge into ground and surface water. Because of complexing agents (organics) contained in the waste, increased mobility of some radionuclides can be expected. The chemical form of radionuclides in the water, the ground-water quality, and the chemistry of the geologic formation in which the waste is buried all influence the movement of radionuclides in the hydrologic system. For the assessment of the environmental impact of low-level waste burial, models capable of simulating both the chemical and the physical factors that affect hydrologic transport must be available. Several models for conducting such simulation are presently available. However, the input parameters used in these models are highly variable; and the accuracy of parameter measurement must be considered in evaluating the reliability of simulated results

Modern concepts of transport in multiple trauma: a narrative review

Directory of Open Access Journals (Sweden)

Zarei Mohammad Reza

2013-06-01

Full Text Available 【Abstract】Multiple variables can influence triage decision in multiple trauma. Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment. This narrative review summarizes the new options and protocols for transport of injured subjects. There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians. Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer. The former provides mini-mum lifesaving treatment at the scene of accident followed by transferring the patient(s as soon as possible, and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport. The destination and mode of transport are selected according to clinical capa-bilities of the receiving hospital, transfer time from the scene to the facility, patient’s medical condition, accessibility of the scene, and weather. Two common methods of transfer are ground transport, including various type of ambulances, and air medical transport, i.e. helicopter and airplane. Key words: Transportation of patients; Multiple trauma; Triage; Emergency medical service communication systems

Using a discrete-event simulation to balance ambulance availability and demand in static deployment systems.

Science.gov (United States)

Wu, Ching-Han; Hwang, Kevin P

2009-12-01

To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete-event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability. The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out-of-routine-duty ambulances and the durations of three types of mass gatherings: marathon races (06:00-10:00 hr), rock concerts (18:00-22:00 hr), and New Year's Eve parties (20:00-01:00 hr). Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response-time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies. Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty

[The correlation between personality characteristics and burnout syndrome in emergency ambulance workers].

Science.gov (United States)

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.

Complexity in the validation of ground-water travel time in fractured flow and transport systems

International Nuclear Information System (INIS)

Davies, P.B.; Hunter, R.L.; Pickens, J.F.

1991-01-01

Ground-water travel time is a widely used concept in site assessment for radioactive waste disposal. While ground-water travel time was originally conceived to provide a simple performance measure for evaluating repository sites, its definition in many flow and transport environments is ambiguous. The U.S. Department of Energy siting guidelines (10 CFR 960) define ground-water travel time as the time required for a unit volume of water to travel between two locations, calculated by dividing travel-path length by the quotient of average ground-water flux and effective porosity. Defining a meaningful effective porosity in a fractured porous material is a significant problem. Although the Waste Isolation Pilot Plant (WIPP) is not subject to specific requirements for ground-water travel time, travel times have been computed under a variety of model assumptions. Recently completed model analyses for WIPP illustrate the difficulties in applying a ground-water travel-time performance measure to flow and transport in fractured, fully saturated flow systems. Computer code used: SWIFT II (flow and transport code). 4 figs., 12 refs

A validation of ground ambulance pre-hospital times modeled using geographic information systems.

Science.gov (United States)

Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

2012-10-03

Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

Appraisal of work ability in relation to job-specific health requirements in ambulance workers

OpenAIRE

van Schaaijk, A.; Boschman, J. S.; Frings-Dresen, M. H. W.; Sluiter, J. K.

2016-01-01

Purpose To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Method Workers Health Surveillance cross-sectional data of 506 ambulance worker...

Urban sprawl and delayed ambulance arrival in the U.S.

Science.gov (United States)

Trowbridge, Matthew J; Gurka, Matthew J; O'Connor, Robert E

2009-11-01

Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.

Adaptation and promotion of emergency medical service transportation for climate change.

Science.gov (United States)

Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

2014-12-01

The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI.

Evaluating public ambulance service levels by applying a GIS based accessibility analysis approach

CSIR Research Space (South Africa)

Baloyi, Ethel

2017-08-01

Full Text Available 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...

Numerical simualtion of underground 37Ar transportation to the ground

International Nuclear Information System (INIS)

She Ruogu; Li Hua; Liu Cheng'an; Wu Jun

2008-01-01

Monitoring radioactive gas 37 Ar is an important technique for the On-Site Inspection(OSI) of the Comprehensive Nuclear Test Ban Treaty (CTBT) verification regime. In order to establish a theoretical model that can be used to calculate the appearing time and radioactivity of 37 Ar which transports to the ground after a nuclear explosion, the rock media in the test area is assumed to be a homogeneous porous media, without consideration of gas absorption by and release from the rock media. The seepage model in the porous media is used to calculate 37 Ar transportation. Computational results give the time 37 Ar leaks to the ground and the variation of its radioactivity with time. And we can analyze and consider the computational results when we have developed OSI noble gas monitoring systems and evaluated their effectiveness. (authors)

An integration of Emergency Department Information and Ambulance Systems.

Science.gov (United States)

Al-Harbi, Nada; El-Masri, Samir; Saddik, Basema

2012-01-01

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.

Reflective and collaborative skills enhances Ambulance nurses' competence - A study based on qualitative analysis of professional experiences.

Science.gov (United States)

Wihlborg, Jonas; Edgren, Gudrun; Johansson, Anders; Sivberg, Bengt

2017-05-01

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.

Dynamic Design of Ground Transport With the Help of Computational Experiment

Directory of Open Access Journals (Sweden)

Kravets Victor

2015-05-01

Full Text Available Objectives of ground transport (motor transport vehicle have been considered. Mathematical model of nonlinear dynamics in spatial motion of asymmetric carriage in the form of Euler-Lagrange equations represented as symmetrical block structure in quaternion matrices has been developed. Kinematic equations and partition matrices of external action in which Rodrigues-Hamilton parameters have been applied describe quaternionic matrices.

Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression.

Science.gov (United States)

Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E

2017-12-28

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

The Fire Brigade acquires a new ambulance with all the bells and whistles!

CERN Multimedia

Anaïs Schaeffer

2012-01-01

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...

Improving community ambulation after hip fracture: protocol for a randomised, controlled trial

Directory of Open Access Journals (Sweden)

D Orwig

2017-01-01

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.

Economic regulation of ambulance services in California.

Science.gov (United States)

Narad, R A

1997-01-01

This study was intended to identify economic regulatory programs used by California counties (including ambulance franchising and rate setting), to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. This study surveyed all California local EMS agencies (LEMSAs); these are California's equivalent of regional EMS organizations. The survey achieved a 100% response rate, and all data involve population parameters obviating the need for inferential statistics. Seventy-three percent of California counties use economic regulations. Large-population counties and those that operate their own LEMSAs are more likely to use economic regulations than are small counties and those that participate in multicounty EMS agencies. Despite a preference for competition in the authorizing statute, most franchises were granted without competition to existing providers. The majority of franchises in the state were granted to public services. Most ambulance rate setting occurs outside of a competitive process. Economic regulations that were intended to provide a structured marketplace are often being used to protect existing providers, particularly public services, from competition. The growing interest by fire departments in entering the market for emergency ambulance service, along with the existing bias toward them in granting of franchises, does not bode well for use of the competitive process. The growth of managed care may change or eliminate the need for economic regulations but, if they are to continue, more state oversight should be considered.

Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel.

Science.gov (United States)

Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind

2008-01-01

This is the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. A comprehensive nationwide questionnaire survey of 1,180 operational ambulance personnel was conducted. Measurements included: Paykel's Suicidal Feelings in the General Population questionnaire, the Hospital Anxiety and Depression scale, the Subjective Health Complaints Questionnaire, the Maslach Burnout Inventory, the Job Satisfaction Scale, the Basic Character Inventory, and the Rosenberg Self-Esteem Scale. Lifetime prevalence ranged from 28% for feelings that life was not worth living to 10.4% for seriously considered suicide and 3.1% for a suicide attempt. Serious suicidal ideation was independently associated with job-related emotional exhaustion (feelings of being overextended and depleted of resources) (OR 1.5, 95% CI 1.1-2.0) and bullying at work (OR 1.7, 95% CI 1.02-2.7), younger age, not married/cohabitant, depression symptoms, low self-esteem and the personality trait reality weakness. In general, suicidal thoughts were hardly attributable to working conditions, since only 1.8% of ambulance personnel attributed suicidal ideation to work problems alone. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that job-related factors like emotional exhaustion and bullying may be of importance.

T-SDN architecture for space and ground integrated optical transport network

Science.gov (United States)

Nie, Kunkun; Hu, Wenjing; Gao, Shenghua; Chang, Chengwu

2015-11-01

Integrated optical transport network is the development trend of the future space information backbone network. The space and ground integrated optical transport network(SGIOTN) may contain a variety of equipment and systems. Changing the network or meeting some innovation missions in the network will be an expensive implement. Software Defined Network(SDN) provides a good solution to flexibly adding process logic, timely control states and resources of the whole network, as well as shielding the differences of heterogeneous equipment and so on. According to the characteristics of SGIOTN, we propose an transport SDN architecture for it, with hierarchical control plane and data plane composed of packet networks and optical transport networks.

The on-line electric vehicle wireless electric ground transportation systems

CERN Document Server

Cho, Dong

2017-01-01

This book details the design and technology of the on-line electric vehicle (OLEV) system and its enabling wireless power-transfer technology, the “shaped magnetic field in resonance” (SMFIR). The text shows how OLEV systems can achieve their three linked important goals: reduction of CO2 produced by ground transportation; improved energy efficiency of ground transportation; and contribution to the amelioration or prevention of climate change and global warming. SMFIR provides power to the OLEV by wireless transmission from underground cables using an alternating magnetic field and the reader learns how this is done. This cable network will in future be part of any local smart grid for energy supply and use thereby exploiting local and renewable energy generation to further its aims. In addition to the technical details involved with design and realization of a fleet of vehicles combined with extensive subsurface charging infrastructure, practical issues such as those involved with pedestrian safety are c...

Open field modifications needed to measure, in the mouse, exploration- driven ambulation and fear of open space.

OpenAIRE

Vidal Gómez, José

2014-01-01

The open field test is used to assess ambulation and anxiety; one way to assess anxiety is to compare ambulation in the center with ambulation in the periphery: the more anxious is the mouse, the less it moves in the center. The results of this report cast doubts on the generality of that rule, because they show that ambulation, both in the center and in the periphery, depends on the mouse strain and on the size of the open field; specifically, in a brightly lit open-field of moderate size (3...

Complexity in the validation of ground-water travel time in fractured flow and transport systems

International Nuclear Information System (INIS)

Davies, P.B; Hunter, R.L.; Pickens, J.F.

1991-02-01

Ground-water travel time is a widely used concept in site assessment for radioactive waste disposal. While ground-water travel time was originally conceived to provide a simple performance measure for evaluating repository sites, its definition in many flow and transport environments is ambiguous. The US Department of Energy siting guidelines (10 CFR 960) define ground-water travel time as the time required for a unit volume of water to travel between two locations, calculated by dividing travel-path length by the quotient of average ground-water flux and effective porosity. Defining a meaningful effective porosity in a fractured porous material is a significant problem. Although the Waste Isolation Pilot Plant (WIPP) is not subject to specific requirements for ground-water travel time, travel times have been computed under a variety of model assumptions. Recently completed model analyses for WIPP illustrate the difficulties in applying a ground-water travel-time performance measure to flow and transport in fractured, fully saturated flow systems. 12 refs., 4 figs

Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

Science.gov (United States)

Ssebunya, Rogers; Matovu, Joseph K B

2016-03-03

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

A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel

Directory of Open Access Journals (Sweden)

Lau Bjørn

2011-03-01

Full Text Available Abstract Objectives To address the relative importance of general job-related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints (emotional exhaustion, psychological distress and musculoskeletal pain among ambulance personnel. Materials and methods A nationwide prospective questionnaire survey of ambulance personnel in operational duty at two time points (n = 1180 at baseline, T1 and n = 298 at one-year follow up, T2. The questionnaires included the Maslach Burnout Inventory, The Job Satisfaction Scale, Hopkins Symptom Checklist (SCL-10, Job Stress Survey, the Norwegian Ambulance Stress Survey and the Basic Character Inventory. Results Overall, 42 out of the possible 56 correlations between job stressors at T1 and job satisfaction and health complaints at T2 were statistically significant. Lower job satisfaction at T2 was predicted by frequency of lack of leader support and severity of challenging job tasks. Emotional exhaustion at T2 was predicted by neuroticism, frequency of lack of support from leader, time pressure, and physical demands. Adjusted for T1 levels, emotional exhaustion was predicted by neuroticism (beta = 0.15, p Psychological distress at T2 was predicted by neuroticism and lack of co-worker support. Adjusted for T1 levels, psychological distress was predicted by neuroticism (beta = 0.12, p Musculoskeletal pain at T2 was predicted by, higher age, neuroticism, lack of co-worker support and severity of physical demands. Adjusted for T1 levels, musculoskeletal pain was predicted neuroticism, and severity of physical demands (beta = 0.12, p Conclusions Low job satisfaction at T2 was predicted by general work-related stressors, whereas health complaints at T2 were predicted by both general work-related stressors and ambulance specific stressors. The personality variable neuroticism predicted increased complaints across all health outcomes.

Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

Science.gov (United States)

Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

2014-01-01

It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

Using genetic algorithms to optimise current and future health planning - the example of ambulance locations

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Suzuki Hiroshi

2010-01-01

Full Text Available Abstract Background Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted EMS case distances to those locations. Results Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71. The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. Conclusions The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making.

Predictive capabilities of a two-dimensional model in the ground water transport of radionuclides

International Nuclear Information System (INIS)

Gureghian, A.B.; Beskid, N.J.; Marmer, G.J.

1978-01-01

The discharge of low-level radioactive waste into tailings ponds is a potential source of ground water contamination. The estimation of the radiological hazards related to the ground water transport of radionuclides from tailings retention systems depends on reasonably accurate estimates of the movement of both water and solute. A two-dimensional mathematical model having predictive capability for ground water flow and solute transport has been developed. The flow equation has been solved under steady-state conditions and the mass transport equation under transient conditions. The simultaneous solution of both equations is achieved through the finite element technique using isoparametric elements, based on the Galerkin formulation. However, in contrast to the flow equation solution, the weighting functions used in the solution of the mass transport equation have a non-symmetric form. The predictive capability of the model is demonstrated using an idealized case based on analyses of field data obtained from the sites of operating uranium mills. The pH of the solution, which regulates the variation of the distribution coefficient (K/sub d/) in a particular site, appears to be the most important factor in the assessment of the rate of migration of the elements considered herein

Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport.

Science.gov (United States)

National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

Ambulance personnel must be able to (1) appraise the extent of first aid rendered by others, (2) carry out additional measures at the scene and en route, (3) operate vehicles safely, (4) maintain communication with traffic authorities, dispatchers, and emergency departments, and (5) keep records for medical and other authorities. Guidelines for…

BURNOUT SYNDROM AMONG PUBLIC AMBULANCE STAFF.

Science.gov (United States)

Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice

2015-01-01

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.

Factors affecting ambulance utilization for asthma attack treatment: understanding where to target interventions.

Science.gov (United States)

Raun, L H; Ensor, K B; Campos, L A; Persse, D

2015-05-01

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

Masculinity and Lifting Accidents among Danish Ambulance Personnel

DEFF Research Database (Denmark)

Hansen, Claus D.; Nielsen, Kent J

Background Work injuries related to lifting are the most prevalent among ambulance personnel (AP) despite the introduction of ‘assistive technologies’ (AT) that help reduce situations of manual lifting. One third of the AP report using AT only ‘sometimes’ and 10% report having lifted a patient...... 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...

75 FR 8412 - Office of New Reactors: Interim Staff Guidance on Assessing Ground Water Flow and Transport of...

Science.gov (United States)

2010-02-24

... NUCLEAR REGULATORY COMMISSION [NRC-2010-0047] Office of New Reactors: Interim Staff Guidance on Assessing Ground Water Flow and Transport of Accidental Radionuclide Releases; Solicitation of Public... ground water flow and transport of accidental radionuclide releases necessary to demonstrate compliance...

EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

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Rinku Girija

2017-01-01

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

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems.

Science.gov (United States)

Brown, Lawrence H; Chaiechi, Taha; Buettner, Petra G; Canyon, Deon V; Crawford, J Mac; Judd, Jenni

2013-02-01

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.

METABOLIC SYNDROME AND DAILY AMBULATION IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

Science.gov (United States)

Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.

2012-01-01

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

A decision making method based on interval type-2 fuzzy sets: An approach for ambulance location preference

Directory of Open Access Journals (Sweden)

Lazim Abdullah

2018-01-01

Full Text Available Selecting the best solution to deploy an ambulance in a strategic location is of the important variables that need to be accounted for improving the emergency medical services. The selection requires both quantitative and qualitative evaluation. Fuzzy set based approach is one of the well-known theories that help decision makers to handle fuzziness, uncertainty in decision making and vagueness of information. This paper proposes a new decision making method of Interval Type-2 Fuzzy Simple Additive Weighting (IT2 FSAW as to deal with uncertainty and vagueness. The new IT2 FSAW is applied to establish a preference in ambulance location. The decision making framework defines four criteria and five alternatives of ambulance location preference. Four experts attached to a Malaysian government hospital and a university medical center were interviewed to provide linguistic evaluation prior to analyzing with the new IT2 FSAW. Implementation of the proposed method in the case of ambulance location preference suggests that the ‘road network’ is the best alternative for ambulance location. The results indicate that the proposed method offers a consensus solution for handling the vague and qualitative criteria of ambulance location preference.

Application of a soil and ground-water pollutant-transport model

International Nuclear Information System (INIS)

Reeves, M.; Duguid, J.O.

1975-01-01

A general two-dimensional model was developed for simulation of saturated-unsaturated transport of radionuclides in ground water. This model is being applied to the transport of radionuclides from waste-disposal sites, where field investigations are currently under way to obtain the necessary parameters. A zero-order simulation of a waste-disposal trench is presented. Estimated values of the soil properties have been used since very limited experimental information is available at the present time. However, as more measured values become available from field studies, the simulation will be updated. The end product of this research will be a reliable computer model useful both in predicting future transport of radionuclides from buried waste and in examining control measures if they are shown to be necessary. (U.S.)

The pattern of ambulance arrivals in the emergency department of an acute care hospital in Singapore

OpenAIRE

Seow, E; Wong, H; Phe, A

2001-01-01

Methods—All (13 697) ambulance arrivals in 1996 to the ED of Tan Tock Seng Hospital were studied and where relevant compared with the walk in and total arrivals of the same year. The following data were obtained from computer records: (a) patients' demographic data; (b) number of ambulance arrivals by hour; (c) the classification of the ambulance arrivals by emergency or non-emergency, trauma or non-trauma; (d) cause of injury for trauma cases; (e) discharge status.

Transport of lincomycin to surface and ground water from manure-amended cropland.

Science.gov (United States)

Kuchta, Sandra L; Cessna, Allan J; Elliott, Jane A; Peru, Kerry M; Headley, John V

2009-01-01

Livestock manure containing antimicrobials becomes a possible source of these compounds to surface and ground waters when applied to cropland as a nutrient source. The potential for transport of the veterinary antimicrobial lincomycin to surface waters via surface runoff and to leach to ground water was assessed by monitoring manure-amended soil, simulated rainfall runoff, snowmelt runoff, and ground water over a 2-yr period in Saskatchewan, Canada, after fall application of liquid swine manure to cropland. Liquid chromatography tandem mass spectrometry was used to quantify lincomycin in all matrix extracts. Initial concentrations in soil (46.3-117 mug kg(-1)) were not significantly different (p > 0.05) for manure application rates ranging from 60,000 to 95,000 L ha(-1) and had decreased to nondetectable levels by mid-summer the following year. After fall manure application, lincomycin was present in all simulated rainfall runoff (0.07-2.7 mug L(-1)) and all snowmelt runoff (0.038-3.2 mug L(-1)) samples. Concentrations in snowmelt runoff were not significantly different from those in simulated rainfall runoff the previous fall. On average, lincomycin concentrations in ephemeral wetlands dissipated by 50% after 31 d. Concentrations of lincomycin in ground water were generally <0.005 mug L(-1). This study demonstrates that the management practice of using livestock manure from confined animal feeding operations as a plant nutrient source on cropland may result in antimicrobial transport to surface and ground waters.

The risk ogf high-risk jobs : psychological health consequences in forensic physicians and ambulance workers

NARCIS (Netherlands)

Ploeg, E. van der

2003-01-01

The risk of high-risk jobs: Psychological health consequences in forensic doctors and ambulance workers This thesis has shown that forensic physicians and ambulance personnel frequently suffer from psychological complaints as a result of dramatic events and sources of chronic work stress. A

Parents as passengers during pediatric transport.

Science.gov (United States)

Lewis, M M; Holditch-Davis, D; Brunssen, S

1997-01-01

The transport environment presents a unique setting in which the feasibility, advantages, and disadvantages of passengers accompanying a patient must be assessed carefully. The purpose of this study was to describe the current practice of including parents as passengers during pediatric interfacility transport. One-hundred-eighty-eight critical care transport programs in the United States responded to a voluntary mail survey, providing information about current policies, practices, and crew perceptions of the advantages and disadvantages of carrying parents as passengers. Extra seating for passengers was available in 96% of ambulances, 86% of fixed-wing aircraft, and 54% of helicopters used for pediatric transport. Parents traveled as passengers in all types of vehicles; most frequently in ambulances and fixed-wing aircraft. Twenty percent of helicopter programs allowed parent passengers on more than half of their pediatric transports in this vehicle. Advantages of parent passengers included emotional benefit for the parent and child, availability of parents for history and consent, good public relations, and having the parent present if the child dies. Disadvantages included potential parent anxiety, crew distraction, and space limitations. This study reflects the widely diverse policies, practices, and opinions relevant to this topic and confirms a need for further study.

Stress and organization change in the ambulance service

NARCIS (Netherlands)

Wastell, D.; Newman, M.

1996-01-01

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

Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention.

Science.gov (United States)

Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P

2016-09-01

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

Design and methods of European Ambulance Acute Coronary Syndrome Angiography Trial (EUROMAX)

DEFF Research Database (Denmark)

Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter

2013-01-01

In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard-of-care ......In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard...

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

Science.gov (United States)

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

2013-07-01

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Modeling ground water flow and radioactive transport in a fractured aquifer

International Nuclear Information System (INIS)

Pohll, G.; Hassan, A.E.; Chapman, J.B.; Papelis, C.; Andricevic, R.

1999-01-01

Three-dimensional numerical modeling is used to characterize ground water flow and contaminant transport at the Shoal nuclear test site in north-central Nevada. The fractured rock aquifer at the site is modeled using an equivalent porous medium approach. Field data are used to characterize the fracture system into classes: large, medium, and no/small fracture zones. Hydraulic conductivities are assigned based on discrete interval measurements. Contaminants from the Shoal test are assumed to all be located within the cavity. Several challenging issues are addressed in this study. Radionuclides are apportioned between surface deposits and volume deposits in nuclear melt glass, based on their volatility and previous observations. Surface-deposited radionuclides are released hydraulically after equilibration of the cavity with the surrounding ground water system, and as a function of ground water flow through the higher-porosity cavity into the low-porosity surrounding aquifer. Processes that are modeled include the release functions, retardation, radioactive decay, prompt injection, and in growth of daughter products. Prompt injection of radionuclides away from the cavity is found to increase the arrival of mass at the control plane but is not found to significantly impact calculated concentrations due to increased spreading. Behavior of the other radionuclides is affected by the slow chemical release and retardation behavior. The transport calculations are sensitive to many flow and transport parameters. Most important are the heterogeneity of the flow field and effective porosity. The effect of porosity in radioactive decay is crucial and has not been adequately addressed in the literature. For reactive solutes, retardation and the glass dissolution rate are also critical

Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study.

Science.gov (United States)

Shaikh, Shiraz; Baig, Lubna A; Polkowski, Maciej

2017-01-01

The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances. This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression. Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during (OR=2.13, 95% CI=1.22-3.71, p=0.007) and after the campaign (OR=1.73, 95% CI=1.02-2.95, p=0.042) were significantly more likely give space to ambulances. Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives.

The analysis of the cases of circulatory and respiratory arrest in the work of the Regional Unit of Ambulance Service - Sródmieście Station.

Science.gov (United States)

Chemperek, Ewa; Mikuła, Agnieszka; Goniewicz, Mariusz; Krawczyk, Wojciech

2004-01-01

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.

Evaluation of insight training of ambulance drivers in Sweden using DART, a new e-learning tool.

Science.gov (United States)

Albertsson, Pontus; Sundström, Anna

2011-12-01

The aim of the study was to evaluate whether a new e-learning tool for insight training of ambulance drivers can have an effect on drivers' driving behaviors, perceived driving competence, competence to assess risks, self-reflection, and safety attitudes. A quasi-experimental study design, with participants nonrandomly assigned into a control and intervention group, was used. The intervention group participated in the insight-training course and the control group did not. Both groups completed a self- and peer assessment online questionnaire before and after the training. The main finding is that the ambulance drivers assessed themselves through the instruments after the training, with the e-learning tool Driver Access Recording Tool (DART), as safer drivers in the areas of speed adaptation, closing up, and overtaking. In the answers from the group-based evaluation, the ambulance drivers responded that they were more reflective/analytical, had increased their risk awareness, and had changed their driving behaviors. After insight training, the ambulance drivers in this study assessed themselves as safer drivers in several important areas, including speed adaptation, closing up, and overtaking. In future training of ambulance drivers there should be more focus on insight training instead of previous training focusing on maneuvering capabilities.

Improving the coding and classification of ambulance data through the application of International Classification of Disease 10th revision.

Science.gov (United States)

Cantwell, Kate; Morgans, Amee; Smith, Karen; Livingston, Michael; Dietze, Paul

2014-02-01

This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. WHAT IS KNOWN ABOUT THE TOPIC? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. WHAT DOES THIS PAPER ADD? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This paper describes

Self-paced brain-computer interface control of ambulation in a virtual reality environment

Science.gov (United States)

Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran

2012-10-01

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.

Perioperative transfusion threshold and ambulation after hip revision surgery

DEFF Research Database (Denmark)

Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny

2014-01-01

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....

A case study from the perspective of medical ethics: refusal of treatment in an ambulance.

Science.gov (United States)

Erbay, Hasan; Alan, Sultan; Kadıoğlu, Selim

2010-11-01

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?

Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis.

Science.gov (United States)

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos

2017-09-15

Ambispective cohort review. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is

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

Directory of Open Access Journals (Sweden)

Ana Paula Iannoni

2008-01-01

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.

Managing emergency department overcrowding via ambulance diversion: a discrete event simulation model.

Science.gov (United States)

Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye

2015-01-01

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.

[Ambulance services in Copenhagen, Odense and Ringkøbing County. Results of the spot test conducted by the Ministry of Health and the County Councils Association in 1990. 1. Epidemiological data].

Science.gov (United States)

Trier, H; Larsen, C F

1992-02-17

In 1990, The Danish Ministry of Health and the County Council Association undertook a spot test investigation of the activities in connection with 3,182 emergency ambulance services (AU) in the Municipality of Copenhagen (a city), the Odense district (a large provincial town) and the County of Ringkøbing (a mixed rural and urban region). The investigation included data collected by the ambulance staff before hospitalization and the diagnoses on discharge from casualty and hospital departments. The frequency of AU per 1,000 population was found to be 101 annually in Copenhagen, 44 in Odense and 19 in the County of Ringkøbing. More than 10% of the services in all three regions did not result in transport of the patient to hospital treatment. The average age of the patients was 52 years in Copenhagen compared with 44 years in the other two regions. The age-specific frequency of AU for patients aged 0-4 year-old was nine times as great in Copenhagen than in Odense and the County of Ringkøbing and, where patients aged more than 80 years were concerned, the frequency was 4-10 times as great. In all three regions, the activities of ambulance services were most numerous between 6-16 hours and lowest during the period 0-6 hours. Services to patients' homes constituted 44-46% and to traffic regions 32-40%. Services on account of illness constituted 41-45% and, on account of accidents, 27-35%. In cases of rapid emergency transport (using signals), 78% of the ambulances had reached the patient within five minutes in Copenhagen as compared with 44% in Odense and the County of Ringkøbing.(ABSTRACT TRUNCATED AT 250 WORDS)

Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting

Directory of Open Access Journals (Sweden)

Nielsen Anne

2012-05-01

Full Text Available Abstract Background 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. Methods The Basic Life Support (BLS and Automated External Defibrillator (AED skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. Results On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2 was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm. The mean compression rate was 123 per min (SD 15/min. The mean tidal volume was 746 ml (SD 221 ml. Only the mean tidal volume deviated significantly from the recommended (p = 0.01. During the rhythm analysis, 65% did not perform any visual or verbal safety check. Conclusion The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.

Ambulance Dispatches From Unaffected Areas After the Great East Japan Earthquake: Impact on Emergency Care in the Unaffected Areas.

Science.gov (United States)

Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Abe, Takeru; Hasegawa, Manabu; Nabeshima, Yoshihiro

2015-12-01

Although dispatching ambulance crews from unaffected areas to a disaster zone is inevitable when a major disaster occurs, the effect on emergency care in the unaffected areas has not been studied. We evaluated whether dispatching ambulance crews from unaffected prefectures to those damaged by the Great East Japan Earthquake was associated with reduced resuscitation outcomes in out-of-hospital cardiac arrest (OHCA) cases in the unaffected areas. We used the Box-Jenkins transfer function model to assess the relationship between ambulance crew dispatches and return of spontaneous circulation (ROSC) before hospital arrival or 1-month survival after the cardiac event. In a model whose output was the rate of ROSC before hospital arrival, dispatching 1000 ambulance crews was associated with a 0.474% decrease in the rate of ROSC after the dispatch in the prefectures (p=0.023). In a model whose output was the rate of 1-month survival, dispatching 1000 ambulance crews was associated with a 0.502% decrease in the rate of 1-month survival after the dispatch in the prefectures (p=0.011). The dispatch of ambulances from unaffected prefectures to earthquake-stricken areas was associated with a subsequent decrease in the ROSC and 1-month survival rates in OHCA cases in the unaffected prefectures.

Patterns of emergency ambulance use, 2009-13: a comparison of older people living in Residential Aged Care Facilities and the Community.

Science.gov (United States)

Dwyer, R; Gabbe, B; Tran, T D; Smith, K; Lowthian, J A

2018-04-24

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.

Geographic information system data from ambulances applied in the emergency department: effects on patient reception.

Science.gov (United States)

Raaber, Nikolaj; Duvald, Iben; Riddervold, Ingunn; Christensen, Erika F; Kirkegaard, Hans

2016-03-31

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

R.I.P. squad bench. European ambulances designed around the patient, not the vehicle.

Science.gov (United States)

Heightman, A J

2013-07-01

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.

Evaluating public ambulance service levels by applying a GIS based ...

African Journals Online (AJOL)

Hunadi Mokgalaka

based analysis of ambulance response time was undertaken. The purpose was to .... He tested the travel time of the primary response vehicles and ..... Real CORP Proceedings / Tagungsband, ISBN: 978-3-9502139-7-3, pp, 22-25, viewed 18.

Feasibility of AmbulanCe-Based Telemedicine (FACT study: safety, feasibility and reliability of third generation in-ambulance telemedicine.

Directory of Open Access Journals (Sweden)

Laetitia Yperzeele

Full Text Available Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third generation.A routine ambulance was equipped with a system for real-time bidirectional audio-video communication, automated transmission of vital parameters, glycemia and electronic patient identification. All patients ( ≥ 18 years transported during emergency missions by a Prehospital Intervention Team of the Universitair Ziekenhuis Brussel were eligible for inclusion. To guarantee mobility and to facilitate 24/7 availability, the teleconsultants used lightweight laptop computers to access a dedicated telemedicine platform, which also provided functionalities for neurological assessment, electronic reporting and prehospital notification of the in-hospital team. Key registrations included any safety issue, mobile connectivity, communication of patient information, audiovisual quality, user-friendliness and accuracy of the prehospital diagnosis.Prehospital teleconsultation was obtained in 41 out of 43 cases (95.3%. The success rates for communication of blood pressure, heart rate, blood oxygen saturation, glycemia, and electronic patient identification were 78.7%, 84.8%, 80.6%, 64.0%, and 84.2%. A preliminary prehospital diagnosis was formulated in 90.2%, with satisfactory agreement with final in-hospital diagnoses. Communication of a prehospital report to the in-hospital team was successful in 94.7% and prenotification of the in-hospital team via SMS in 90.2%. Failures resulted mainly from limited mobile connectivity and to a lesser extent from software, hardware or human error. The user acceptance was high.Ambulance-based telemedicine of the third generation is safe, feasible and reliable but further research and development, especially with regard to high

Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial.

Science.gov (United States)

Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad

2015-06-01

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.

Radiology trainer. Surgical ambulance. Revision 2. rev. and enl. ed.

International Nuclear Information System (INIS)

Ackermann, Ole; Barkhausen, Joerg

2013-01-01

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.

Predictors of workplace violence among ambulance personnel : A longitudinal study.

NARCIS (Netherlands)

van der Velden, Peter; Bosmans, Mark; van der Meulen, Erik

Abstract Aim To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed

Optimizing the location of ambulances in Tijuana, Mexico.

Science.gov (United States)

Dibene, Juan Carlos; Maldonado, Yazmin; Vera, Carlos; de Oliveira, Mauricio; Trujillo, Leonardo; Schütze, Oliver

2017-01-01

In this work we report on modeling the demand for Emergency Medical Services (EMS) in Tijuana, Baja California, Mexico, followed by the optimization of the location of the ambulances for the Red Cross of Tijuana (RCT), which is by far the largest provider of EMS services in the region. We used data from more than 10,000 emergency calls surveyed during the year 2013 to model and classify the demand for EMS in different scenarios that provide different perspectives on the demand throughout the city, considering such factors as the time of day, work and off-days. A modification of the Double Standard Model (DSM) is proposed and solved to determine a common robust solution to the ambulance location problem that simultaneously satisfies all specified constraints in all demand scenarios selecting from a set of almost 1000 possible base locations. The resulting optimization problems are solved using integer linear programming and the solutions are compared with the locations currently used by the Red Cross. Results show that demand coverage and response times can be substantially improved by relocating the current bases without the need for additional resources. Copyright © 2016 Elsevier Ltd. All rights reserved.

A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

Directory of Open Access Journals (Sweden)

Staff Trine

2011-03-01

Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians?

Science.gov (United States)

Fothergill, Rachael T; Williams, Julia; Edwards, Melanie J; Russell, Ian T; Gompertz, Patrick

2013-11-01

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.

Climate change, productivity shocks and demand for freight ground transportation in Atlantic Canada

International Nuclear Information System (INIS)

Yevdokimov, Y. |; New Brunswick Univ., Fredericton, NB; Byelyayev, O.

2005-01-01

A study was conducted to determine the impacts of climate change on the transportation sector in a regional context. The purpose was to analyze potential climate change impacts on demand for freight transportation in Atlantic Canada through its association with other sectors of the regional economy. Freight transportation is designed to meet transportation demands of commodity producers who must deliver their goods to final users. Since it is a by-product of profit maximization and cost minimization by producers of all types of commodities in various sectors of the economy, this study modelled climate change impacts as productivity shocks in relevant sectors of the economy. A computerized simulation was then used to determine how the consequences of these shocks influence the demand for freight transportation. This was accomplished by collecting climate related data in Atlantic Canada as well as aggregate economic data that reflects the economic performance of the regional economy. A growth model that links regional economy to freight transportation was then developed and different scenarios for future developments associated with climate change impacts were evaluated. Computer simulation with Mathcad-8 showed that the conditions specified in the best-case scenario, expected-case scenario and worst-case scenario resulted in a cumulative loss in demand for ground freight transportation of 7.213, 582.127 and 610.92 billion tonne-kilometers respectively, over the 2001-2100 period. In general, the results of the computer simulation demonstrated a considerable decrease in the demand for ground freight transportation in Atlantic Canada resulting from climate change impacts. The loss in demand was found to occur mostly in the first half of this century, with some recovery in the second half because the economic system would adapt to new climate conditions. It was recommended that policy instruments such as regulations or taxes, should be put in place to reduce the impacts

Dyspnea in the ambulance - etiology, mortality, and point-of-care diagnostics

DEFF Research Database (Denmark)

Bøtker, Morten Thingemann

2016-01-01

dyspnea in the ambulance requires identification of high-risk groups and early correct treatment. Bringing forward simplified versions of advanced diagnostic modalities known from the hospital as point-of-care diagnostics already in the ambulance may aid the discrimination of underlying conditions causing......, we included all patients dialing the emergency number (1-1-2) due to a medical emergency in three of five Danish regions. For identification of highrisk patients and evaluation of electrocardiogram-based triage, we compared short-term mortality between patients included in the first study based...... that are highly prioritized in emergency medical services – including chest pain and trauma. Whether this increased mortality can be ascribed to an older age and comorbidity among patients suffering dyspnea, or if modifiable risk factors are also present, is unsettled. Improving outcome for patients suffering...

Day-to-day consistency of lower extremity kinematics during stair ambulation in 24-45 years old athletes.

Science.gov (United States)

Husa-Russell, Johanna; Ukelo, Thomas; List, Renate; Lorenzetti, Silvio; Wolf, Peter

2011-04-01

Before making interpretations on the effects of interventions or on the features of pathological gait patterns during stair ambulation, the day-to-day consistency of the investigated variables must be established. In this article, the day-to-day consistency was determined for kinematic variables during barefoot stair ambulation. Ten healthy athletes performed two gait analysis sessions, at least one week apart, utilizing a marker set of 47 skin markers, and a functional joint center/axes determination. Being found on limits of agreement and mean differences between the repeated stair ambulation sessions, totally 43 ranges of motions were examined at the hip, knee, ankle, and midfoot joints. The day-to-day consistency was generally in the magnitude of three degrees, irrespective of test condition, investigated joint, or regarded cardinal body plane. The reported values of the day-to-day consistency provide guidelines to distinguish between pathological and healthy gait patterns, and thresholds to determine minimal effects of interventions during stair ambulation. Copyright © 2011 Elsevier B.V. All rights reserved.

An association between fine particulate matter (PM2.5) levels and emergency ambulance dispatches for cardiovascular diseases in Japan.

Science.gov (United States)

Ichiki, Toshihiro; Onozuka, Daisuke; Kamouchi, Masahiro; Hagihara, Akihito

2016-11-01

The aim of this study is to determine whether short-term exposure to fine particulate matter (PM 2.5 ) is associated with emergency ambulance dispatches for cardiovascular diseases in Japan. The nationwide data on emergency dispatches of ambulance for cardiovascular diseases classified as I00-I99 by International Classification of Diseases-10th revision in 30 Japanese prefectures between April 1 and December 31, in 2010 were analyzed. Data on weather variability including PM 2.5 , temperature and relative humidity were acquired from ambient air pollution monitoring stations. Conditional Poisson regression models were used to estimate the prefecture-specific effects of PM 2.5 on morbidity, and adjust for confounding factors. A meta-analysis was then applied to pool estimates at the 30-prefecture level. A total of 160,566 emergency ambulance dispatches for cardiovascular diseases were reported during the study period. The risk of emergency ambulance dispatch for cardiovascular diseases significantly increased with an increase in the exposure to PM 2.5 in Fukuoka and Iwate Prefectures. However, we found no statistically significant associations between PM 2.5 and emergency ambulance dispatches in the pooled analysis (odds ratio 1.00, 95 % confidence interval 0.99-1.00). Heterogeneity was not observed between prefectures (Cochran Q test, p = 0.187, I 2  = 18.4 %). Exposure to PM 2.5 is not associated with overall emergency ambulance dispatches for cardiovascular diseases in Japan.

Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial

Directory of Open Access Journals (Sweden)

Ali Akbar Abdollahi

2015-06-01

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.

Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis.

Directory of Open Access Journals (Sweden)

Zhenlei Liu

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.

What an ambulance nurse needs to know: a content analysis of curricula in the specialist nursing programme in prehospital emergency care.

Science.gov (United States)

Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa

2015-04-01

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.

Treatment of presumed acute cardiogenic pulmonary oedema in an ambulance system by nurses using Boussignac continuous positive airway pressure

NARCIS (Netherlands)

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

Respiratory, cardiovascular and metabolic responses during different modes of overground bionic ambulation in persons with motor-incomplete spinal cord injury: A case series

Directory of Open Access Journals (Sweden)

Jochen Kressler

2017-09-01

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.

Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

Science.gov (United States)

Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

2016-04-01

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.

Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services.

Science.gov (United States)

Wandling, Michael W; Nathens, Avery B; Shapiro, Michael B; Haut, Elliott R

2018-02-01

Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems. Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle. In-hospital mortality. Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR,  0.45; 95% CI, 0.36-0.56) and stab wound (OR,  0.32; 95% CI, 0.20-0.52) subgroups. Private vehicle transport is associated with a significantly lower likelihood of death when compared with

Sustainable ground transportation – review of technologies, challenges and opportunities

Energy Technology Data Exchange (ETDEWEB)

Agarwal, Ramesh K. [Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130 (United States)

2013-07-01

Currently there are nearly 750 million ground vehicles in service worldwide. They are responsible for 50% of petroleum (oil) consumption and 60% of all greenhouse gas (GHG) emissions worldwide. The number of vehicles is forecasted to double by 2050. Therefore the environmental issues such as noise, emissions and fuel burn have become important for energy and environmental sustainability. This paper provides an overview of specific energy and environmental issues related to ground transportation. The technologies related to reduction in energy requirements such as reducing the vehicle mass by using the high strength low weight materials and reducing the viscous drag by active flow control and smoothing the operational profile, and reducing the contact friction by special tire materials are discussed along with the portable energy sources for reducing the GHG emissions such as low carbon fuels (biofuels), Lithium-ion batteries with high energy density and stability, and fuel cells. The technological challenges and opportunities for innovations are discussed.

Predominance of neurologic diseases in international aeromedical transportation.

Science.gov (United States)

Chen, Wan-Lin; Lin, Yu-Ming; Ma, Hong-Ping; Chiu, Wen-Ta; Tsai, Shin-Han

2009-12-01

International travel industry in Taiwan is expanding. The number of people traveling abroad was approximately 480,000 people in 1980; 2,940,000 in 1990; 7,320,000 in 2000, and in 2007, it has reached 8,960,000, which was more than one third of total population. Air medical transportation will be necessary when local medical facilities do not approximate the international standards. No previous study on epidemiology in Taiwan on patients received international medical repatriation. This is the first report to discuss the epidemiology of Taiwan's international aeromedical transportation and its focus on neurologic diseases. Retrospective analysis of all international aeromedical transports on Taiwanese patients from October 2005 to September 2007 was performed. All materials were collected from the databank of International SOS, Taipei. The data were analyzed with Microsoft Excel and SPSS v. 11.0 software (SPSS, Chicago, Ill). A total of 416 patients were transported. Excluding expatriates transported outbound and 2-stage inbound transports, the Taiwanese patient number with international aeromedical transport was 379; 51 by air ambulance and 328 commercially. There were 271 male (72%) and 108 female patients (18%). Of the 379 patients, 178 (47%) were neurologic diseases. Two hundred ninety-five (78%) patients were transported from China. Patient transports peaked in autumn by 105 (28%). Of all 33 ventilated patients, 12 (36%) were neurologic diseases. In-flight complications occurred in 10% of neurologic and 2% of nonneurologic cases. No in-flight mortality occurred in both groups. Neurologic diseases comprise most of the Taiwanese patients that requires medical transportation. With relatively suboptimal medical standard and high medical expenses in China, patients with neurologic conditions need timely and safe aeromedical transport than those with other diseases. Transport of patients with neurologic diseases, either by air ambulance or commercial flights, can

Knee disarticulation : Survival, wound healing and ambulation. A historic cohort study

NARCIS (Netherlands)

Ten Duis, K.; Bosmans, J. C.; Voesten, H. G. J.; Geertzen, J. H. B.; Dijkstra, P. U.

2009-01-01

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,

The relationship between airborne fine particle matter and emergency ambulance dispatches in a southwestern city in Chengdu, China

International Nuclear Information System (INIS)

Liu, Ruicong; Zeng, Jie; Jiang, Xianyan; Chen, Jianyu; Gao, Xufang; Zhang, Li; Li, Tiantian

2017-01-01

High levels of fine particulate matter (PM 2.5 ) are known to cause adverse effects to human health. The goal of this study was to estimate the acute health effects of short-term exposure to ambient PM 2.5 by analyzing cause-specific emergency ambulance dispatches as the endpoint in Chengdu, a city in Sichuan Province in southwest China. The ambient PM 2.5 concentration of Chengdu reached 63 μg/m 3 in 2015. Data related to the causes of specific emergency ambulance dispatches, air pollution, and meteorological conditions were collected from 2013 to 2015 (1095 days). A generalized additive model (GAM) was constructed to control the confounding conditions and to estimate the effects of PM 2.5 on human health conditions. Emergency ambulance dispatches for all causes with (RR for lag0 = 1.0010, 95%CI: 1.0002, 1.0019) or without injuries (RR for lag0 = 1.0012, 95%CI: 1.0002, 1.0022), respiratory diseases (RR for lag0 = 1.0051, 95%CI: 1.0012, 1.0089), and cardiovascular diseases (RR for lag0 = 1.0041, 95%CI: 1.0009, 1.0074) were associated with ambient PM 2.5 concentrations in Chengdu. In addition, the effects of PM 2.5 were not confounded by ozone. - Highlights: • Short-term exposure to PM 2.5 was associated to emergency ambulance dispatches. • PM 2.5 strongly affected ambulance dispatches for respiratory and cardiovascular diseases. • High PM 2.5 levels induced acute health effects in Chengdu and other east China cities. - PM 2.5 strongly affected emergency ambulance dispatches for respiratory and cardiovascular diseases in Chengdu, a southwestern city in China.

Effects of Improved Access to Transportation on Emergency obstetric ...

African Journals Online (AJOL)

Reduction in maternal mortality has not been appreciable in most low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using 'Caesarean section rate' (CSR) ...

Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test.

Science.gov (United States)

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

2015-10-01

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.

Superconducting magnet suspensions in high speed ground transport

Energy Technology Data Exchange (ETDEWEB)

Alston, I A

1973-08-01

A technical and economic definition of high speed ground transport systems using magnetic suspensions is given. The full range of common superconducting suspensions and of propulsions are covered with designs produced for speeds ranging from 100 m/s (225 miles/hr) to 250 m/s (560 mile/hr). Technical descriptions of the vehicles, their suspensions, propulsions and tracks are given in some detail and operating costs are presented for all the systems together with details of the breakdown of costs and the capital costs involved. The design assumptions, the costing procedure and a cost sensitivity study are presented. It is concluded that the systems are technically feasible; that they are suited to existing duorail track for low speed running and that, in these circumstances, they would be economically viable over many routes.

Helicopter versus ground emergency medical services for the transportation of traumatically injured children.

Science.gov (United States)

Stewart, Camille L; Metzger, Ryan R; Pyle, Laura; Darmofal, Joe; Scaife, Eric; Moulton, Steven L

2015-02-01

Helicopter emergency medical services (HEMS) are a common mode of transportation for pediatric trauma patients. We hypothesized that HEMS improve outcomes for traumatically injured children compared to ground emergency medical services (GEMS). We queried trauma registries of two level 1 pediatric trauma centers for children 0-17 years, treated from 2003 to 2013, transported by HEMS or GEMS, with known transport starting location and outcome. A geocoding service estimated travel distance and time. Multivariate regression analyses were performed to adjust for injury severity variables and travel distance/time. We identified 14,405 traumatically injured children; 3870 (26.9%) transported by HEMS and 10,535 (73.1%) transported by GEMS. Transport type was not significantly associated with survival, ICU length of stay, or discharge disposition. Transport by GEMS was associated with a 68.6%-53.1% decrease in hospital length of stay, depending on adjustment for distance/time. Results were similar for children with severe injuries, and with propensity score matched cohorts. Of note, 862/3850 (22.3%) of HEMS transports had an ISS<10 and hospitalization<1 day. HEMS do not independently improve outcomes for traumatically injured children, and 22.3% of children transported by HEMS are not significantly injured. These factors should be considered when requesting HEMS for transport of traumatically injured children. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of high ambient temperature on ambulance dispatches in different age groups in Fukuoka, Japan.

Science.gov (United States)

Kotani, Kazuya; Ueda, Kayo; Seposo, Xerxes; Yasukochi, Shusuke; Matsumoto, Hiroko; Ono, Masaji; Honda, Akiko; Takano, Hirohisa

2018-01-01

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.

Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup.

Science.gov (United States)

Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark

2007-06-01

Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol-related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls.

Mission impossible or border security – Practical and effective infection control on air ambulances

Directory of Open Access Journals (Sweden)

M. Kuhn*

2013-12-01

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.

Vertical unstable stability of electrodynamic suspension of high-speed ground transport

International Nuclear Information System (INIS)

Baiko, A.V.; Voevodskii, K.E.; Kochetkov, V.M.

1980-01-01

The problem considered is the vertical oscillation of a superconducting solenoid moving over a conducting sheet in connection with the electrodynamic suspension of high-speed ground transport. The oscillation is considered to be unstable at a sufficiently high speed. The current oscillation in the superconducting solenoid caused by its mechanical oscillation is also investigated. The superconducting properties of a solenoid are found to have a pronounced effect on stability. Both the theory and numerical results are presented. Methods of oscillation damping are also discussed. (author)

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

Science.gov (United States)

Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy D.

2014-01-01

Objective We determined the minimum mortality reduction that helicopter emergency medical services (HEMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of minor injury patients. Methods We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective over a patient's lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality adjusted life year (QALY) gained compared to ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma (NSCOT), National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses. Results HEMS must provide a minimum of a 17% relative risk reduction in mortality (1.6 lives saved/100 patients with the mean characteristics of the NSCOT cohort) to cost less than $100,000 per QALY gained and a reduction of at least 33% (3.7 lives saved/100 patients) to cost less than $50,000 per QALY. HEMS becomes more cost-effective with significant reductions in minor injury patients triaged to air transport or if long-term disability outcomes are improved. Conclusions HEMS needs to provide at least a 17% mortality reduction or a measurable improvement in long-term disability to compare favorably to other interventions considered cost-effective. Given current evidence, it is not clear that HEMS achieves this mortality or disability reduction. Reducing overtriage of minor injury patients to HEMS would improve its cost-effectiveness. PMID:23582619

Utility of Ambulance Data for Real-Time Syndromic Surveillance: A Pilot in the West Midlands Region, United Kingdom.

Science.gov (United States)

Todkill, Dan; Loveridge, Paul; Elliot, Alex J; Morbey, Roger A; Edeghere, Obaghe; Rayment-Bishop, Tracy; Rayment-Bishop, Chris; Thornes, John E; Smith, Gillian

2017-12-01

Introduction The Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the "severe" end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England. Hypothesis/Problem Is an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems? An ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients' demographics, partial postcode of patients' location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system. The pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory

49 CFR 229.97 - Grounding fuel tanks.

Science.gov (United States)

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Grounding fuel tanks. 229.97 Section 229.97 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION... Equipment § 229.97 Grounding fuel tanks. Fuel tanks and related piping shall be electrically grounded. ...

The combined use of mechanical CPR and a carry sheet to maintain quality resuscitation in out-of-hospital cardiac arrest patients during extrication and transport.

Science.gov (United States)

Lyon, Richard M; Crawford, Anna; Crookston, Colin; Short, Steven; Clegg, Gareth R

2015-08-01

Quality of manual cardiopulmonary resuscitation (CPR) during extrication and transport of out-of-hospital cardiac arrest victims is known to be poor. Performing manual CPR during ambulance transport poses significant risk to the attending emergency medical services crew. We sought to use pre-hospital video recording to objectively analyse the impact of introducing mechanical CPR with an extrication sheet (Autopulse, Zoll) to an advanced, second-tier cardiac arrest response team. The study was conducted prospectively using defibrillator downloads and analysis of pre-hospital video recording to measure the quality of CPR during extrication from scene and ambulance transport of the OHCA patient. Adult patients with non-traumatic OHCA were included. The interruption to manual CPR to during extrication and to deploy the mechanical CPR device was analysed. In the manual CPR group, 53 OHCA cases were analysed for quality of CPR during extrication. The median time that chest compression was interrupted to allow the patient to be carried from scene to the ambulance was 270 s (IQR 201-387 s). 119 mechanical CPR cases were analysed. The median time interruption from last manual compression to first Autopulse compression was 39 s (IQR 29-47 s). The range from last manual compression to first Autopulse compression was 14-118 s. Mechanical CPR used in combination with an extrication sheet can be effectively used to improve the quality of resuscitation during extrication and ambulance transport of the refractory OHCA patient. The time interval to deploy the mechanical CPR device can be shortened with regular simulation training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Flow and Pollutant Transport in Urban Street Canyons of Different Aspect Ratios with Ground Heating: Large-Eddy Simulation

OpenAIRE

Li, Xian-Xiang; Koh, Tieh-Yong; Britter, Rex E; Norford, Leslie Keith; Entekhabi, Dara

2010-01-01

A validated large-eddy simulation model was employed to study the effect of the aspect ratio and ground heating on the flow and pollutant dispersion in urban street canyons. Three ground-heating intensities (neutral, weak and strong) were imposed in street canyons of aspect ratio 1, 2, and 0.5. The detailed patterns of flow, turbulence, temperature and pollutant transport were analyzed and compared. Significant changes of flow and scalar patterns were caused by ground heating in the street ca...

Impact of interventions for patients refusing emergency medical services transport.

Science.gov (United States)

Alicandro, J; Hollander, J E; Henry, M C; Sciammarella, J; Stapleton, E; Gentile, D

1995-06-01

To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance. Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital. A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED. Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

HOMING PLACE: TOWARDS A PARTICIPATORY, AMBULANT AND CONVERSIVE METHODOLOGY

OpenAIRE

Myers, Misha

2009-01-01

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...

ECONOMIC AND LEGAL GROUNDS FOR INVESTMENT IN DEVELOPMENT OF TRANSPORT INFRASTRUCTURE

Directory of Open Access Journals (Sweden)

V. V. Zhelezniak

2017-02-01

Full Text Available Purpose. In Ukraine, as in many countries of the world, transport is one of the most fundamental sectors of the national economy, important part of the industrial and social spheres. But in the conditions of industry reforming there are problems of investing in development of rail transport. So the work is devoted to the grounds of potentially available sources of investment in infrastructure of railway transport of Ukraine. The work stresses the importance of the problem of attracting foreign investment in the economy, highlights the proposals to solve this problem. Methodology. To solve the problems of this class the work presents the proposed methods of analysis, synthesis and comparison, deduction, induction, logic and abstraction. It becomes necessary to search for and study of new conceptual approaches to organization of investment processes at railway transport enterprises, appropriate management and financial decisions and schemes of railway infrastructure development. Findings. The paper shows ways to optimize investment for modernization and technical re-equipment of the transport complex of Ukraine. It proposes the ways of attracting capital of investors for development of transport infrastructure: compliance with European laws and regulations; reforming of the tax system of Ukraine; combating corruption in the country; implementation of public-private partnership tools into the mechanism of state regulation of investment processes; creating a favourable investment climate for implementation of rail transport infrastructure projects; creating a system of compensation to investors; guarantees of transport infrastructure investment protection. Originality. The work offers the sources of investment for development of railway infrastructure in Ukraine, which should include: state budget funds, use of targeted loans and leasing. The main direction of the state policy concerning infrastructure should be a gradual transition of activity in

[Ambulant compression therapy for crural ulcers; an effective treatment when applied skilfully].

Science.gov (United States)

de Boer, Edith M; Geerkens, Maud; Mooij, Michael C

2015-01-01

The incidence of crural ulcers is high. They reduce quality of life considerably and create a burden on the healthcare budget. The key treatment is ambulant compression therapy (ACT). We describe two patients with crural ulcers whose ambulant compression treatment was suboptimal and did not result in healing. When the bandages were applied correctly healing was achieved. If correctly applied ACT should provide sufficient pressure to eliminate oedema, whilst taking local circumstances such as bony structures and arterial qualities into consideration. To provide pressure-to-measure regular practical training, skills and regular quality checks are needed. Knowledge of the properties of bandages and the proper use of materials for padding under the bandage enables good personalised ACT. In trained hands adequate compression and making use of simple bandages and dressings provides good care for patients suffering from crural ulcers in contrast to inadequate ACT using the same materials.

[Índice de Saturación Modificado y Ambulancias (ISMA): Ambulance assignment and remote Emergency Room Bed Reservation].

Science.gov (United States)

Polanco-González, Carlos; Castañón-González, Jorge Alberto; Villanueva-Martínez, Sebastián; Samaniego-Mendoza, José Lino; Buhse, Thomas

2015-01-01

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.

Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

Science.gov (United States)

Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

2015-08-01

The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

Assessment of ground transportation stress in juvenile Kemp's ridley sea turtles (Lepidochelys kempii).

Science.gov (United States)

Hunt, Kathleen E; Innis, Charles J; Kennedy, Adam E; McNally, Kerry L; Davis, Deborah G; Burgess, Elizabeth A; Merigo, Constance

2016-01-01

Sea turtle rehabilitation centres frequently transport sea turtles for long distances to move animals between centres or to release them at beaches, yet there is little information on the possible effects of transportation-related stress ('transport stress') on sea turtles. To assess whether transport stress is a clinically relevant concern for endangered Kemp's ridley sea turtles (Lepidochelys kempii), we obtained pre-transport and post-transport plasma samples from 26 juvenile Kemp's ridley sea turtles that were transported for 13 h (n = 15 turtles) or 26 h (n = 11 turtles) by truck for release at beaches. To control for effects of handling, food restriction and time of day, the same turtles were also studied on 'control days' 2 weeks prior to transport, i.e. with two samples taken to mimic pre-transport and post-transport timing, but without transportation. Blood samples were analysed for nine clinical health measures (pH, pCO2, pO2, HCO3, sodium, potassium, ionized calcium, lactate and haematocrit) and four 'stress-associated' parameters (corticosterone, glucose, white blood cell count and heterophil-to-lymphocyte ratio). Vital signs (heart rate, respiratory rate and cloacal temperature) were also monitored. Corticosterone and glucose showed pronounced elevations due specifically to transportation; for corticosterone, this elevation was significant only for the longer transport duration, whereas glucose increased significantly after both transport durations. However, clinical health measures and vital signs showed minimal or no changes in response to any sampling event (with or without transport), and all turtles appeared to be in good clinical health after both transport durations. Thus, transportation elicits a mild, but detectable, adrenal stress response that is more pronounced during longer durations of transport; nonetheless, Kemp's ridley sea turtles can tolerate ground transportation of up to 26 h in good health. These results are likely

Feasibility, Reliability and Predictive Value Of In-Ambulance Heart Rate Variability Registration

NARCIS (Netherlands)

Yperzeele, Laetitia; van Hooff, Robbert-Jan; De Smedt, Ann; Nagels, Guy; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

2016-01-01

Background Heart rate variability (HRV) is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and prognosis in several conditions. Objective We aim to investigate the feasibility and the reliability of in-ambulance HRV

[Structure Parameters and Quality Outcomes of Ambulant Home-care].

Science.gov (United States)

Suhr, Ralf; Raeder, Kathrin; Kuntz, Simone; Strube-Lahmann, Sandra; Latendorf, Antje; Klingelhöfer-Noe, Jürgen; Lahmann, Nils

2018-05-14

So far, there are few data available on the changes of ambulant home-care in Germany over the last decades. Therefore, the aim of this research was to provide structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany. In addition, a possible association between structure parameters and quality outcomes for pressure ulcer and malnutrition was investigated. In 2015, a multicenter cross-sectional study was conducted in home-care services in Germany. Structure data from 99 randomly selected home-care services as well as data on pressure ulcers and malnutrition of 903 care-dependent clients were analyzed. The median (home-care services. From a cut-off of 20,000 inhabitants, a region was considered urban. The average prevalence for decubitus and malnutrition (BMIhome-care service, and possible associations with structure parameters were analyzed using a multiple linear regression model. The proportion of registered nurses in non-private (private) home-care services was 60.6% (52.3%). The proportion of employees with a 200- h basic qualification in nursing was higher in private (12.5 vs. 4.7%), small home-care services (14.0 vs. 5.8%) and in urban regions (11.5 vs 5.7%). In average, registered nurses working in small home-care services spent significantly more time per client than the ones working in large services (3.8 vs. 2.9 h/week). The highest need for further training was shown on the subjects of pain, medication and cognitive impairment. No statistically significant correlation could be found between the average decubitus prevalence and structure parameters. Only the association between malnutrition prevalence and the proportion of registered nurses was statistically significant. The present representative study provides structure data on nursing personnel, funding, size, regional differences, and training needs of ambulant home-care services in Germany that could be used as a baseline

ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien

2017-01-01

BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin o...

Multi-Agent Simulation of Allocating and Routing Ambulances Under Condition of Street Blockage after Natural Disaster

Science.gov (United States)

Azimi, S.; Delavar, M. R.; Rajabifard, A.

2017-09-01

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%.

The effect of early ambulation on the incidence of neurological complication after spinal anesthesia with lidocaine

Directory of Open Access Journals (Sweden)

Reihanak Talakoub

2015-01-01

Full Text Available Background: Transient neurological symptoms (TNS, was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%. Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation. Results: Four subjects (13.3% in Group A and two patients (6.7% in Group B had pain at anesthesia injection site (P = 0.019. Fourteen patients in Group A (46.7% and six patients in Group B (20% had post-dural puncture headache (P = 0.014. Participants in Group B reported difficult urination more than Group A (P = 0.002. there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site. Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication.

Simulations of Ground-Water Flow, Transport, Age, and Particle Tracking near York, Nebraska, for a Study of Transport of Anthropogenic and Natural Contaminants (TANC) to Public-Supply Wells

Science.gov (United States)

Clark, Brian R.; Landon, Matthew K.; Kauffman, Leon J.; Hornberger, George Z.

2008-01-01

Contamination of public-supply wells has resulted in public-health threats and negative economic effects for communities that must treat contaminated water or find alternative water supplies. To investigate factors controlling vulnerability of public-supply wells to anthropogenic and natural contaminants using consistent and systematic data collected in a variety of principal aquifer settings in the United States, a study of Transport of Anthropogenic and Natural Contaminants to public-supply wells was begun in 2001 as part of the U.S. Geological Survey National Water-Quality Assessment Program. The area simulated by the ground-water flow model described in this report was selected for a study of processes influencing contaminant distribution and transport along the direction of ground-water flow towards a public-supply well in southeastern York, Nebraska. Ground-water flow is simulated for a 60-year period from September 1, 1944, to August 31, 2004. Steady-state conditions are simulated prior to September 1, 1944, and represent conditions prior to use of ground water for irrigation. Irrigation, municipal, and industrial wells were simulated using the Multi-Node Well package of the modular three-dimensional ground-water flow model code, MODFLOW-2000, which allows simulation of flow and solutes through wells that are simulated in multiple nodes or layers. Ground-water flow, age, and transport of selected tracers were simulated using the Ground-Water Transport process of MODFLOW-2000. Simulated ground-water age was compared to interpreted ground-water age in six monitoring wells in the unconfined aquifer. The tracer chlorofluorocarbon-11 was simulated directly using Ground-Water Transport for comparison with concentrations measured in six monitoring wells and one public supply well screened in the upper confined aquifer. Three alternative model simulations indicate that simulation results are highly sensitive to the distribution of multilayer well bores where leakage

Effect of introduction of electronic patient reporting on the duration of ambulance calls.

Science.gov (United States)

Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne

2009-10-01

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.

Air Versus Ground Transportation in Isolated Severe Head Trauma: A National Trauma Data Bank Study.

Science.gov (United States)

Aiolfi, Alberto; Benjamin, Elizabeth; Recinos, Gustavo; De Leon Castro, Alejandro; Inaba, Kenji; Demetriades, Demetrios

2018-03-01

The effect of prehospital helicopter emergency medical services (HEMS) on mortality has been analyzed previously in polytrauma patients with discordant results. Our aim was to compare outcomes in patients with isolated severe blunt traumatic brain injuries (TBIs) transported by HEMS or ground emergency medical services (GEMS). We conducted a National Trauma Data Bank study (2007-2014). All adult patients (≥16 years old) who sustained an isolated severe blunt TBI and were transported by HEMS or GEMS were included in the study. There were 145,559 patients who met the inclusion criteria. Overall, 116,391 (80%) patients were transported via GEMS and 29,168 (20%) via HEMS. Median transportation time was longer for HEMS patients (41 vs. 25 min; p transportation was independently associated with improved survival (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.47-0.67; p transport was an independent predictor of survival (AIS 3: OR 0.35; p transport time was not an independent predictor of mortality. Helicopter transport, in adult patients with isolated severe TBI, is associated with improved survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Simplified estimation technique for organic contaminant transport in ground water

Energy Technology Data Exchange (ETDEWEB)

Piver, W T; Lindstrom, F T

1984-05-01

The analytical solution for one-dimensional dispersive-advective transport of a single solute in a saturated soil accompanied by adsorption onto soil surfaces and first-order reaction rate kinetics for degradation can be used to evaluate the suitability of potential sites for burial of organic chemicals. The technique can be used to the greatest advantage with organic chemicals that are present in ground waters in small amounts. The steady-state solution provides a rapid method for chemical landfill site evaluation because it contains the important variables that describe interactions between hydrodynamics and chemical transformation. With this solution, solute concentration, at a specified distance from the landfill site, is a function of the initial concentration and two dimensionless groups. In the first group, the relative weights of advective and dispersive variables are compared, and in the second group the relative weights of hydrodynamic and degradation variables are compared. The ratio of hydrodynamic to degradation variables can be rearranged and written as (a/sub L lambda)/(q/epsilon), where a/sub L/ is the dispersivity of the soil, lambda is the reaction rate constant, q is ground water flow velocity, and epsilon is the soil porosity. When this term has a value less than 0.01, the degradation process is occurring at such a slow rate relative to the hydrodynamics that it can be neglected. Under these conditions the site is unsuitable because the chemicals are unreactive, and concentrations in ground waters will change very slowly with distance away from the landfill site.

Long-term outcome of neurosurgical untethering on neurosegmental motor and ambulation levels

NARCIS (Netherlands)

Schoenmakers, M. A. G. C.; Gooskens, R. H. J. M.; Gulmans, V. A. M.; Hanlo, P. W.; Vandertop, W. P.; Uiterwaal, C. S. P. M.; Helders, P. J. M.

2003-01-01

The aim of this study was to determine the long-term outcome of neurosurgical untethering on neurosegmental motor level and ambulation level in children with tethered spinal cord syndrome. Forty-four children were operated on (17 males, 27 females; mean age at operation 6 years 2 months, SD 5

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke : Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

NARCIS (Netherlands)

Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study

Assessment of ground-water flow and chemical transport in a tidally influenced aquifer using geostatistical filtering and hydrocarbon fingerprinting

International Nuclear Information System (INIS)

Marquis, S.A. Jr.; Smith, E.A.

1994-01-01

Traditional environmental investigations at tidally influenced hazardous waste sites such as marine fuel storage terminals have generally failed to characterize ground-water flow and chemical transport because they have been based on only a cursory knowledge of plume geometry, chemicals encountered, and hydrogeologic setting and synoptic ground-water level measurement. Single-time observations cannot be used to accurately determine flow direction and gradient in tidally fluctuating aquifers since these measurements delineate hydraulic head at only one point in time during a tidal cycle, not the net effect of the fluctuations. In this study, a more rigorous approach was used to characterize flow and chemical transport in a tidally influenced aquifer at a marine fuel storage terminal using: (1) ground-water-level monitoring over three tidal cycles (72 hours), (2) geostatistical filtering of ground-water-level data using 25-hour and 71-hour filtering methods, and (3) hydrocarbon fingerprinting analysis. The results from the study indicate that naphtha released from one of the on-site naphtha tanks has been the predominant contributor to the hydrocarbon plume both on-site and downgradient off-site and that net ground-water and hydrocarbon movement has been to the southeast away from the tank since 1989

Identification and characteristics of biological agents in work environment of medical emergency services in selected ambulances

Directory of Open Access Journals (Sweden)

Agata Bielawska-Drózd

2017-08-01

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

Identification and characteristics of biological agents in work environment of medical emergency services in selected ambulances.

Science.gov (United States)

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

2017-06-19

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

Guide to the Revised Ground-Water Flow and Heat Transport Simulator: HYDROTHERM - Version 3

Science.gov (United States)

Kipp, Kenneth L.; Hsieh, Paul A.; Charlton, Scott R.

2008-01-01

The HYDROTHERM computer program simulates multi-phase ground-water flow and associated thermal energy transport in three dimensions. It can handle high fluid pressures, up to 1 ? 109 pascals (104 atmospheres), and high temperatures, up to 1,200 degrees Celsius. This report documents the release of Version 3, which includes various additions, modifications, and corrections that have been made to the original simulator. Primary changes to the simulator include: (1) the ability to simulate unconfined ground-water flow, (2) a precipitation-recharge boundary condition, (3) a seepage-surface boundary condition at the land surface, (4) the removal of the limitation that a specified-pressure boundary also have a specified temperature, (5) a new iterative solver for the linear equations based on a generalized minimum-residual method, (6) the ability to use time- or depth-dependent functions for permeability, (7) the conversion of the program code to Fortran 90 to employ dynamic allocation of arrays, and (8) the incorporation of a graphical user interface (GUI) for input and output. The graphical user interface has been developed for defining a simulation, running the HYDROTHERM simulator interactively, and displaying the results. The combination of the graphical user interface and the HYDROTHERM simulator forms the HYDROTHERM INTERACTIVE (HTI) program. HTI can be used for two-dimensional simulations only. New features in Version 3 of the HYDROTHERM simulator have been verified using four test problems. Three problems come from the published literature and one problem was simulated by another partially saturated flow and thermal transport simulator. The test problems include: transient partially saturated vertical infiltration, transient one-dimensional horizontal infiltration, two-dimensional steady-state drainage with a seepage surface, and two-dimensional drainage with coupled heat transport. An example application to a hypothetical stratovolcano system with unconfined

Ground transport stress affects bacteria in the rumen of beef cattle: A real-time PCR analysis.

Science.gov (United States)

Deng, Lixin; He, Cong; Zhou, Yanwei; Xu, Lifan; Xiong, Huijun

2017-05-01

Transport stress syndrome often appears in beef cattle during ground transportation, leading to changes in their capacity to digest food due to changes in rumen microbiota. The present study aimed to analyze bacteria before and after cattle transport. Eight Xianan beef cattle were transported over 1000 km. Rumen fluid and blood were sampled before and after transport. Real-time PCR was used to quantify rumen bacteria. Cortisol and adrenocorticotrophic hormone (ACTH) were measured. Cortisol and ACTH were increased on day 1 after transportation and decreased by day 3. Cellulolytic bacteria (Fibrobacter succinogenes and Ruminococcus flavefaciens), Ruminococcus amylophilus and Prevotella albensis were increased at 6 h and declined by 15 days after transport. There was a significant reduction in Succinivibrio dextrinosolvens, Prevotella bryantii, Prevotella ruminicola and Anaerovibrio lipolytica after transport. Rumen concentration of acetic acid increased after transport, while rumen pH and concentrations of propionic and butyric acids were decreased. Body weight decreased by 3 days and increased by 15 days after transportation. Using real-time PCR analysis, we detected changes in bacteria in the rumen of beef cattle after transport, which might affect the growth of cattle after transport. © 2016 Japanese Society of Animal Science.

Predictors of workplace violence among ambulance personnel: a longitudinal study

OpenAIRE

van der Velden, Peter G.; Bosmans, Mark W.G.; van der Meulen, Erik

2015-01-01

Abstract Aim To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE’s are WPV-related and their abilities to prevent escalations. Design A longitudinal study with a 6 months’ time ...

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

Science.gov (United States)

Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

2015-01-01

Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

Abnormalities of left colonic motility in ambulant nonconstipated patients with irritable bowel syndrome

NARCIS (Netherlands)

Clemens, C. H. M.; Samsom, M.; van Berge Henegouwen, G. P.; Smout, A. J. P. M.

2003-01-01

Our objective was to evaluate left colonic motility patterns recorded under physiological conditions during 24 hr in fully ambulant nonconstipated IBS patients compared to healthy controls. A 42-hr manometry of the left colon was performed in 11 nonconstipated IBS patients and 10 age- and

Assessment of ground transportation stress in juvenile Kemp’s ridley sea turtles (Lepidochelys kempii)

Science.gov (United States)

Hunt, Kathleen E.; Innis, Charles J.; Kennedy, Adam E.; McNally, Kerry L.; Davis, Deborah G.; Burgess, Elizabeth A.; Merigo, Constance

2016-01-01

Sea turtle rehabilitation centres frequently transport sea turtles for long distances to move animals between centres or to release them at beaches, yet there is little information on the possible effects of transportation-related stress (‘transport stress’) on sea turtles. To assess whether transport stress is a clinically relevant concern for endangered Kemp’s ridley sea turtles (Lepidochelys kempii), we obtained pre-transport and post-transport plasma samples from 26 juvenile Kemp’s ridley sea turtles that were transported for 13 h (n = 15 turtles) or 26 h (n = 11 turtles) by truck for release at beaches. To control for effects of handling, food restriction and time of day, the same turtles were also studied on ‘control days’ 2 weeks prior to transport, i.e. with two samples taken to mimic pre-transport and post-transport timing, but without transportation. Blood samples were analysed for nine clinical health measures (pH, pCO2, pO2, HCO3, sodium, potassium, ionized calcium, lactate and haematocrit) and four ‘stress-associated’ parameters (corticosterone, glucose, white blood cell count and heterophil-to-lymphocyte ratio). Vital signs (heart rate, respiratory rate and cloacal temperature) were also monitored. Corticosterone and glucose showed pronounced elevations due specifically to transportation; for corticosterone, this elevation was significant only for the longer transport duration, whereas glucose increased significantly after both transport durations. However, clinical health measures and vital signs showed minimal or no changes in response to any sampling event (with or without transport), and all turtles appeared to be in good clinical health after both transport durations. Thus, transportation elicits a mild, but detectable, adrenal stress response that is more pronounced during longer durations of transport; nonetheless, Kemp’s ridley sea turtles can tolerate ground transportation of up to 26 h in good health. These

Aspects of neutrality: two Dutch ambulances at the eastern front in the First World War.

Science.gov (United States)

van Bergen, Leo

2010-01-01

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.

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

Science.gov (United States)

Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.

2016-01-01

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

Planning like an Olympian. How London Ambulance Service successfully handled their 'summer of sport'.

Science.gov (United States)

Killens, Jason

2013-03-01

LOCOG Medical managed thousands of patient contacts across all the Games venues without our intervention. A polyclinic in the athlete's village had extensive diagnostic options, including X-ray and magnetic resonance imaging for athletes and the Olympic family. These helped limit the number of patients who needed transport to the ED. Although the delivery was seamless, there were "behind the scenes" moments in the final stages of planning that made us think. We received additional requests for ambulance cover at training venues that hadn't been planned for on short notice. In addition, the torch relay attracted bigger crowds than initially planned for. Some of the planning assumptions and agreements changed on short notice for various reasons. This meant we had to adjust our plans while also solving human resource issues that you would expect to see among a workforce of around 500 across a six-week period. As part of the National Health Service (NHS) ambulance service Games cohort, more than 500 staff were deployed across 18 venues and 30 days of sport in London. In doing so, they delivered in excess of 165,000 hours of standby and care, responded to nearly 1,500 Games-related incidents and conveyed 800 patients to emergency departments across the capital. After such an influx, it wasn't easy to return to business as usual. Officials with previous host cities had advised us that there would be a feeling of "what next" once the Games concluded. When I first heard this, I thought the opposite would be the case. I expected feeling relieved of overwhelming emotion as well as from the exhaustion of the long days. I do have to say that although this was the case, it's also true that there is a "post Games" come down. We had just been part of a fantastic summer of sport with a brilliant medal tally from Team Great Britain and Paralympics Great Britain that, of course, helped the euphoria. But we did feel real sense of uncertainty about what to do next. We had spent five

PHAST--a program for simulating ground-water flow, solute transport, and multicomponent geochemical reactions

Science.gov (United States)

Parkhurst, David L.; Kipp, Kenneth L.; Engesgaard, Peter; Charlton, Scott R.

2004-01-01

The computer program PHAST simulates multi-component, reactive solute transport in three-dimensional saturated ground-water flow systems. PHAST is a versatile ground-water flow and solute-transport simulator with capabilities to model a wide range of equilibrium and kinetic geochemical reactions. The flow and transport calculations are based on a modified version of HST3D that is restricted to constant fluid density and constant temperature. The geochemical reactions are simulated with the geochemical model PHREEQC, which is embedded in PHAST. PHAST is applicable to the study of natural and contaminated ground-water systems at a variety of scales ranging from laboratory experiments to local and regional field scales. PHAST can be used in studies of migration of nutrients, inorganic and organic contaminants, and radionuclides; in projects such as aquifer storage and recovery or engineered remediation; and in investigations of the natural rock-water interactions in aquifers. PHAST is not appropriate for unsaturated-zone flow, multiphase flow, density-dependent flow, or waters with high ionic strengths. A variety of boundary conditions are available in PHAST to simulate flow and transport, including specified-head, flux, and leaky conditions, as well as the special cases of rivers and wells. Chemical reactions in PHAST include (1) homogeneous equilibria using an ion-association thermodynamic model; (2) heterogeneous equilibria between the aqueous solution and minerals, gases, surface complexation sites, ion exchange sites, and solid solutions; and (3) kinetic reactions with rates that are a function of solution composition. The aqueous model (elements, chemical reactions, and equilibrium constants), minerals, gases, exchangers, surfaces, and rate expressions may be defined or modified by the user. A number of options are available to save results of simulations to output files. The data may be saved in three formats: a format suitable for viewing with a text editor; a

Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

Science.gov (United States)

Nordby, Halvor

2015-01-01

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.

How do they get here: Does the method of transportation impact salvage for patients with testicular torsion?

Science.gov (United States)

Weiss, D A; Tsarouhas, N; Carr, M C; Kalmus, A; Zderic, S A

2017-06-01

A growing number of patients are arriving at our tertiary care center for evaluation of possible testicular torsion using ambulance or helicopter transport. In many cases the parents arrive by car before the patient arrives. Are these advanced methods of medical transport worth the expense and risk in the case of suspected testicular torsion? We evaluated the total number of patients presenting to our emergency room for suspected testicular torsion to see if the means of transport affected testicular survival. Retrospective. As shown below in the table, the means of transport did not impact on testicular salvage. It is understandable that many patients with scrotal pain seek treatment closer to home because of their pediatrician's recommendation and/or family preference. However once evaluated many patients are transferred because of a lack of urologists willing to evaluate and treat the pediatric patients in community settings or because of a lack of anesthesia support. These patients are often transported by ambulance or helicopter. Our data would suggest that there is no improvement in the testicular salvage rate seen with these more advanced means of medical transportation compared with transfer by private car even when we restrict the analysis to patients traveling from over 40 miles away. We suspect that important time is lost while waiting to make such transfer arrangements. Furthermore transfer by ambulance or helicopter is more expensive and these costs are often passed on to families. Transfer by helicopter is also riskier. While an argument can be made in favor of medical transport over long distances or long driving times, this data suggests that many of these transfers could be accomplished by car with no effect on testicular salvage rates. The rate of testicular salvage was not affected by the means of transport to our tertiary facility. Only 4 patients would have required advanced of medical transport if this were limited to those facilities over 100

Five-year mortality after acute poisoning treated in ambulances, an emergency outpatient clinic and hospitals in Oslo.

Science.gov (United States)

Lund, Cathrine; Bjornaas, Mari A; Sandvik, Leiv; Ekeberg, Oivind; Jacobsen, Dag; Hovda, Knut E

2013-08-21

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.

Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station.

Science.gov (United States)

Banitsas, Konstantinos A; Perakis, Konstantinos; Tachakra, Sapal; Koutsouris, Dimitrios

2006-01-01

We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.

A proposed strategy for the validation of ground-water flow and solute transport models

International Nuclear Information System (INIS)

Davis, P.A.; Goodrich, M.T.

1991-01-01

Ground-water flow and transport models can be thought of as a combination of conceptual and mathematical models and the data that characterize a given system. The judgment of the validity or invalidity of a model depends both on the adequacy of the data and the model structure (i.e., the conceptual and mathematical model). This report proposes a validation strategy for testing both components independently. The strategy is based on the philosophy that a model cannot be proven valid, only invalid or not invalid. In addition, the authors believe that a model should not be judged in absence of its intended purpose. Hence, a flow and transport model may be invalid for one purpose but not invalid for another. 9 refs

Evaluation of a Novel Wireless Transmission System for Trauma Ultrasound Examinations From Moving Ambulances.

Science.gov (United States)

Morchel, Herman; Ogedegbe, Chinwe; Chaplin, William; Cheney, Brianna; Zakharchenko, Svetlana; Misch, David; Schwartz, Matthew; Feldman, Joseph; Kaul, Sanjeev

2018-03-01

To determine if physicians trained in ultrasound interpretation perceive a difference in image quality and usefulness between Extended Focused Assessment with Sonography ultrasound examinations performed at bedside in a hospital vs. by emergency medical technicians minimally trained in medical ultrasound on a moving ambulance and transmitted to the hospital via a novel wireless system. In particular, we sought to demonstrate that useful images could be obtained from patients in less than optimal imaging conditions; that is, while they were in transport. Emergency medical technicians performed the examinations during transport of blunt trauma patients. Upon patient arrival at the hospital, a bedside Extended Focused Assessment with Sonography examination was performed by a physician. Both examinations were recorded and later reviewed by physicians trained in ultrasound interpretation. Data were collected on 20 blunt trauma patients over a period of 13 mo. Twenty ultrasound-trained physicians blindly compared transmitted vs. bedside images using 11 Questionnaire for User Interaction Satisfaction scales. Four paired samples t-tests were conducted to assess mean differences between ratings for ambulatory and base images. Although there is a slight tendency for the average rating across all subjects and raters to be slightly higher in the base than in the ambulatory condition, none of these differences are statistically significant. These results suggest that the quality of the ambulatory images was viewed as essentially as good as the quality of the base images.

Appraisal of work ability in relation to job-specific health requirements in ambulance workers.

Science.gov (United States)

van Schaaijk, A; Boschman, J S; Frings-Dresen, M H W; Sluiter, J K

2017-01-01

To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. Outcomes in 'raised alertness and judgment ability' (R 2  = 0.09), 'job-specific physical abilities' (R 2  = 0.10) and 'emotional peak load' (R 2  = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.

Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist.

Science.gov (United States)

Kinsella, Rita; Collins, Tom; Shaw, Bridget; Sayer, James; Cary, Belinda; Walby, Andrew; Cowan, Sallie

2017-05-09

Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time

Psychometric properties of the Cumulated Ambulation Score

DEFF Research Database (Denmark)

Ferriero, Giorgio; Kristensen, Morten T; Invernizzi, Marco

2018-01-01

INTRODUCTION: In the geriatric population, independent mobility is a key factor in determining readiness for discharge following acute hospitalization. The Cumulated Ambulation Score (CAS) is a potentially valuable score that allows day-to-day measurements of basic mobility. The CAS was developed...... and validated in older patients with hip fracture as an early postoperative predictor of short-term outcome, but it is also used to assess geriatric in-patients with acute medical illness. Despite the fast- accumulating literature on the CAS, to date no systematic review synthesizing its psychometric properties....... Of 49 studies identified, 17 examined the psychometric properties of the CAS. EVIDENCE SYNTHESIS: Most papers dealt with patients after hip fracture surgery, and only 4 studies assessed the CAS psychometric characteristics also in geriatric in-patients with acute medical illness. Two versions of CAS...

Noise exposure during ambulance flights and repatriation operations.

Science.gov (United States)

Küpper, Thomas E; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline

2010-01-01

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.

GROUND TRANSPORTATION OF NUCLEAR PROPULSION STAGES

Energy Technology Data Exchange (ETDEWEB)

Marjon, P. L.

1963-08-15

The results of studies on transportation problems associated with the development and testing of nuclear rocket powered space vehicles at the static test size are presented. Factors involved in selecting a transport mode are discussed. Radiation shutdown considerations and a conceptual transporter capable of handling test articles of foreseeable size are examined. (D.C.W.)

Air medical transport of cardiac patients.

Science.gov (United States)

Essebag, Vidal; Halabi, Abdul R; Churchill-Smith, Michael; Lutchmedial, Sohrab

2003-11-01

The air medical transport of cardiac patients is a rapidly expanding practice. For various medical, social, and economic indications, patients are being flown longer distances at commercial altitudes, including international and intercontinental flights. There are data supporting the use of short-distance helicopter flights early in the course of a cardiac event for patients needing emergent transfer for percutaneous coronary intervention or aortocoronary bypass. When considering elective long-distance air medical transport of cardiac patients for social or economic reasons, it is necessary to weigh the benefits against the potential risks of flight. A few recent studies suggest that long-distance air medical transport is safe under certain circumstances. Current guidelines for air travel after myocardial infarction do not address the use of medical escorts or air ambulances equipped with intensive care facilities. Further research using larger prospective studies is needed to better define criteria for safe long-distance air medical transport of cardiac patients.

Posicionamento de ambulâncias do SAMU através de Programação Inteira e Teoria de Filas

Directory of Open Access Journals (Sweden)

Bruno Barreto

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.

Fun at Antarctic grounding lines: Ice-shelf channels and sediment transport

Science.gov (United States)

Drews, Reinhard; Mayer, Christoph; Eisen, Olaf; Helm, Veit; Ehlers, Todd A.; Pattyn, Frank; Berger, Sophie; Favier, Lionel; Hewitt, Ian H.; Ng, Felix; Fürst, Johannes J.; Gillet-Chaulet, Fabien; Bergeot, Nicolas; Matsuoka, Kenichi

2017-04-01

Meltwater beneath the polar ice sheets drains, in part, through subglacial conduits. Landforms created by such drainages are abundant in areas formerly covered by ice sheets during the last glacial maximum. However, observations of subglacial conduit dynamics under a contemporary ice sheet are lacking. We present results from ice-penetrating radar to infer the existence of subglacial conduits upstream of the grounding line of Roi Baudouin Ice Shelf, Antarctica. The conduits are aligned with ice-shelf channels, and underlain by esker ridges formed from sediment deposition due to reduced water outflow speed near the grounding line. In turn, the eskers modify local ice flow to initiate the bottom topography of the ice-shelf channels, and create small surface ridges extending onto the shelf. Relict features on the shelf are interpreted to indicate a history of these interactions and variability of past subglacial drainages. Because ice-shelf channels are loci where intense melting occurs to thin an ice shelf, these findings expose a novel link between subglacial drainage, sedimentation, and ice-shelf stability. To investigate the role of sediment transport beneath ice sheets further, we model the sheet-shelf system of the Ekstömisen catchment, Antarctica. A 3D finite element model (Elmer/ICE) is used to solve the transients full Stokes equation for isotropic, isothermal ice with a dynamic grounding line. We initialize the model with surface topography from the TanDEM-X satellites and by inverting simultaneously for ice viscosity and basal drag using present-day surface velocities. Results produce a flow field which is consitent with sattelite and on-site observations. Solving the age-depth relationship allows comparison with radar isochrones from airborne data, and gives information about the atmospheric/dynamic history of this sector. The flow field will eventually be used to identify potential sediment sources and sinks which we compare with more than 400 km of

Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

LENUS (Irish Health Repository)

Feeney, A

2016-04-01

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

Large-Eddy Simulation of Flow and Pollutant Transport in Urban Street Canyons with Ground Heating

Science.gov (United States)

Li, Xian-Xiang; Britter, Rex E.; Koh, Tieh Yong; Norford, Leslie K.; Liu, Chun-Ho; Entekhabi, Dara; Leung, Dennis Y. C.

2010-11-01

Our study employed large-eddy simulation (LES) based on a one-equation subgrid-scale model to investigate the flow field and pollutant dispersion characteristics inside urban street canyons. Unstable thermal stratification was produced by heating the ground of the street canyon. Using the Boussinesq approximation, thermal buoyancy forces were taken into account in both the Navier-Stokes equations and the transport equation for subgrid-scale turbulent kinetic energy (TKE). The LESs were validated against experimental data obtained in wind-tunnel studies before the model was applied to study the detailed turbulence, temperature, and pollutant dispersion characteristics in the street canyon of aspect ratio 1. The effects of different Richardson numbers ( Ri) were investigated. The ground heating significantly enhanced mean flow, turbulence, and pollutant flux inside the street canyon, but weakened the shear at the roof level. The mean flow was observed to be no longer isolated from the free stream and fresh air could be entrained into the street canyon at the roof-level leeward corner. Weighed against higher temperature, the ground heating facilitated pollutant removal from the street canyon.

Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival.

Science.gov (United States)

Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob

2011-12-01

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.

Large-Eddy Simulation of Flow and Pollutant Transport in Urban Street Canyons with Ground Heating

OpenAIRE

Li, Xian-Xiang; Britter, Rex E.; Koh, Tieh Yong; Norford, Leslie Keith; Liu, Chun-Ho; Entekhabi, Dara; Leung, Dennis Y. C.

2009-01-01

Our study employed large-eddy simulation (LES) based on a one-equation subgrid-scale model to investigate the flow field and pollutant dispersion characteristics inside urban street canyons. Unstable thermal stratification was produced by heating the ground of the street canyon. Using the Boussinesq approximation, thermal buoyancy forces were taken into account in both the Navier–Stokes equations and the transport equation for subgrid-scale turbulent kinetic energy (TKE). The LESs were valida...

Osteogenesis imperfecta in childhood: effects of spondylodesis on functional ability, ambulation and perceived competence

NARCIS (Netherlands)

Tolboom, N.; Cats, E. A.; Helders, P. J. M.; Pruijs, J. E. H.; Engelbert, R. H. H.

2004-01-01

We studied the effects of spondylodesis on spinal curvature, functional outcome, level of ambulation and perceived competence in 11 children with osteogenesis imperfecta (OI). Mean age at surgical intervention was 13.1 years (SD 2.5 years) and follow-up amounted to 3.4 years (SD 2.3 years). Spinal

Development and pilot testing of 24/7 in-ambulance telemedicine for acute stroke : prehospital stroke study at the Universitair Ziekenhuis Brussel-project

OpenAIRE

Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

Abstract: Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the develop...

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke: Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project

OpenAIRE

Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Tellez, Helio Fernandez; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

Background: In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Methods: Successful execution of the project involved the development and v...

Disposal facility in Olkiluoto, description of above ground facilities in tunnel transport alternative

International Nuclear Information System (INIS)

Kukkola, T.

2006-11-01

The above ground facilities of the disposal plant on the Olkiluoto site are described in this report as they will be when the operation of the disposal facility starts in the year 2020. The disposal plant is visualised on the Olkiluoto site. Parallel construction of the deposition tunnels and disposal of the spent fuel canisters constitute the principal design basis of the disposal plant. The annual production of disposal canisters for spent fuel amounts to about 40. Production of 100 disposal canisters has been used as the capacity basis. Fuel from the Olkiluoto plant and from the Loviisa plant will be encapsulated in the same production line. The disposal plant will require an area of about 15 to 20 hectares above ground level. The total building volume of the above ground facilities is about 75000 m 3 . The purpose of the report is to provide the base for detailed design of the encapsulation plant and the repository spaces, as well as for coordination between the disposal plant and ONKALO. The dimensioning bases for the disposal plant are shown in the Tables at the end of the report. The report can also be used as a basis for comparison in deciding whether the fuel canisters are transported to the repository by a lift or a by vehicle along the access tunnel. (orig.)

Disposal facility in olkiluoto, description of above ground facilities in lift transport alternative

International Nuclear Information System (INIS)

Kukkola, T.

2006-11-01

The above ground facilities of the disposal plant on the Olkiluoto site are described in this report as they will be when the operation of the disposal facility starts in the year 2020. The disposal plant is visualised on the Olkiluoto site. Parallel construction of the deposition tunnels and disposal of the spent fuel canisters constitute the principal design basis of the disposal plant. The annual production of disposal canisters for spent fuel amounts to about 40. Production of 100 disposal canisters has been used as the capacity basis. Fuel from the Olkiluoto plant and from the Loviisa plant will be encapsulated in the same production line. The disposal plant will require an area of about 15 to 20 hectares above ground level. The total building volume of the above ground facilities is about 75000 m 3 . The purpose of the report is to provide the base for detailed design of the encapsulation plant and the repository spaces, as well as for coordination between the disposal plant and ONKALO. The dimensioning bases for the disposal plant are shown in the Tables at the end of the report. The report can also be used as a basis for comparison in deciding whether the fuel canisters are transported to the repository by a lift or by a vehicle along the access tunnel. (orig.)

EFFECT OF SHOE RAISE ALONG WITH MOTOR RELEARNING PROGRAMME (MRP ON AMBULATION IN CHRONIC STROKE

Directory of Open Access Journals (Sweden)

Gajanan Bhalerao

2016-06-01

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.

The importance of manager support for the mental health and well-being of ambulance personnel.

Science.gov (United States)

Petrie, Katherine; Gayed, Aimée; Bryan, Bridget T; Deady, Mark; Madan, Ira; Savic, Anita; Wooldridge, Zoe; Counson, Isabelle; Calvo, Rafael A; Glozier, Nicholas; Harvey, Samuel B

2018-01-01

Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622). Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate) and managers' observed behaviours (manager behaviour) on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6%) were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, pManager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, pmanagement places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.

North Star Ambulatory Assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy.

Science.gov (United States)

Mazzone, Elena; Martinelli, Diego; Berardinelli, Angela; Messina, Sonia; D'Amico, Adele; Vasco, Gessica; Main, Marion; Doglio, Luca; Politano, Luisa; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Carlesi, Adelina; Bonetti, Anna Maria; Zucchini, Elisabetta; De Sanctis, Roberto; Scutifero, Marianna; Bianco, Flaviana; Rossi, Francesca; Motta, Maria Chiara; Sacco, Annalisa; Donati, Maria Alice; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Pane, Marika; Pasquini, Elisabetta; Bruno, Claudio; Vita, Giuseppe; de Waure, Chiara; Bertini, Enrico; Mercuri, Eugenio

2010-11-01

The North Star Ambulatory Assessment is a functional scale specifically designed for ambulant boys affected by Duchenne muscular dystrophy (DMD). Recently the 6-minute walk test has also been used as an outcome measure in trials in DMD. The aim of our study was to assess a large cohort of ambulant boys affected by DMD using both North Star Assessment and 6-minute walk test. More specifically, we wished to establish the spectrum of findings for each measure and their correlation. This is a prospective multicentric study involving 10 centers. The cohort included 112 ambulant DMD boys of age ranging between 4.10 and 17 years (mean 8.18±2.3 DS). Ninety-one of the 112 were on steroids: 37/91 on intermittent and 54/91 on daily regimen. The scores on the North Star assessment ranged from 6/34 to 34/34. The distance on the 6-minute walk test ranged from 127 to 560.6 m. The time to walk 10 m was between 3 and 15 s. The time to rise from the floor ranged from 1 to 27.5 s. Some patients were unable to rise from the floor. As expected the results changed with age and were overall better in children treated with daily steroids. The North Star assessment had a moderate to good correlation with 6-minute walk test and with timed rising from floor but less with 10 m timed walk/run test. The 6-minute walk test in contrast had better correlation with 10 m timed walk/run test than with timed rising from floor. These findings suggest that a combination of these outcome measures can be effectively used in ambulant DMD boys and will provide information on different aspects of motor function, that may not be captured using a single measure. Copyright © 2010. Published by Elsevier B.V.

14 CFR 417.109 - Ground safety.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Ground safety. 417.109 Section 417.109... TRANSPORTATION LICENSING LAUNCH SAFETY Launch Safety Responsibilities § 417.109 Ground safety. (a) Ground safety... 417.115(c), and subpart E of this part provide launch operator ground safety requirements. ...

Characterization of the Hanford 300 area burial grounds. Task IV. Biological transport

International Nuclear Information System (INIS)

Fitzner, R.E.; Gano, K.A.; Rickard, W.H.; Rogers, L.E.

1979-10-01

The characteristics of radioactive waste burial sites at the 300 area burial grounds on the Department of Energy's Hanford Site, southeastern Washington were studied. The potential vectors of radionuclide transport studied were vegetation and animals. The overall results showed a low potential for uptake and transport of radionuclides from the 300 area sites. However, additional methods to control physical and biological mechanisms may contribute to the effectiveness of waste burial practices. From the results, the Biological Transport task recommended field studies which include reduction of soil erosion and addition of biobarriers to plants and animals. Vegetation plays a major role in reducing soil erosion, and thereby maintaining the backfill over the burial sites. Of the several species found on the 300 area sites, cheatgrass (Bromus tectorum) appears to be the most desirable as a cover. Besides retarding erosion, it has a shallow root system (does not easily penetrate buried material); it has a low affinity for radionuclide uptake; and its tissues are not easily blown away. Small mammals (specifically, mice) appear to have the most potential for radionuclide exposure and uptake. Small mammals were live-trapped within 10 x 10-meter trap grids. Each animal trapped was surgically implanted with a thermoluminescent dosimeter. When the animal was recaptured, the dosimeter was removed and read for exposure. Exposures were reported in milli-Roentgens. The most consistently trapped small mammals were the Great Basin pocket mouse (Perognathus parvus) and the deer mouse (Peromyscus maniculatus). Results from the dosimeter readings showed that some of those animals had higher than background exposures. Biobarriers to animals could be considered as a mechanism to reduce the potential for radionuclide transport

Characterization of the Hanford 300 area burial grounds. Task IV. Biological transport

Energy Technology Data Exchange (ETDEWEB)

Fitzner, R.E.; Gano, K.A.; Rickard, W.H.; Rogers, L.E.

1979-10-01

The characteristics of radioactive waste burial sites at the 300 area burial grounds on the Department of Energy's Hanford Site, southeastern Washington were studied. The potential vectors of radionuclide transport studied were vegetation and animals. The overall results showed a low potential for uptake and transport of radionuclides from the 300 area sites. However, additional methods to control physical and biological mechanisms may contribute to the effectiveness of waste burial practices. From the results, the Biological Transport task recommended field studies which include reduction of soil erosion and addition of biobarriers to plants and animals. Vegetation plays a major role in reducing soil erosion, and thereby maintaining the backfill over the burial sites. Of the several species found on the 300 area sites, cheatgrass (Bromus tectorum) appears to be the most desirable as a cover. Besides retarding erosion, it has a shallow root system (does not easily penetrate buried material); it has a low affinity for radionuclide uptake; and its tissues are not easily blown away. Small mammals (specifically, mice) appear to have the most potential for radionuclide exposure and uptake. Small mammals were live-trapped within 10 x 10-meter trap grids. Each animal trapped was surgically implanted with a thermoluminescent dosimeter. When the animal was recaptured, the dosimeter was removed and read for exposure. Exposures were reported in milli-Roentgens. The most consistently trapped small mammals were the Great Basin pocket mouse (Perognathus parvus) and the deer mouse (Peromyscus maniculatus). Results from the dosimeter readings showed that some of those animals had higher than background exposures. Biobarriers to animals could be considered as a mechanism to reduce the potential for radionuclide transport.

Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review

Directory of Open Access Journals (Sweden)

Stephanie Armstrong

2017-09-01

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.

Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review.

Science.gov (United States)

Armstrong, Stephanie; Langlois, Adele; Laparidou, Despina; Dixon, Mark; Appleton, Jason P; Bath, Philip M; Snooks, Helen; Siriwardena, A Niroshan

2017-09-16

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.

Posicionamento de ambulâncias do SAMU através de Programação Inteira e Teoria de Filas

OpenAIRE

Barreto,Bruno; Alexandrino,Fernando; Coelho,Ormeu

2016-01-01

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 p...

Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Executive summary

International Nuclear Information System (INIS)

Simmons, C.S.; Cole, C.R.

1985-05-01

This document was written to provide guidance to managers and site operators on how ground-water transport codes should be selected for assessing burial site performance. There is a need for a formal approach to selecting appropriate codes from the multitude of potentially useful ground-water transport codes that are currently available. Code selection is a problem that requires more than merely considering mathematical equation-solving methods. These guidelines are very general and flexible and are also meant for developing systems simulation models to be used to assess the environmental safety of low-level waste burial facilities. Code selection is only a single aspect of the overall objective of developing a systems simulation model for a burial site. The guidance given here is mainly directed toward applications-oriented users, but managers and site operators need to be familiar with this information to direct the development of scientifically credible and defensible transport assessment models. Some specific advice for managers and site operators on how to direct a modeling exercise is based on the following five steps: identify specific questions and study objectives; establish costs and schedules for achieving answers; enlist the aid of professional model applications group; decide on approach with applications group and guide code selection; and facilitate the availability of site-specific data. These five steps for managers/site operators are discussed in detail following an explanation of the nine systems model development steps, which are presented first to clarify what code selection entails

Flow and Pollutant Transport in Urban Street Canyons of Different Aspect Ratios with Ground Heating: Large-Eddy Simulation

Science.gov (United States)

Li, Xian-Xiang; Britter, Rex E.; Norford, Leslie K.; Koh, Tieh-Yong; Entekhabi, Dara

2012-02-01

A validated large-eddy simulation model was employed to study the effect of the aspect ratio and ground heating on the flow and pollutant dispersion in urban street canyons. Three ground-heating intensities (neutral, weak and strong) were imposed in street canyons of aspect ratio 1, 2, and 0.5. The detailed patterns of flow, turbulence, temperature and pollutant transport were analyzed and compared. Significant changes of flow and scalar patterns were caused by ground heating in the street canyon of aspect ratio 2 and 0.5, while only the street canyon of aspect ratio 0.5 showed a change in flow regime (from wake interference flow to skimming flow). The street canyon of aspect ratio 1 does not show any significant change in the flow field. Ground heating generated strong mixing of heat and pollutant; the normalized temperature inside street canyons was approximately spatially uniform and somewhat insensitive to the aspect ratio and heating intensity. This study helps elucidate the combined effects of urban geometry and thermal stratification on the urban canyon flow and pollutant dispersion.

Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 2. Special test cases

International Nuclear Information System (INIS)

Simmons, C.S.; Cole, C.R.

1985-08-01

This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. Volume 1, titled ''Guideline Approach,'' consists of Chapters 1 through 5 and a glossary. Chapters 2 through 5 provide the more detailed discussions about the code selection approach. This volume, Volume 2, consists of four appendices reporting on the technical evaluation test cases designed to help verify the accuracy of ground-water transport codes. 20 refs

Evaluation of ground-water flow and solute transport in the Lompoc area, Santa Barbara County, California

Science.gov (United States)

Bright, Daniel J.; Nash, David B.; Martin, Peter

1997-01-01

Ground-water quality in the Lompoc area, especially in the Lompoc plain, is only marginally acceptable for most uses. Demand for ground water has increased for municipal use since the late 1950's and has continued to be high for irrigation on the Lompoc plain, the principal agricultural area in the Santa Ynez River basin. As use has increased, the quality of ground water has deteriorated in some areas of the Lompoc plain. The dissolved-solids concentration in the main zone of the upper aquifer beneath most of the central and western plains has increased from less than 1,000 milligrams per liter in the 1940's to greater than 2,000 milligrams per liter in the 1960's. Dissolved- solids concentration have remained relatively constant since the 1960's. A three-dimensional finite-difference model was used to simulate ground-water flow in the Lompoc area and a two-dimensional finite-element model was used to simulate solute transport to gain a better understanding of the ground-water system and to evaluate the effects of proposed management plans for the ground-water basin. The aquifer system was simulated in the flow model as four horizontal layers. In the area of the Lompoc plain, the layers represent the shallow, middle, and main zones of the upper aquifer, and the lower aquifer. For the Lompoc upland and Lompoc terrace, the four layers represent the lower aquifer. The solute transport model was used to simulate dissolved-solids transport in the main zone of the upper aquifer beneath the Lompoc plain. The flow and solute-transport models were calibrated to transient conditions for 1941-88. A steady-state simulation was made to provide initial conditions for the transient-state simulation by using long-term average (1941-88) recharge rates. Model- simulated hydraulic heads generally were within 5 feet of measured heads in the main zone for transient conditions. Model-simulated dissolved- solids concentrations for the main zone generally differed less than 200milligrams

Rehabilitation of children and infants with osteogenesis imperfecta. A program for ambulation.

Science.gov (United States)

Gerber, L H; Binder, H; Weintrob, J; Grange, D K; Shapiro, J; Fromherz, W; Berry, R; Conway, A; Nason, S; Marini, J

1990-02-01

Management of children and infants with osteogenesis imperfecta (OI) poses difficult decisions for pediatricians, orthopedists, and physiatrists. These children are frequently frail with disabling bone and joint deformities and fractures. In an eight-year cumulative management of 12 children with OI, a comprehensive program included strengthening exercises to the pelvic girdle and lower extremity muscles, in addition to pool exercises and molded seating to support upright posture. Long leg braces were fitted when the children were able to sit unsupported. All 12 were fitted with braces; nine were functional ambulators, and three were home ambulators. Six children required femoral plating or rodding, two of whom subsequently had the metal removed. Lower extremity fractures averaged one and one-half per year prior to bracing for nine children who had fractures. There was 0.83 fracture per year for the ten children who had fractures after bracing. The degree of femoral bowing increased in four, decreased in four, and remained unchanged in four, while the degree of tibial bowing increased in two, decreased in nine, and remained unchanged in one during the observation period. A comprehensive rehabilitation program and long leg bracing with surgical operations on the femur result in a high level of functional activity for children with OI with an acceptable level of risk for fracture.

75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

Science.gov (United States)

2010-10-12

... helicopter air ambulance operators implement a safety management system program that includes sound risk... partially address NTSB Safety Recommendation A-09-89 regarding the implementation of sound risk management... documents. Authority for This Rulemaking The FAA's authority to issue rules on aviation safety is found in...

The importance of manager support for the mental health and well-being of ambulance personnel.

Directory of Open Access Journals (Sweden)

Katherine Petrie

Full Text Available Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622. Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate and managers' observed behaviours (manager behaviour on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6% were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, p<0.01 and well-being (13%, p<0.01. Manager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, p<0.01 and well-being (10% of variance, p<0.05. The perceived importance management places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.

Multicomponent mass transport model: a model for simulating migration of radionuclides in ground water

International Nuclear Information System (INIS)

Washburn, J.F.; Kaszeta, F.E.; Simmons, C.S.; Cole, C.R.

1980-07-01

This report presents the results of the development of a one-dimensional radionuclide transport code, MMT2D (Multicomponent Mass Transport), for the AEGIS Program. Multicomponent Mass Transport is a numerical solution technique that uses the discrete-parcel-random-wald (DPRW) method to directly simulate the migration of radionuclides. MMT1D accounts for: convection;dispersion; sorption-desorption; first-order radioactive decay; and n-membered radioactive decay chains. Comparisons between MMT1D and an analytical solution for a similar problem show that: MMT1D agrees very closely with the analytical solution; MMT1D has no cumulative numerical dispersion like that associated with solution techniques such as finite differences and finite elements; for current AEGIS applications, relatively few parcels are required to produce adequate results; and the power of MMT1D is the flexibility of the code in being able to handle complex problems for which analytical solution cannot be obtained. Multicomponent Mass Transport (MMT1D) codes were developed at Pacific Northwest Laboratory to predict the movement of radiocontaminants in the saturated and unsaturated sediments of the Hanford Site. All MMT models require ground-water flow patterns that have been previously generated by a hydrologic model. This report documents the computer code and operating procedures of a third generation of the MMT series: the MMT differs from previous versions by simulating the mass transport processes in systems with radionuclide decay chains. Although MMT is a one-dimensional code, the user is referred to the documentation of the theoretical and numerical procedures of the three-dimensional MMT-DPRW code for discussion of expediency, verification, and error-sensitivity analysis

A low-cost transportable ground station for capture and processing of direct broadcast EOS satellite data

Science.gov (United States)

Davis, Don; Bennett, Toby; Short, Nicholas M., Jr.

1994-01-01

The Earth Observing System (EOS), part of a cohesive national effort to study global change, will deploy a constellation of remote sensing spacecraft over a 15 year period. Science data from the EOS spacecraft will be processed and made available to a large community of earth scientists via NASA institutional facilities. A number of these spacecraft are also providing an additional interface to broadcast data directly to users. Direct broadcast of real-time science data from overhead spacecraft has valuable applications including validation of field measurements, planning science campaigns, and science and engineering education. The success and usefulness of EOS direct broadcast depends largely on the end-user cost of receiving the data. To extend this capability to the largest possible user base, the cost of receiving ground stations must be as low as possible. To achieve this goal, NASA Goddard Space Flight Center is developing a prototype low-cost transportable ground station for EOS direct broadcast data based on Very Large Scale Integration (VLSI) components and pipelined, multiprocessing architectures. The targeted reproduction cost of this system is less than $200K. This paper describes a prototype ground station and its constituent components.

Technical support for GEIS: radioactive waste isolation in geologic formations. Volume 21. Ground water movement and nuclide transport

Energy Technology Data Exchange (ETDEWEB)

None

1978-04-01

This volume, TM-36/21 Ground Water Movement and Nuclide Transport, is one of a 23-volume series, ''Technical Support for GEIS: Radioactive Waste Isolation in Geologic Formations, Y/OWI/TM-36'' which supplements a ''Contribution to Draft Generic Environmental Impact Statement on Commercial Waste Management: Radioactive Waste Isolation in Geologic Formations, Y/OWI/TM-44.'' The series provides a more complete technical basis for the preconceptual designs, resource requirements, and environmental source terms associated with isolating commercial LWR wastes in underground repositories in salt, granite, shale and basalt. Wastes are considered from three fuel cycles: uranium and plutonium recycling of spent fuel and uranium-only recycling. The studies presented in this volume consider the effect of the construction of the repository and the consequent heat generation on the ground water movement. Additionally, the source concentrations and leach rates of selected radionuclides were studied in relation to the estimated ground water inflow rates. Studies were also performed to evaluate the long term migration of radionuclides as affected by the ground water flow. In all these studies, three geologic environments are considered; granite, shale and basalt.

Update of super-speed ground transportation technology development status and performance capabilities. CIGGT report No. 89-16

Energy Technology Data Exchange (ETDEWEB)

Hayes, W F

1990-01-01

This report presents an update of the Phase II assessment of development status and performance capabilities for four candidate super-speed ground transportation system alternatives for the Las Vegas-Southern California corridor. The four alternatives considered are the TGV wheel-on-rail technology, the Transrapid TR- 07 long-stator Electromagnetic Maglev (EMS) technology, the Japan Railways MLU Electrodynamic Maglev (EDS) technology, and the HSST Corp. HSST-400 short-stator Electromagnetic Maglev technology.

Feasibility of AmbulanCe-Based Telemedicine (FACT) Study : Safety, Feasibility and Reliability of Third Generation Ambulance Telemedicine

NARCIS (Netherlands)

Yperzeele, Laetitia; Van Hooff, Robbert-Jan; De Smedt, Ann; Espinoza, Alexis Valenzuela; Van Dyck, Rita; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; Lauwaert, Door; De Keyser, Jacques; Brouns, Raf

2014-01-01

Background: Telemedicine is currently mainly applied as an in-hospital service, but this technology also holds potential to improve emergency care in the prehospital arena. We report on the safety, feasibility and reliability of in-ambulance teleconsultation using a telemedicine system of the third

Body weight-supported bedside treadmill training facilitates ambulation in ICU patients: An interventional proof of concept study

NARCIS (Netherlands)

Sommers, Juultje; Wieferink, Denise C.; Dongelmans, Dave A.; Nollet, Frans; Engelbert, Raoul H. H.; van der Schaaf, Marike

2017-01-01

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

Peripubertal castration of male rats, adult open field ambulation and partner preference behavior.

Science.gov (United States)

Brand, T; Slob, A K

1988-09-15

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.

A mathematical model for efficient emergency transportation in a disaster situation.

Science.gov (United States)

Tlili, Takwa; Abidi, Sofiene; Krichen, Saoussen

2018-01-29

This work focuses on a real-life patient transportation problem derived from emergency medical services (EMS), whereby providing ambulatory service for emergency requests during disaster situations. Transportation of patients in congested traffic compounds already time sensitive treatment. An urgent situation is defined as individuals with major or minor injuries requiring EMS assistance simultaneously. Patients are either (1) slightly injured and treated on site or (2) are seriously injured and require transfer to points of care (PoCs). This paper will discuss enhancing the response-time of EMS providers by improving the ambulance routing problem (ARP). A genetic based algorithm is proposed to efficiently guide the ARP while simultaneously solving two scenarios. Copyright © 2018. Published by Elsevier Inc.

Optimizing the design of large-scale ground-coupled heat pump systems using groundwater and heat transport modeling

Energy Technology Data Exchange (ETDEWEB)

Fujii, H.; Itoi, R.; Fujii, J. [Kyushu University, Fukuoka (Japan). Faculty of Engineering, Department of Earth Resources Engineering; Uchida, Y. [Geological Survey of Japan, Tsukuba (Japan)

2005-06-01

In order to predict the long-term performance of large-scale ground-coupled heat pump (GCHP) systems, it is necessary to take into consideration well-to-well interference, especially in the presence of groundwater flow. A mass and heat transport model was developed to simulate the behavior of this type of system in the Akita Plain, northern Japan. The model was used to investigate different operational schemes and to maximize the heat extraction rate from the GCHP system. (author)

Simulation of ground-water flow and solute transport in the Glen Canyon aquifer, East-Central Utah

Science.gov (United States)

Freethey, Geoffrey W.; Stolp, Bernard J.

2010-01-01

The extraction of methane from coal beds in the Ferron coal trend in central Utah started in the mid-1980s. Beginning in 1994, water from the extraction process was pressure injected into the Glen Canyon aquifer. The lateral extent of the aquifer that could be affected by injection is about 7,600 square miles. To address regional-scale effects of injection over a decadal time frame, a conceptual model of ground-water movement and transport of dissolved solids was formulated. A numerical model that incorporates aquifer concepts was then constructed and used to simulate injection.The Glen Canyon aquifer within the study area is conceptualized in two parts—an active area of ground-water flow and solute transport that exists between recharge areas in the San Rafael Swell and Desert, Waterpocket Fold, and Henry Mountains and discharge locations along the Muddy, Dirty Devil, San Rafael, and Green Rivers. An area of little or negligible ground-water flow exists north of Price, Utah, and beneath the Wasatch Plateau. Pressurized injection of coal-bed methane production water occurs in this area where dissolved-solids concentrations can be more than 100,000 milligrams per liter. Injection has the potential to increase hydrologic interaction with the active flow area, where dissolved-solids concentrations are generally less than 3,000 milligrams per liter.Pressurized injection of coal-bed methane production water in 1994 initiated a net addition of flow and mass of solutes into the Glen Canyon aquifer. To better understand the regional scale hydrologic interaction between the two areas of the Glen Canyon aquifer, pressurized injection was numerically simulated. Data constraints precluded development of a fully calibrated simulation; instead, an uncalibrated model was constructed that is a plausible representation of the conceptual flow and solute-transport processes. The amount of injected water over the 36-year simulation period is about 25,000 acre-feet. As a result

Review of ground-water flow and transport models in the unsaturated zone

Energy Technology Data Exchange (ETDEWEB)

Oster, C.A.

1982-11-01

Models of partially saturated flow and transport in porous media have application in the analysis of existing as well as future low-level radioactive waste facilities located above the water table. An extensive literature search along with telephone and mail correspondence with recognized leading experts in the field, was conducted to identify computer models suitable for studies of low-level radioactive waste facilities located in the unsaturated zone. Fifty-five existing models were identified as potentially useful. Ten of these models were selected for further examination. This report contains a statement of the ground-water flow-contaminant transport problem, a discussion of those methods used to reduce the physical problem to a computer model, a brief discussion about the data requirements of these models. The procedure used to select the ten codes for further discussion is given, along with a list of these models. Finally, the Appendices contain the data about the fifty-five codes examined. Specifically Appendix D contains the detailed discussion of each of the ten selected codes. Included in each discussion are such items which a potential user requires in determining whether the code is suitable for his applications. Appendix E contains brief summary information about each of the fifty-five codes. Included in the summaries are identification data, authors, pertinent references, and model type.

Review of ground-water flow and transport models in the unsaturated zone

International Nuclear Information System (INIS)

Oster, C.A.

1982-11-01

Models of partially saturated flow and transport in porous media have application in the analysis of existing as well as future low-level radioactive waste facilities located above the water table. An extensive literature search along with telephone and mail correspondence with recognized leading experts in the field, was conducted to identify computer models suitable for studies of low-level radioactive waste facilities located in the unsaturated zone. Fifty-five existing models were identified as potentially useful. Ten of these models were selected for further examination. This report contains a statement of the ground-water flow-contaminant transport problem, a discussion of those methods used to reduce the physical problem to a computer model, a brief discussion about the data requirements of these models. The procedure used to select the ten codes for further discussion is given, along with a list of these models. Finally, the Appendices contain the data about the fifty-five codes examined. Specifically Appendix D contains the detailed discussion of each of the ten selected codes. Included in each discussion are such items which a potential user requires in determining whether the code is suitable for his applications. Appendix E contains brief summary information about each of the fifty-five codes. Included in the summaries are identification data, authors, pertinent references, and model type

Action observation training of community ambulation for improving walking ability of patients with post-stroke hemiparesis: a randomized controlled pilot trial.

Science.gov (United States)

Park, Hyun-Ju; Oh, Duck-Won; Choi, Jong-Duk; Kim, Jong-Man; Kim, Suhn-Yeop; Cha, Yong-Jun; Jeon, Su-Jin

2017-08-01

To investigate the effects of action observation training involving community-based ambulation for improving walking ability after stroke. Randomized, controlled pilot study. Inpatient rehabilitation hospital. A total of 25 inpatients with post-stroke hemiparesis were randomly assigned to either the experimental group ( n = 12) or control group ( n = 13). Subjects of the experimental group watched video clips demonstrating four-staged ambulation training with a more complex environment factor for 30 minutes, three times a week for four weeks. Meanwhile, subjects of the control group watched video clips, which showed different landscape pictures. Walking function was evaluated before and after the four-week intervention using a 10-m walk test, community walk test, activities-specific balance confidence scale, and spatiotemporal gait measures. Changes in the values for the 10-m walk test (0.17 ±0.19 m/s vs. 0.05 ±0.08 m/s), community walk test (-151.42 ±123.82 seconds vs. 67.08 ±176.77 seconds), and activities-specific balance confidence (6.25 ±5.61 scores vs. 0.72 ±2.24 scores) and the spatiotemporal parameters (i.e. stride length (19.00 ±11.34 cm vs. 3.16 ±11.20 cm), single support (5.87 ±5.13% vs. 0.25 ±5.95%), and velocity (15.66 ±12.34 cm/s vs. 2.96 ±10.54 cm/s)) indicated a significant improvement in the experimental group compared with the control group. In the experimental group, walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the control group showed a significant difference only in the 10-m walk test. Action observation training of community ambulation may be favorably used for improving walking function of patients with post-stroke hemiparesis.

A Systems Approach to Developing an Affordable Space Ground Transportation Architecture using a Commonality Approach

Science.gov (United States)

Garcia, Jerry L.; McCleskey, Carey M.; Bollo, Timothy R.; Rhodes, Russel E.; Robinson, John W.

2012-01-01

This paper presents a structured approach for achieving a compatible Ground System (GS) and Flight System (FS) architecture that is affordable, productive and sustainable. This paper is an extension of the paper titled "Approach to an Affordable and Productive Space Transportation System" by McCleskey et al. This paper integrates systems engineering concepts and operationally efficient propulsion system concepts into a structured framework for achieving GS and FS compatibility in the mid-term and long-term time frames. It also presents a functional and quantitative relationship for assessing system compatibility called the Architecture Complexity Index (ACI). This paper: (1) focuses on systems engineering fundamentals as it applies to improving GS and FS compatibility; (2) establishes mid-term and long-term spaceport goals; (3) presents an overview of transitioning a spaceport to an airport model; (4) establishes a framework for defining a ground system architecture; (5) presents the ACI concept; (6) demonstrates the approach by presenting a comparison of different GS architectures; and (7) presents a discussion on the benefits of using this approach with a focus on commonality.

Occupational accidents among ambulance drivers in the emergency relief.

Science.gov (United States)

Takeda, Elisabete; do Carmo Cruz Robazzi, Maria Lúcia

2007-01-01

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.

PRE-HOSPITAL EMERGENCY CARE IN SWEDEN

Directory of Open Access Journals (Sweden)

Ulf BJÖRNSTIG

2004-01-01

In Sweden (9 million inhabitants, a sparsely populated country with sometimes long transportation distances to the nearest trauma hospital, 800 ambulances, 7 ambulance helicopters and 3–5 fixed wing ambulance aircraft are the available transport resources. In case of a mass casualty or disaster situation, inside or outside the country, a governmental project (Swedish National Medevac aims to convert a passenger aircraft from Scandinavian Airlines System (SAS to a qualified medical resource for long distance transport, with capacity to nurse six intensive care patients and an additional 6–20 lieing or seated patients during transport.

Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

OpenAIRE

Langabeer, James R.; Gonzalez, Michael; Alqusairi, Diaa; Champagne-Langabeer, Tiffany; Jackson, Adria; Mikhail, Jennifer; Persse, David

2016-01-01

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. T...

Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

OpenAIRE

Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.

2013-01-01

Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional st...

Task-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review.

Science.gov (United States)

Toovey, Rachel; Bernie, Charmaine; Harvey, Adrienne R; McGinley, Jennifer L; Spittle, Alicia J

2017-01-01

The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. Systematic review. Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, pmotor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. PROSPERO ID42016036727.

Seasonal associations and atmospheric transport distances of Fusarium collected with unmanned aerial vehicles and ground-based sampling devices

Science.gov (United States)

Schmale, David; Ross, Shane; Lin, Binbin

2014-05-01

Spores of fungi in the genus Fusarium may be transported through the atmosphere over long distances. Members of this genus are important pathogens and mycotoxin producers. New information is needed to characterize seasonal trends in atmospheric loads of Fusarium and to pinpoint the source(s) of inoculum at both local (farm) and regional (state or country) scales. Spores of Fusarium were collected from the atmosphere in an agricultural ecosystem in Blacksburg, VA, USA using a Burkard volumetric sampler (BVS) 1 m above ground level and autonomous unmanned aerial vehicles (UAVs) 100 m above ground level. More than 2,200 colony forming units (CFUs) of Fusarium were collected during 104 BVS sampling periods and 180 UAV sampling periods over four calendar years (2009-2012). Spore concentrations ranged from 0 to 13 and 0 to 23 spores m-3 for the BVS and the UAVs, respectively. Spore concentrations were generally higher in the fall, spring, and summer, and lower in the winter. Spore concentrations from the BVS were generally higher than those from the UAVs for both seasonal and hourly collections. Some of the species of Fusarium identified from our collections have not been previously reported in the state of Virginia. A Gaussian plume transport model was used to estimate distances to the potential inoculum source(s) by season. This work extends previous studies showing an association between atmospheric transport barriers (Lagrangian coherent structures or LCSs) and the movement of Fusarium in the lower atmosphere. An increased understanding of the aerobiology of Fusarium may contribute to new and improved control strategies for diseases causes by fusaria in the future.

The role of moisture transport between ground and atmosphere in global change

International Nuclear Information System (INIS)

Rind, D.; Rosenzweig, C.; Stieglitz, M.

1997-01-01

Projections of the effect of climate change on future water availability are examined by reviewing the formulations used to calculate moisture transport between the ground and the atmosphere. General circulation models and climate change impact models have substantially different formulations for evapotranspiration, so their projections of future water availability often disagree, even though they use the same temperature and precipitation forecasts. General circulation models forecast little change in tropical and subtropical water availability, while impact models show severe water and agricultural shortages. A comparison of observations and modeling techniques shows that the parameterizations in general circulation models likely lead to an underestimate of the impacts of global warming on soil moisture and vegetation. Such errors would crucially affect the temperature and precipitation forecasts used in impact models. Some impact model evaporation formulations are probably more appropriate than those in general circulation models, but important questions remain. More observations are needed, especially in the vicinity of forests, to determine appropriate parameterizations

Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

Science.gov (United States)

Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

2012-01-01

Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers

14 CFR 415.117 - Ground safety.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Ground safety. 415.117 Section 415.117... TRANSPORTATION LICENSING LAUNCH LICENSE Safety Review and Approval for Launch of an Expendable Launch Vehicle From a Non-Federal Launch Site § 415.117 Ground safety. (a) General. An applicant's safety review...

Living in critical times: The impact of critical incidents on frontline ambulance personnel--a qualitative perspective.

LENUS (Irish Health Repository)

Gallagher, Sharon

2007-01-01

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.

Referral to the Hospital And Emergency Ambulance Service Uses Patterns of the Inmates and Convicts

Directory of Open Access Journals (Sweden)

Emine Oncu

2014-03-01

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.

Low-Speed Stability-and-Control and Ground-Effects Measurements on the Industry Reference High Speed Civil Transport

Science.gov (United States)

Kemmerly, Guy T.; Campbell, Bryan A.; Banks, Daniel W.; Yaros, Steven F.

1999-01-01

As a part of a national effort to develop an economically feasible High Speed Civil Transport (HSCT), a single configuration has been accepted as the testing baseline by the organizations working in the High Speed Research (HSR) program. The configuration is based on a design developed by the Boeing Company and is referred to as the Reference H (Ref H). The data contained in this report are low-speed stability-and-control and ground-effect measurements obtained on a 0.06 scale model of the Ref H in a subsonic tunnel.

Long-range transport of dust aerosols over the Arabian Sea and Indian region – A case study using satellite data and ground-based measurements

Digital Repository Service at National Institute of Oceanography (India)

Badarinath, K.V.S.; Kharol, S.K.; Kaskaoutis, D.G.; Sharma, A; Ramaswamy, V.; Kambezidis, H.D.

The present study addresses an intense dust storm event over the Persian Gulf and the Arabian Sea (AS) region and its transport over the Indian subcontinent using multi-satellite observations and ground-based measurements. A time series of Indian...

Profile of the horizontal wind variance near the ground in near neutral flow – K-theory and the transport of the turbulent kinetic energy

Directory of Open Access Journals (Sweden)

S. Yahaya

2009-05-01

Full Text Available This paper deals with the characteristics of the atmospheric turbulent flow in the vicinity of the ground, and particularly with the profile of the horizontal wind variance. The study is based on experimental measurements performed with fast cup anemometers located near the ground at 5 different levels (from 0.25 to 4 m and sampled at 1 Hz. The experiment was carried over two agricultural plots with various tillage treatments in a fallow semiarid area (Central Aragon, Spain. The results of this study reveal that near the ground surface and under moderate wind, the horizontal wind variance logarithmically increases with height, in direct relationship with the friction velocity and the roughness length scale. A theoretical development has allowed us to link this behaviour to the modeling of the turbulent kinetic energy (TKE transport through the eddy diffusivity. Thus, the study proposes a formulation of the similarity universal function of the horizontal wind variance. Besides, the formulation offers a new method for the determination of the friction velocity and the roughness length scale and can be used for the evaluation of the TKE transport rate.

Characterization of the Hanford 300 Area Burial Grounds. Task III: fluid transport and modeling

International Nuclear Information System (INIS)

Gee, G.W.; Simmons, C.S.

1979-08-01

In Task III, Fluid Transport and Modeling, a computer model was developed and applied to the 300 Area Burial Grounds to analyze the influence of potential evaporation and rainfall patterns on drainage. The model describes one-dimensional unsaturated flow. Fluid transport equations were evaluated to describe the driving forces of fluid flow. The data indicate that the major processes are evaporative drying, capillarity, and gravity flow. Thermally induced transport does not appear significant in the subsurface sediments of the area. Several empirical evaporation methods are available for assessing potential evaporation/evapotranspiration. Four methods were used with the unsaturated flow model. Ultimately, the Blaney-Criddle method was chosen for subsequent simulation examples because it relies only on the climatic data available and gave results comparable to the other methods tested. Simulations showed that a dry layer formation is important in controlling the soil-water balance in the profile. The surface dry layer acts as a mulch to retard the evaporative water losses and increase water storage. The most important climatic factor in determining drainage appears to be yearly rainfall distribution. When rainfall is distributed in fall or winter, during periods of low potential evaporation, both water storage and drainage are increased. Summer showers, on the other hand, were shown to add little to the annual water storage. Rainfall occurring in one year influences the subsequent annual drainage for several succeeding years because of annual changes in water storage capacity and the transient nature of unsaturated flow in the storage zone. 47 figures, 9 tables

Transonic and supersonic ground effect aerodynamics

Science.gov (United States)

Doig, G.

2014-08-01

A review of recent and historical work in the field of transonic and supersonic ground effect aerodynamics has been conducted, focussing on applied research on wings and aircraft, present and future ground transportation, projectiles, rocket sleds and other related bodies which travel in close ground proximity in the compressible regime. Methods for ground testing are described and evaluated, noting that wind tunnel testing is best performed with a symmetry model in the absence of a moving ground; sled or rail testing is ultimately preferable, though considerably more expensive. Findings are reported on shock-related ground influence on aerodynamic forces and moments in and accelerating through the transonic regime - where force reversals and the early onset of local supersonic flow is prevalent - as well as more predictable behaviours in fully supersonic to hypersonic ground effect flows.

Comparing population and incident data for optimal air ambulance base locations in Norway.

Science.gov (United States)

Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Uleberg, Oddvar; Aardal, Karen; van Essen, J Theresia

2018-05-24

Helicopter emergency medical services are important in many health care systems. Norway has a nationwide physician manned air ambulance service servicing a country with large geographical variations in population density and incident frequencies. The aim of the study was to compare optimal air ambulance base locations using both population and incident data. We used municipality population and incident data for Norway from 2015. The 428 municipalities had a median (5-95 percentile) of 4675 (940-36,264) inhabitants and 10 (2-38) incidents. Optimal helicopter base locations were estimated using the Maximal Covering Location Problem (MCLP) optimization model, exploring the number and location of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, in green field scenarios and conditioned on the existing base structure. The existing bases covered 96.90% of the population and 91.86% of the incidents for time threshold 45 min. Correlation between municipality population and incident frequencies was -0.0027, and optimal base locations varied markedly between the two data types, particularly when lowering the target time. The optimal solution using population density data put focus on the greater Oslo area, where one third of Norwegians live, while using incident data put focus on low population high incident areas, such as northern Norway and winter sport resorts. Using population density data as a proxy for incident frequency is not recommended, as the two data types lead to different optimal base locations. Lowering the target time increases the sensitivity to choice of data.

Coupling the effect of mental practice and Pilates on ambulation of individuals with multiple sclerosis: Five case studies

Directory of Open Access Journals (Sweden)

Darshpreet Kaur

2016-01-01

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.

Grounding transport planning on principles of social justice

NARCIS (Netherlands)

Martens, C.J.C.M.

2006-01-01

Transport modeling and cost-bene?t analysis are two key tools used in trans-port planning. Both tools have been adapted substantially to cope with thechallenges posed by the goal of sustainable development. However, the changeshave primarily focused on the negative environmental impacts of the

Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

Science.gov (United States)

Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

2014-01-01

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

A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment.

Directory of Open Access Journals (Sweden)

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

A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment.

Science.gov (United States)

Le Moing, Anne-Gaëlle; Seferian, Andreea Mihaela; Moraux, Amélie; Annoussamy, Mélanie; Dorveaux, Eric; Gasnier, Erwan; Hogrel, Jean-Yves; Voit, Thomas; Vissière, David; Servais, Laurent

2016-01-01

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. ClinicalTrials.gov NCT

Exchange of moisture between atmosphere and ground regarding tritium transfer

International Nuclear Information System (INIS)

Bunnenberg, C.

1980-09-01

Two measuring equipment have been developed in the framework of this study which fulfill important conditions to avoid microclimatic interferences during measurement by using site-specific ground samples and embedding these in the ground surface. The beta-absorption lysimeter allows the detection of a minimum deposit height of 0.001 mm in a 1 mm sample layer. The conductivity moisture probe is to measure the moisture diffusion within the first 80 mm of the upper ground with a vertical spacial resolution of 2 mm. It is possible to measure a minimum water content increase of 0.02 wt% per 2 mm ground layer using this probe. The influences of single microclimatic parameter on condensation and evaporation were investigated and a transport equation was developed. Investigations in the Negev proved the application ability of the measuring equipment. The application of the transport equation showed very good agreement with the measured values. When the ground surface starts to cool in the afternoon, there is a countercurrent moisture transport from the atmosphere and the deeper ground layers which lead to a higher water content in the upper ground layer. At about 50 mm depth there is an overlapping layer of the two moisture flows which remains almost constant over the 24 h cycle. This exchange zone of atmospheric humidity and ground water must be paid great attention with regard to HTO transfer. (orig./HP) [de

Residence times and nitrate transport in ground water discharging to streams in the Chesapeake Bay Watershed

Science.gov (United States)

Lindsey, Bruce D.; Phillips, Scott; Donnelly, Colleen A.; Speiran, Gary K.; Plummer, Niel; Bohlke, John Karl; Focazio, Michael J.; Burton, William C.; Busenberg, Eurybiades

2003-01-01

One of the major water-quality problems in the Chesapeake Bay is an overabundance of nutrients from the streams and rivers that discharge to the Bay. Some of these nutrients are from nonpoint sources such as atmospheric deposition, agricultural manure and fertilizer, and septic systems. The effects of efforts to control nonpoint sources, however, can be difficult to quantify because of the lag time between changes at the land surface and the response in the base-flow (ground water) component of streams. To help resource managers understand the lag time between implementation of management practices and subsequent response in the nutrient concentrations in the base-flow component of streamflow, a study of ground-water discharge, residence time, and nitrate transport in springs throughout the Chesapeake Bay Watershed and in four smaller watersheds in selected hydrogeomorphic regions (HGMRs) was conducted. The four watersheds were in the Coastal Plain Uplands, Piedmont crystalline, Valley and Ridge carbonate, and Valley and Ridge siliciclastic HGMRs.A study of springs to estimate an apparent age of the ground water was based on analyses for concentrations of chlorofluorocarbons in water samples collected from 48 springs in the Chesapeake Bay Watershed. Results of the analysis indicate that median age for all the samples was 10 years, with the 25th percentile having an age of 7 years and the 75th percentile having an age of 13 years. Although the number of samples collected in each HGMR was limited, there did not appear to be distinct differences in the ages between the HGMRs. The ranges were similar between the major HGMRs above the Fall Line (modern to about 50 years), with only two HGMRs of small geographic extent (Piedmont carbonate and Mesozoic Lowland) having ranges of modern to about 10 years. The median values of all the HGMRs ranged from 7 to 11 years. Not enough samples were collected in the Coastal Plain for comparison. Spring samples showed slightly younger

Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty

DEFF Research Database (Denmark)

Jenstrup, M T; Jæger, P; Lund, J

2012-01-01

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 hypothe...... 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.......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...

Seasonal associations and atmospheric transport distances of fungi in the genus Fusarium collected with unmanned aerial vehicles and ground-based sampling devices

Science.gov (United States)

Lin, Binbin; Ross, Shane D.; Prussin, Aaron J.; Schmale, David G.

2014-09-01

Spores of fungi in the genus Fusarium may be transported through the atmosphere over long distances. New information is needed to characterize seasonal trends in atmospheric loads of Fusarium and to pinpoint the source(s) of inoculum at both local (farm) and regional (state or country) scales. We hypothesized that (1) atmospheric concentrations of Fusarium spores in an agricultural ecosystem vary with height and season and (2) transport distances from potential inoculum source(s) vary with season. To test these hypotheses, spores of Fusarium were collected from the atmosphere in an agricultural ecosystem in Blacksburg, VA, USA using a Burkard volumetric sampler (BVS) 1 m above ground level and autonomous unmanned aerial vehicles (UAVs) 100 m above ground level. More than 2200 colony forming units (CFUs) of Fusarium were collected during 104 BVS sampling periods and 180 UAV sampling periods over four calendar years (2009-2012). Spore concentrations ranged from 0 to 13 and 0 to 23 spores m-3 for the BVS and the UAVs, respectively. Spore concentrations were generally higher in the fall, spring, and summer, and lower in the winter. Spore concentrations from the BVS were generally higher than those from the UAVs for both seasonal and hourly collections. A Gaussian plume transport model was used to estimate distances to the potential inoculum source(s) by season, and produced mean transport distances of 1.4 km for the spring, 1.7 km for the summer, 1.2 km for the fall, and 4.1 km for the winter. Environmental signatures that predict atmospheric loads of Fusarium could inform disease spread, air pollution, and climate change.

The Effect of Older Age on EMS Use for Transportation to an Emergency Department.

Science.gov (United States)

Jones, Courtney M C; Wasserman, Erin B; Li, Timmy; Amidon, Ashley; Abbott, Marissa; Shah, Manish N

2017-06-01

Introduction Previous studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied. Hypothesis/Problem This study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables. A cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival. Data from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adultstransportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults. Jones CMC , Wasserman EB , Li T , Amidon A , Abbott M , Shah MN . The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261-268.

Regional-scale modeling of near-ground ozone in the Central East China, source attributions and an assessment of outflow to East Asia The role of regional-scale transport during MTX2006

Science.gov (United States)

Li, J.; Wang, Z.; Akimoto, H.; Yamaji, K.; Takigawa, M.; Pochanart, P.; Liu, Y.; Kanaya, Y.

2008-07-01

A 3-D regional chemical transport model, the Nested Air Quality Prediction Model System (NAQPMS), with an on-line tracer tagging module was applied to study the source of the near-ground (pollutants. In particular, the model captured highly polluted and clean cases well. The simulated near-ground ozone over CEC is 60 85 ppbv (parts per billion by volume), higher than those (20 50 ppbv) in Japan and over the North Pacific. The simulated tagged tracer indicates that the regional-scale transport of chemically produced ozone over other areas in CEC contributes to the most fractions (49%) of the near-ground mean ozone at Mt. Tai in June, rather than the in-situ photochemistry (12%). Due to high anthropogenic and biomass burning emissions, the contributions of the ground ozone from the southern part of CEC plays the most important role (32.4 ppbv, 37.9% of total ozone) in the monthly mean ozone concentration at Mt. Tai, which even reached 59 ppbv (62%) on 6 7 June 2006. The monthly mean horizontal distribution of chemically produced ozone from various source regions indicates that the spatial distribution of O3 over CEC is controlled by the photochemical reactions. In addition, the regional-scale transport of pollutants also plays an important role in the spatial and temporal distribution of ozone over CEC. The chemically produced ozone from the southern part of the study region can be transported northeastwardly to the northern rim of CEC. The mean contribution is 5 10 ppbv, and it can reach 25 ppbv during high ozone events. This work also studied the outflow of CEC ozone and its precursors, as well as their influences and contributions to the ozone level over adjacent regions/countries. It shows that the contribution of CEC ozone to mean ozone mixing ratios over Korea Peninsula and Japan is 5 15 ppbv, of which about half was due to the direct transport of ozone from CEC and half was contributed by the ozone produced locally by the transported ozone precursors from CEC.

Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment.

Science.gov (United States)

Simonsen, Sofie Amalie; Andresen, Morten; Michelsen, Lene; Viereck, Søren; Lippert, Freddy K; Iversen, Helle Klingenberg

2014-11-13

Effective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009. We performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch of the ambulance to arrival at the scene, on-scene time and transport time to the hospital-in total, alarm-to-door time. In addition, we noted baseline characteristics. We reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33-52), of which 18 (12-24) minutes were spent on scene. Response time was reduced from the period before to the period after reorganization (7 vs. 5 minutes, p <0.001). In a linear multiple regression model, higher patient age and longer distance to the hospital correlated with significantly longer transportation time (p <0.001). This study shows an unchanged alarm-to-door time of 41 minutes over a five-year period. Response time, but not total alarm-to-door time, was reduced during the five years. On-scene time constituted nearly half of the total alarm-to-door time and is thus a point of focus for improvement.

Measurement of ground motion in various sites

International Nuclear Information System (INIS)

Bialowons, W.; Amirikas, R.; Bertolini, A.; Kruecker, D.

2007-04-01

Ground vibrations may affect low emittance beam transport in linear colliders, Free Electron Lasers (FEL) and synchrotron radiation facilities. This paper is an overview of a study program to measure ground vibrations in various sites which can be used for site characterization in relation to accelerator design. Commercial broadband seismometers have been used to measure ground vibrations and the resultant database is available to the scientific community. The methodology employed is to use the same equipment and data analysis tools for ease of comparison. This database of ground vibrations taken in 19 sites around the world is first of its kind. (orig.)

Integrated Suit Test 1 - A Study to Evaluate Effects of Suit Weight, Pressure, and Kinematics on Human Performance during Lunar Ambulation

Science.gov (United States)

Gernhardt, Michael L.; Norcross, Jason; Vos, Jessica R.

2008-01-01

In an effort to design the next generation Lunar suit, NASA has initiated a series of tests aimed at understanding the human physiological and biomechanical affects of space suits under a variety of conditions. The first of these tests was the EVA Walkback Test (ICES 2007-01-3133). NASA-JSC assembled a multi-disciplinary team to conduct the second test of the series, titled Integrated Suit Test 1 (IST-1), from March 6 through July 24, 2007. Similar to the Walkback Test, this study was performed with the Mark III (MKIII) EVA Technology Demonstrator suit, a treadmill, and the Partial Gravity Simulator in the Space Vehicle Mock-Up Facility at Johnson Space Center. The data collected for IST-1 included metabolic rates, ground reaction forces, biomechanics, and subjective workload and controllability feedback on both suited and unsuited (shirt-sleeve) astronaut subjects. For IST-1 the center of gravity was controlled to a nearly perfect position while the weight, pressure and biomechanics (waist locked vs. unlocked) were varied individually to evaluate the effects of each on the ability to perform level (0 degree incline) ambulation in simulated Lunar gravity. The detailed test methodology and preliminary key findings of IST-1 are summarized in this report.

Effect of Planned Early Recommended Ambulation Technique on Selected Post caesarean Biophysiological Health Parameters

Directory of Open Access Journals (Sweden)

Jyoti V. Dube

2014-01-01

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

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

Science.gov (United States)

Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O

2014-06-01

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

Body weight-supported bedside treadmill training facilitates ambulation in ICU patients: An interventional proof of concept study.

Science.gov (United States)

Sommers, Juultje; Wieferink, Denise C; Dongelmans, Dave A; Nollet, Frans; Engelbert, Raoul H H; van der Schaaf, Marike

2017-10-01

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.

Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik

2006-01-01

fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. MAIN OUTCOME MEASURE: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental......OBJECTIVE: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. DESIGN: Prospective, descriptive study. SETTING: An orthopaedic hip fracture unit in a university hospital. PATIENTS: Four hundred and twenty-six consecutive hip...... of short-term postoperative outcome after hip fracture surgery....

Accident Management System Based on Vehicular Network for an Intelligent Transportation System in Urban Environments

Directory of Open Access Journals (Sweden)

Yusor Rafid Bahar Al-Mayouf

2018-01-01

Full Text Available As cities across the world grow and the mobility of populations increases, there has also been a corresponding increase in the number of vehicles on roads. The result of this has been a proliferation of challenges for authorities with regard to road traffic management. A consequence of this has been congestion of traffic, more accidents, and pollution. Accidents are a still major cause of death, despite the development of sophisticated systems for traffic management and other technologies linked with vehicles. Hence, it is necessary that a common system for accident management is developed. For instance, traffic congestion in most urban areas can be alleviated by the real-time planning of routes. However, the designing of an efficient route planning algorithm to attain a globally optimal vehicle control is still a challenge that needs to be solved, especially when the unique preferences of drivers are considered. The aim of this paper is to establish an accident management system that makes use of vehicular ad hoc networks coupled with systems that employ cellular technology in public transport. This system ensures the possibility of real-time communication among vehicles, ambulances, hospitals, roadside units, and central servers. In addition, the accident management system is able to lessen the amount of time required to alert an ambulance that it is required at an accident scene by using a multihop optimal forwarding algorithm. Moreover, an optimal route planning algorithm (ORPA is proposed in this system to improve the aggregate spatial use of a road network, at the same time bringing down the travel cost of operating a vehicle. This can reduce the incidence of vehicles being stuck on congested roads. Simulations are performed to evaluate ORPA, and the results are compared with existing algorithms. The evaluation results provided evidence that ORPA outperformed others in terms of average ambulance speed and travelling time. Finally, our

Longitudinal effect of eteplirsen versus historical control on ambulation in Duchenne muscular dystrophy

Science.gov (United States)

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

2016-01-01

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

Radiation exposure during air and ground transportation

International Nuclear Information System (INIS)

Hsu, P.C.; Weng, P.S.

1976-01-01

The results of a one year study program of radiation exposure experienced on both domestic and international flights of the China Airline and the Far East Airline in the Pacific, Southeast Asia and Taiwan areas and on trains and buses on Taiwan island are reported. CaSO 4 :Dy thermoluminescent dosimeters were used. It has been shown that transit exposures may amount to 10 times that on the ground with an altitude varying from 3,050 to 12,200 m. (U.K.)

Anticipatory kinematics and muscle activity preceding transitions from level-ground walking to stair ascent and descent.

Science.gov (United States)

Peng, Joshua; Fey, Nicholas P; Kuiken, Todd A; Hargrove, Levi J

2016-02-29

The majority of fall-related accidents are during stair ambulation-occurring commonly at the top and bottom stairs of each flight, locations in which individuals are transitioning to stairs. Little is known about how individuals adjust their biomechanics in anticipation of walking-stair transitions. We identified the anticipatory stride mechanics of nine able-bodied individuals as they approached transitions from level ground walking to stair ascent and descent. Unlike prior investigations of stair ambulation, we analyzed two consecutive "anticipation" strides preceding the transitions strides to stairs, and tested a comprehensive set of kinematic and electromyographic (EMG) data from both the leading and trailing legs. Subjects completed ten trials of baseline overground walking and ten trials of walking to stair ascent and descent. Deviations relative to baseline were assessed. Significant changes in mechanics and EMG occurred in the earliest anticipation strides analyzed for both ascent and descent transitions. For stair descent, these changes were consistent with observed reductions in walking speed, which occurred in all anticipation strides tested. For stair ascent, subjects maintained their speed until the swing phase of the latest anticipation stride, and changes were found that would normally be observed for decreasing speed. Given the timing and nature of the observed changes, this study has implications for enhancing intent recognition systems and evaluating fall-prone or disabled individuals, by testing their abilities to sense upcoming transitions and decelerate during locomotion. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

Directory of Open Access Journals (Sweden)

M Kit Delgado

2013-09-01

Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.

Effects of Weather and Heliophysical Conditions on Emergency Ambulance Calls for Elevated Arterial Blood Pressure

Directory of Open Access Journals (Sweden)

Jone Vencloviene

2015-02-01

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.

Ground-water monitoring and modeling at the Hanford Site

International Nuclear Information System (INIS)

Mitchell, P.J.; Freshley, M.D.

1987-01-01

The ground-water monitoring program at the Hanford Site in southeastern Washington State is continually evolving in response to changing operations at the site, changes in the ground-water flow system, movement of the constituents in the aquifers, and regulatory requirements. Sampling and analysis of ground water, along with ground-water flow and solute transport modeling are used to evaluate the movement and resulting distributions of radionuclides and hazardous chemical constituents in the unconfined aquifer. Evaluation of monitoring results, modeling, and information on waste management practices are being combined to continually improve the network of ground-water monitoring wells at the site

Ground-water monitoring and modeling at the Hanford Site

International Nuclear Information System (INIS)

Mitchell, P.J.; Freshley, M.D.

1987-01-01

The ground-water monitoring program at the Hanford Site in southeastern Washington State is continually evolving in response to changing operations at the site, changes in the ground-water flow system, movement of the constituents in the aquifers, and regulatory requirements. Sampling and analysis of ground water, along with ground-water flow and solute transport modeling are used ito evaluate the movement and resulting distributions of radionuclides and hazardous chemical constituents in the unconfined aquifer. Evaluation of monitoring results, modeling, and information on waste management practices are being combined to continually improve the network of ground-water monitoring wells at the site

Biodiesel Production from Spent Coffee Grounds

Science.gov (United States)

Blinová, Lenka; Bartošová, Alica; Sirotiak, Maroš

2017-06-01

The residue after brewing the spent coffee grounds is an oil-containing waste material having a potential of being used as biodiesel feedstock. Biodiesel production from the waste coffee grounds oil involves collection and transportation of coffee residue, drying, oil extraction, and finally production of biodiesel. Different methods of oil extraction with organic solvents under different conditions show significant differences in the extraction yields. In the manufacturing of biodiesel from coffee oil, the level of reaction completion strongly depends on the quality of the feedstock oil. This paper presents an overview of oil extraction and a method of biodiesel production from spent coffee grounds.

Field Evaluation Of Arsenic Transport Across The Ground-Water/Surface Water Interface: Ground-Water Discharge And Iron Oxide Precipitation

Science.gov (United States)

A field investigation was conducted to examine the distribution of arsenic in ground water, surface water, and sediments at a Superfund Site in the northeastern United States (see companion presentation by K. G. Scheckel et al). Ground-water discharge into the study area was cha...

A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.

Science.gov (United States)

Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L

2007-11-01

This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

Uranium mineralization by ground water in sedimentary rocks, Japan

International Nuclear Information System (INIS)

Doi, K.; Hirono, S.; Sakamaki, Y.

1975-01-01

To solve the mechanism of uranium concentration in stratabound uranium deposits occurring in the basal part of Neogene sediments overlying granite basement, attention was paid to uranium leaching from weathered granite by circulating carbonated fissure waters, to effective adsorbents for fixing uranium from uraniferous ground waters, to structural features controlling the ground-water circulation, and other relevant factors. The evidence for uranium transportation by hydothermal solutions, including hot spring waters, is hard to observe. Conclusions are summarized as follows: Uranium in the deposits is supplied from surrounding source rocks, mostly from granite. Uranium is transported by circulating ground-water solutions. The uranium dissolved in ground water is fixed in minerals in various ways, the most important being adsorption by carbonaceous matter. Ore-grade uranium concentrated from very dilute solutions occurs by multiple repetition of a leaching-and-fixation cycle between minerals or adsorbents and circulating uraniferous ground water. Important factors for uranium mineralization are sufficient uranium, supplied mostly from granite, the existence of effective adsorbents such as carbonaceous matter in the host rocks, and favorable geological, geochemical, and geophysical environments. The last seem to require not only physical and chemical conditions but also correct flow and volume of ground water. (U.S.)

Prehospital helicopter transport and survival of patients with traumatic brain injury.

Science.gov (United States)

Bekelis, Kimon; Missios, Symeon; Mackenzie, Todd A

2015-03-01

To investigate the association of helicopter transport with survival of patients with traumatic brain injury (TBI), in comparison with ground emergency medical services (EMS). Helicopter utilization and its effect on the outcomes of TBI remain controversial. We performed a retrospective cohort study involving patients with TBI who were registered in the National Trauma Data Bank between 2009 and 2011. Regression techniques with propensity score matching were used to investigate the association of helicopter transport with survival of patients with TBI, in comparison with ground EMS. During the study period, there were 209,529 patients with TBI who were registered in the National Trauma Data Bank and met the inclusion criteria. Of these patients, 35,334 were transported via helicopters and 174,195 via ground EMS. For patients transported to level I trauma centers, 2797 deaths (12%) were recorded after helicopter transport and 8161 (7.8%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival [OR (odds ratio), 1.95; 95% confidence interval (CI), 1.81-2.10; absolute risk reduction (ARR), 6.37%]. This persisted after propensity score matching (OR, 1.88; 95% CI, 1.74-2.03; ARR, 5.93%). For patients transported to level II trauma centers, 1282 deaths (10.6%) were recorded after helicopter transport and 5097 (7.3%) after ground EMS. Multivariable logistic regression analysis demonstrated an association of helicopter transport with increased survival (OR, 1.81; 95% CI, 1.64-2.00; ARR 5.17%). This again persisted after propensity score matching (OR, 1.73; 95% CI, 1.55-1.94; ARR, 4.69). Helicopter transport of patients with TBI to level I and II trauma centers was associated with improved survival, in comparison with ground EMS.

Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal

2012-01-01

Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use ...... is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark....

Comparison of flying qualities derived from in-flight and ground-based simulators for a jet-transport airplane for the approach and landing pilot tasks

Science.gov (United States)

Grantham, William D.

1989-01-01

The primary objective was to provide information to the flight controls/flying qualities engineer that will assist him in determining the incremental flying qualities and/or pilot-performance differences that may be expected between results obtained via ground-based simulation (and, in particular, the six-degree-of-freedom Langley Visual/Motion Simulator (VMS)) and flight tests. Pilot opinion and performance parameters derived from a ground-based simulator and an in-flight simulator are compared for a jet-transport airplane having 32 different longitudinal dynamic response characteristics. The primary pilot tasks were the approach and landing tasks with emphasis on the landing-flare task. The results indicate that, in general, flying qualities results obtained from the ground-based simulator may be considered conservative-especially when the pilot task requires tight pilot control as during the landing flare. The one exception to this, according to the present study, was that the pilots were more tolerant of large time delays in the airplane response on the ground-based simulator. The results also indicated that the ground-based simulator (particularly the Langley VMS) is not adequate for assessing pilot/vehicle performance capabilities (i.e., the sink rate performance for the landing-flare task when the pilot has little depth/height perception from the outside scene presentation).

Effects of a Static Bicycling Programme on the Functional Ability of Young People with Cerebral Palsy Who Are Non-Ambulant

Science.gov (United States)

Williams, Heather; Pountney, Teresa

2007-01-01

This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…

UTMTOX, Toxic Chemical Transport in Atmosphere, Ground Water, Sediments

International Nuclear Information System (INIS)

1988-01-01

A - Description of program or function: UTMTOX is a unified transport model for toxic materials. It combines hydrologic, atmospheric, and sediment transport in one computer code and extends the scope to predict the transport of not only trace metals but also many chemical compounds, including organics. UTMTOX is capable of calculating 1) the atmospheric dispersion of up to 20 chemicals from a maximum of 10 point, 10 line, and 10 area sources; 2) deposition of one chemical at a time in both wet and dry form on foliage or the surface of the earth; 3) surface flow and erosion; 4) percolation through the soil to a stream channel; and 5) flow in the stream channel to the outfall of a watershed. B - Method of solution: UTMTOX calculates rates of flux of chemicals from release to the atmosphere, through deposition on a watershed, infiltration, and runoff from the soil to flow in the stream channel and the associated sediment transport. From these values, mass balances can be established, budgets for the chemical can be made, and concentrations in many environmental compartments can be estimated. Since the coupling is established among three major submodels, they can share data

Radiation transport in earth for neutron and gamma ray point sources above an air-ground interface

International Nuclear Information System (INIS)

Lillie, R.A.; Santoro, R.T.

1979-03-01

Two-dimensional discrete ordinates methods were used to calculate the instantaneous dose rate in silicon and neutron and gamma ray fluences as a function of depth in earth from point sources at various heights (1.0, 61.3, and 731.5 meters) above an air--ground interface. The radiation incident on the earth's surface was transported through an earth-only and an earth--concrete model containing 0.9 meters of borated concrete beginning 0.5 meters below the earth's surface to obtain fluence distributions to a depth of 3.0 meters. The inclusion of borated concrete did not significantly reduce the total instantaneous dose rate in silicon and, in all cases, the secondary gamma ray fluence and corresponding dose are substantially larger than the primary neutron fluence and corresponding dose for depths greater than 0.6 meter. 4 figures, 4 tables

Radiation transport in earth for neutron and gamma-ray point sources above an air-ground interface

International Nuclear Information System (INIS)

Lillie, R.A.; Santoro, R.T.

1980-01-01

Two-dimensional discrete-ordinates methods have been used to calculate the instantaneous dose rate in silicon and neutron and gamma-ray fluences as a function of depth in earth from point sources at various heights (1.0, 61.3, and 731.5 m) above an air-ground interface. The radiation incident on the earth's surface was transported through an earth-only and an earth-concrete model containing 0.9 m of borated concrete beginning 0.5 m below the earth's surface to obtain fluence distributions to a depth of 3.0 m. The inclusion of borated concrete did not significantly reduce the total instantaneous dose rate in silicon, and in all cases, the secondary gamma-ray fluence and corresponding dose are substantially larger than the primary neutron fluence and corresponding dose for depths > 0.6 m

Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

Directory of Open Access Journals (Sweden)

Joseph H. Schwab

2011-01-01

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.

The impact of fatigue on the non-technical skills performance of critical care air ambulance clinicians.

Science.gov (United States)

Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F

2017-11-01

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.

Previsional evaluation of risks associated with ground transportation of uranium hexafluoride

International Nuclear Information System (INIS)

Pages, P.; Tomachevsky, E.

1987-11-01

This communication is a concrete example of application of the evaluation method for risks associated with road transportation of uranium hexafluoride by 48Y shipping container. The statistical bases for UF6 transportation are given by analysis of the list of accidents for dangerous road transportation. This study examines all parameters (cost-safety-meteorology-radiation doses) to take in account in the safety analysis of the UF6 transportation between Pierrelatte and Le Havre [fr

[Customer orientation in ambulant medicine].

Science.gov (United States)

Heinrich, M

2014-07-01

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

Initial site characterization and evaluation of radionuclide contaminated soil waste burial grounds

International Nuclear Information System (INIS)

Phillips, S.J.; Reisenauer, A.E.; Rickard, W.H.; Sandness, G.A.

1977-02-01

A survey of historical records and literature containing information on the contents of 300 Area and North Burial Grounds was completed. Existing records of radioactive waste location, type, and quantity within each burial ground facility were obtained and distributed to cooperating investigators. A study was then initiated to evaluate geophysical exploration techniques for mapping buried waste materials, waste containers, and trench boundaries. Results indicate that a combination of ground penetrating radar, magnetometer, metal detector, and acoustic measurements will be effective but will require further study, hardware development, and field testing. Drilling techniques for recovering radionuclide-contaminated materials and sediment cores were developed and tested. Laboratory sediment characterization and fluid transport and monitoring analyses were begun by installation of in situ transducers at the 300 North Burial Ground site. Biological transport mechanisms that control radionuclide movement at contaminated sites were also studied. Flora and fauna presently inhabiting specific burial ground areas were identified and analyzed. Future monitoring of specific mammal populations will permit determination of dose rate and pathways of contaminated materials contained in and adjacent to burial ground sites

Ground and Helicopter Emergency Medical Services Time Tradeoffs Assessed with Geographic Information.

Science.gov (United States)

Widener, Michael J; Ginsberg, Zac; Schleith, Daniel; Floccare, Douglas J; Hirshon, Jon Mark; Galvagno, Samuel

2015-07-01

We describe how geographic information systems (GIS) can be used to assess and compare estimated transport time for helicopter and ground emergency medical services. Recent research shows that while the odds of a trauma patient's survival increase with helicopter emergency medical services (HEMS), they may not increase to the extent necessary to make HEMS cost effective. This study offers an analytic tool to objectively quantify the patient travel time advantage that HEMS offers compared to ground emergency medical services (GEMS). Using helicopter dispatch data from the Maryland State Police from 2000-2011, we computed transport time estimates for HEMS and GEMS, compare these results to a reference transport time of 60 min, and use geospatial interpolation to extrapolate the total response times for each mode across the study region. Mapping the region's trauma incidents and modeling response times, our findings indicate the GIS framework for calculating transportation time tradeoffs is useful in identifying which areas can be better served by HEMS or GEMS. The use of GIS and the analytical methodology described in this study present a method to compare transportation by air and ground in the prehospital setting that accounts for how mode, distance, and road infrastructure impact total transport time. Whether used to generate regional maps in advance or applied real-time, the presented framework provides a tool to identify earlier incident locations that favor HEMS over GEMS transport modes.

Modeling Water and Nutrient Transport through the Soil-Root-Canopy Continuum: Explicitly Linking the Below- and Above-Ground Processes

Science.gov (United States)

Kumar, P.; Quijano, J. C.; Drewry, D.

2010-12-01

Vegetation roots provide a fundamental link between the below ground water and nutrient dynamics and above ground canopy processes such as photosynthesis, evapotranspiration and energy balance. The “hydraulic architecture” of roots, consisting of the structural organization of the root system and the flow properties of the conduits (xylem) as well as interfaces with the soil and the above ground canopy, affect stomatal conductance thereby directly linking them to the transpiration. Roots serve as preferential pathways for the movement of moisture from wet to dry soil layers during the night, both from upper soil layer to deeper layers during the wet season (‘hydraulic descent’) and vice-versa (‘hydraulic lift’) as determined by the moisture gradients. The conductivities of transport through the root system are significantly, often orders of magnitude, larger than that of the surrounding soil resulting in movement of soil-moisture at rates that are substantially larger than that through the soil. This phenomenon is called hydraulic redistribution (HR). The ability of the deep-rooted vegetation to “bank” the water through hydraulic descent during wet periods for utilization during dry periods provides them with a competitive advantage. However, during periods of hydraulic lift these deep-rooted trees may facilitate the growth of understory vegetation where the understory scavenges the hydraulically lifted soil water. In other words, understory vegetation with relatively shallow root systems have access to the banked deep-water reservoir. These inter-dependent root systems have a significant influence on water cycle and ecosystem productivity. HR induced available moisture may support rhizosphere microbial and mycorrhizal fungi activities and enable utilization of heterogeneously distributed water and nutrient resources To capture this complex inter-dependent nutrient and water transport through the soil-root-canopy continuum we present modeling

Ground based measurements of particulate emissions from supersonic transports. Concorde olympus engine

Energy Technology Data Exchange (ETDEWEB)

Whitefield, Ph D; Hagen, D E [Missouri Univ., Rolla, MO (United States). Cloud and Aerosol Sciences Lab.; Lilenfeld, H V [McDonnell Douglas Corp., St. Louis, MO (United States)

1998-12-31

The application of a mobile aerosol monitoring facility, the Mobile Aerosol Sampling System (MASS) is described to characterize engine aerosol emissions from the Rolls Royce Olympus Engine. The multi-configurational MASS has been employed in both ground and airborne field operations. It has been successfully flown on research aircrafts. In ground tests the MASS has participated in numerous jet engine related ground tests, and has been deployed to resolve aerosol generation problems in a high power chemical laser system. In all cases the measurements were made on samples taken from a harsh physical and chemical environment, with both high and low temperature and pressure, and in the presence of highly reactive gases. (R.P.) 9 refs.

Ground based measurements of particulate emissions from supersonic transports. Concorde olympus engine

Energy Technology Data Exchange (ETDEWEB)

Whitefield, Ph.D.; Hagen, D.E. [Missouri Univ., Rolla, MO (United States). Cloud and Aerosol Sciences Lab.; Lilenfeld, H.V. [McDonnell Douglas Corp., St. Louis, MO (United States)

1997-12-31

The application of a mobile aerosol monitoring facility, the Mobile Aerosol Sampling System (MASS) is described to characterize engine aerosol emissions from the Rolls Royce Olympus Engine. The multi-configurational MASS has been employed in both ground and airborne field operations. It has been successfully flown on research aircrafts. In ground tests the MASS has participated in numerous jet engine related ground tests, and has been deployed to resolve aerosol generation problems in a high power chemical laser system. In all cases the measurements were made on samples taken from a harsh physical and chemical environment, with both high and low temperature and pressure, and in the presence of highly reactive gases. (R.P.) 9 refs.

Prehospital transported patients

DEFF Research Database (Denmark)

Bech, Camilla Louise Nørgaard; Brabrand, M.; Lassen, Annmarie Touborg

2015-01-01

-based healthcare registers in order to identify comorbid conditions and information on mortality. Demographic factors and first registered vital sign were analysed by univariate logistic regression analysis, with 7-day mortality as outcome. Results In total, 18,572 first-time ambulance contacts were identified...

Assessing the ground vibrations produced by a heavy vehicle traversing a traffic obstacle.

Science.gov (United States)

Ducarne, Loïc; Ainalis, Daniel; Kouroussis, Georges

2018-01-15

Despite advancements in alternative transport networks, road transport remains the dominant mode in many modern and developing countries. The ground-borne motions produced by the passage of a heavy vehicle over a geometric obstacle (e.g. speed hump, train tracks) pose a fundamental problem in transport annoyance in urban areas. In order to predict the ground vibrations generated by the passage of a heavy vehicle over a geometric obstacle, a two-step numerical model is developed. The first step involves simulating the dynamic loads generated by the heavy vehicle using a multibody approach, which includes the tyre-obstacle-ground interaction. The second step involves the simulation of the ground wave propagation using a three dimensional finite element model. The simulation is able to be decoupled due to the large difference in stiffness between the vehicle's tyres and the road. First, the two-step model is validated using an experimental case study available in the literature. A sensitivity analysis is then presented, examining the influence of various factors on the generated ground vibrations. Factors investigated include obstacle shape, obstacle dimensions, vehicle speed, and tyre stiffness. The developed model can be used as a tool in the early planning stages to predict the ground vibrations generated by the passage of a heavy vehicle over an obstacle in urban areas. Copyright © 2017 Elsevier B.V. All rights reserved.

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury.

Science.gov (United States)

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2017-01-01

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 Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20-67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60-90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

Directory of Open Access Journals (Sweden)

Yukiyo Shimizu

2017-11-01

Full Text Available 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 Assistive Limb® (HAL in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67 years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention

Management of ground water using isotope techniques

International Nuclear Information System (INIS)

Romani, Saleem

2004-01-01

Ground water play a major role in national economy and sustenance of life and environment. Prevalent water crisis in India includes falling water table, water quality deterioration, water logging and salinity. Keeping in view the increasing thrust on groundwater resources and the present scenario of availability vis-a vis demand there is a need to reorient our approach to ground water management. The various ground water management options require proper understanding of ground water flow system. Isotopes are increasingly being applied in hydrogeological investigations as a supplementary tool for assessment of aquifer flow and transport characteristics. Isotope techniques coupled with conventional hydrogeological and hydrochemical methods can bring in greater accuracy in the conceptualization of hydrogeological control mechanism. The use of isotope techniques in following areas can certainly be of immense help in implementing various ground water management options in an efficient manner. viz.Interaction between the surface water - groundwater systems to plan conjunctive use of surface and ground water. Establishing hydraulic interconnections between the aquifers in a multi aquifer system. Depth of circulation of water and dating of ground water. Demarcating ground water recharge and discharge areas. Plan ground water development in coastal aquifers to avoid sea water ingress. Development of flood plain aquifer. (author)

Spacelab Level 4 Programmatic Implementation Assessment Study. Volume 2: Ground Processing requirements

Science.gov (United States)

1978-01-01

Alternate ground processing options are summarized, including installation and test requirements for payloads, space processing, combined astronomy, and life sciences. The level 4 integration resource requirements are also reviewed for: personnel, temporary relocation, transportation, ground support equipment, and Spacelab flight hardware.

Hydrogeologic controls on the transport and fate of nitrate in ground water beneath riparian buffer zones: Results from thirteen studies across the United States

Science.gov (United States)

Puckett, L.J.

2004-01-01

During the last two decades there has been growing interest in the capacity of riparian buffer zones to remove nitrate from ground waters moving through them. Riparian zone sediments often contain organic carbon, which favors formation of reducing conditions that can lead to removal of nitrate through denitrification. Over the past decade the National Water Quality Assessment (NAWQA) Program has investigated the transport and fate of nitrate in ground and surface waters in study areas across the United States. In these studies riparian zone efficiency in removing nitrate varied widely as a result of variations in hydrogeologic factors. These factors include (1) denitrification in the up-gradient aquifer due to the presence of organic carbon or other electron donors, (2) long residence times (>50 years) along ground-water flow paths allowing even slow reactions to completely remove nitrate, (3) dilution of nitrate enriched waters with older water having little nitrate, (4) bypassing of riparian zones due to extensive use of drains and ditches, and (5) movement of ground water along deep flow paths below reducing zones. By developing a better understanding of the hydrogeologic settings in which riparian buffer zones are likely to be inefficient we can develop improved nutrient management plans. ?? US Government 2004.

Patients in prehospital transport to the emergency department

DEFF Research Database (Denmark)

Bech, Camilla Louise Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren

2018-01-01

BACKGROUND: Ambulance transfer is the first contact with the healthcare system for many patients in emergency conditions.We aimed to identify prognostic risk factors accessible in the prehospital phase that indicate an increased risk of 7-day mortality. PATIENTS AND METHODS: We included patients ...... aged 18 years or older, transferred by ambulance to the emergency department at Odense University Hospital, from 1 April 2012 to 30 September 2014. We carried out multivariate logistic regressions, adjusted for age and sex, to describe the relationship between vital sign values recorded...

Ground robotic measurement of aeolian processes

Science.gov (United States)

Qian, Feifei; Jerolmack, Douglas; Lancaster, Nicholas; Nikolich, George; Reverdy, Paul; Roberts, Sonia; Shipley, Thomas; Van Pelt, R. Scott; Zobeck, Ted M.; Koditschek, Daniel E.

2017-08-01

Models of aeolian processes rely on accurate measurements of the rates of sediment transport by wind, and careful evaluation of the environmental controls of these processes. Existing field approaches typically require intensive, event-based experiments involving dense arrays of instruments. These devices are often cumbersome and logistically difficult to set up and maintain, especially near steep or vegetated dune surfaces. Significant advances in instrumentation are needed to provide the datasets that are required to validate and improve mechanistic models of aeolian sediment transport. Recent advances in robotics show great promise for assisting and amplifying scientists' efforts to increase the spatial and temporal resolution of many environmental measurements governing sediment transport. The emergence of cheap, agile, human-scale robotic platforms endowed with increasingly sophisticated sensor and motor suites opens up the prospect of deploying programmable, reactive sensor payloads across complex terrain in the service of aeolian science. This paper surveys the need and assesses the opportunities and challenges for amassing novel, highly resolved spatiotemporal datasets for aeolian research using partially-automated ground mobility. We review the limitations of existing measurement approaches for aeolian processes, and discuss how they may be transformed by ground-based robotic platforms, using examples from our initial field experiments. We then review how the need to traverse challenging aeolian terrains and simultaneously make high-resolution measurements of critical variables requires enhanced robotic capability. Finally, we conclude with a look to the future, in which robotic platforms may operate with increasing autonomy in harsh conditions. Besides expanding the completeness of terrestrial datasets, bringing ground-based robots to the aeolian research community may lead to unexpected discoveries that generate new hypotheses to expand the science

Air medical transportation in India: Our experience

Directory of Open Access Journals (Sweden)

Himanshu Khurana

2016-01-01

Conclusion: Cardiac and central nervous system ailments are the most common indication for air medical transportation. These patients may need attention and interventions as any critical patient in the hospital but in a difficult environment lacking space and help. Air medical transport carries no more risk than ground transportation.

Association of Bystander Cardiopulmonary Resuscitation and Survival According to Ambulance Response Times After Out-of-Hospital Cardiac Arrest.

Science.gov (United States)

Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Steen Møller; Gerds, Thomas A; Kragholm, Kristian; Hansen, Carolina Malta; Karlsson, Lena; Lippert, Freddy K; Køber, Lars; Gislason, Gunnar H; Torp-Pedersen, Christian

2016-12-20

response time in this study) to 5 minutes. The absolute survival associated with bystander CPR declined rapidly with time. Yet bystander CPR while waiting for an ambulance was associated with a more than doubling of 30-day survival even in case of long ambulance response time. Decreasing ambulance response time by even a few minutes could potentially lead to many additional lives saved every year. © 2016 American Heart Association, Inc.

Effects of the addition of functional electrical stimulation to ground level gait training with body weight support after chronic stroke.

Science.gov (United States)

Prado-Medeiros, Christiane L; Sousa, Catarina O; Souza, Andréa S; Soares, Márcio R; Barela, Ana M F; Salvini, Tania F

2011-01-01

The addition of functional electrical stimulation (FES) to treadmill gait training with partial body weight support (BWS) has been proposed as a strategy to facilitate gait training in people with hemiparesis. However, there is a lack of studies that evaluate the effectiveness of FES addition on ground level gait training with BWS, which is the most common locomotion surface. To investigate the additional effects of commum peroneal nerve FES combined with gait training and BWS on ground level, on spatial-temporal gait parameters, segmental angles, and motor function. Twelve people with chronic hemiparesis participated in the study. An A1-B-A2 design was applied. A1 and A2 corresponded to ground level gait training using BWS, and B corresponded to the same training with the addition of FES. The assessments were performed using the Modified Ashworth Scale (MAS), Functional Ambulation Category (FAC), Rivermead Motor Assessment (RMA), and filming. The kinematics analyzed variables were mean walking speed of locomotion; step length; stride length, speed and duration; initial and final double support duration; single-limb support duration; swing period; range of motion (ROM), maximum and minimum angles of foot, leg, thigh, and trunk segments. There were not changes between phases for the functional assessment of RMA, for the spatial-temporal gait variables and segmental angles, no changes were observed after the addition of FES. The use of FES on ground level gait training with BWS did not provide additional benefits for all assessed parameters.

Primary heat transport pump trip by ground fault (deterioration of insulation in the cable quick disconnect)

International Nuclear Information System (INIS)

Chun, C.-Y.

1991-01-01

At 08:29 Sept. 1, 1988, Wolsong unit 1 was operating at 100% full power when a primary heat transport pump was suddenly tripped by breaker trip due to ground fault in the power distribution connector assembly. Soon after the pump trip, the reactor was shut down automatically on low heat transport flow. Operators tried to restart the pump twice but failed. A field operator reported to the shift supervisor that he found an electrical spark and smoke at the vicinity of the pump when the pump started to run. Inspection showed that a power distribution connector assembly for making fast and easy power connections to the PHT pump motor, 3312-PM2, was damaged severely by thermal shock. Particularly, broken parts of the insulating plug flew away across the boiler room and dropped to the floor. Direct causes of the failure were bad contact and deterioration of integrity along the creep paths between the insulating plug and the connector housing. The failed connector assembly had been used for more than 7 years. Its status had been checked infrequently during the in-service period. The standard torque value was not applied to the installation of connectors. Therefore, we concluded that long term inservice in combinations of application of improper torque value induced failure of insulation. This paper describes the scenarios, causes of the event and corrective actions to prevent recurrence of this event. (author)

Primary heat transport pump trip by ground fault (deterioration of insulation in the cable quick disconnect)

Energy Technology Data Exchange (ETDEWEB)

Chun, C -Y [Wolsong Nuclear Power Plant, Korea Electric Power Corporation, Wolsong (Korea, Republic of)

1991-04-01

At 08:29 Sept. 1, 1988, Wolsong unit 1 was operating at 100% full power when a primary heat transport pump was suddenly tripped by breaker trip due to ground fault in the power distribution connector assembly. Soon after the pump trip, the reactor was shut down automatically on low heat transport flow. Operators tried to restart the pump twice but failed. A field operator reported to the shift supervisor that he found an electrical spark and smoke at the vicinity of the pump when the pump started to run. Inspection showed that a power distribution connector assembly for making fast and easy power connections to the PHT pump motor, 3312-PM2, was damaged severely by thermal shock. Particularly, broken parts of the insulating plug flew away across the boiler room and dropped to the floor. Direct causes of the failure were bad contact and deterioration of integrity along the creep paths between the insulating plug and the connector housing. The failed connector assembly had been used for more than 7 years. Its status had been checked infrequently during the in-service period. The standard torque value was not applied to the installation of connectors. Therefore, we concluded that long term inservice in combinations of application of improper torque value induced failure of insulation. This paper describes the scenarios, causes of the event and corrective actions to prevent recurrence of this event. (author)

MASCOT user's guide--Version 2.0: Analytical solutions for multidimensional transport of a four-member radionuclide decay chain in ground water

International Nuclear Information System (INIS)

Gureghian, A.B.

1988-07-01

The MASCOT code computes the two- and three-dimensional space-time dependent convective-dispersive transport of a four-member radionuclide decay chain in unbounded homogeneous porous media, for constant and radionuclide-dependent release, and assuming steady- state isothermal ground-water flow and parallel streamlines. The model can handle a single or multiple finite line source or a Gaussian distributed source in the two-dimensional case, and a single or multiple patch source or bivariate-normal distributed source in the three-dimensional case. The differential equations are solved by Laplace and Fourier transforms and a Gauss-Legendre integration scheme. 33 figs., 3 tabs

Biogeochemical Processes Responsible for the Enhanced Transport of Plutonium Under transient Unsaturated Ground Water Conditions

Energy Technology Data Exchange (ETDEWEB)

Fred J. Molz, III

2010-05-28

to Pu uptake by corn roots and xylem transport. Plants were started in wet paper wrapped around each corn seed. When the tap roots were sufficiently long, the seedlings were transplanted to a soil container with the tap root extending out the container bottom. The soil container was then placed over a nutrient solution container, and the solution served as an additional medium for root growth. To conduct an uptake study, a radioactive substance, such as Pu complexed with the bacterial siderophore DFOB, was added to the nutrient solution. After a suitable elapsed time, the corn plant was sacrificed, cut into 10 cm lengths, and the activity distribution measured. Experimental results clarified the basic nature of Pu uptake and transport in corn plants, and resulting simulations suggested that each growing season Pu in the SRS lysimeters would move into the plant shoots and be deposited on the soil surface during the Fall dieback. Subsequent isotope ratio analyses showed that this did happen. OVERALL RESULTS AND CONCLUSIONS - (1) Pu transport downward from the source is controlled by advection, dispersion and adsorption, along with surface-mediated REDOX reactions. (2) Hysteresis, extreme root distribution functions, air-content dependent oxidation rate constants, and large evaporation rates from the soil surface were not able to explain the observed upward migration of Pu. (3) Small amounts of Pu uptake by plant roots and translocation in the transpiration stream creates a realistic mechanism for upward Pu migration (4) Realistic xylem cross-sectional areas imply high flow velocities under hot, wet conditions. Such flow velocities produce the correct shape for the observed activity distributions in the top 20 cm of the lysimeter soil. (5) Simulations imply that Pu should have moved into the above-ground grass tissue each year during the duration of the experiments, resulting in an activity residual accumulating on the soil surface. An isotope ratio analysis showed that

Biogeochemical Processes Responsible for the Enhanced Transport of Plutonium Under transient Unsaturated Ground Water Conditions

International Nuclear Information System (INIS)

Molz, Fred J. III

2010-01-01

to Pu uptake by corn roots and xylem transport. Plants were started in wet paper wrapped around each corn seed. When the tap roots were sufficiently long, the seedlings were transplanted to a soil container with the tap root extending out the container bottom. The soil container was then placed over a nutrient solution container, and the solution served as an additional medium for root growth. To conduct an uptake study, a radioactive substance, such as Pu complexed with the bacterial siderophore DFOB, was added to the nutrient solution. After a suitable elapsed time, the corn plant was sacrificed, cut into 10 cm lengths, and the activity distribution measured. Experimental results clarified the basic nature of Pu uptake and transport in corn plants, and resulting simulations suggested that each growing season Pu in the SRS lysimeters would move into the plant shoots and be deposited on the soil surface during the Fall dieback. Subsequent isotope ratio analyses showed that this did happen. OVERALL RESULTS AND CONCLUSIONS - (1) Pu transport downward from the source is controlled by advection, dispersion and adsorption, along with surface-mediated REDOX reactions. (2) Hysteresis, extreme root distribution functions, air-content dependent oxidation rate constants, and large evaporation rates from the soil surface were not able to explain the observed upward migration of Pu. (3) Small amounts of Pu uptake by plant roots and translocation in the transpiration stream creates a realistic mechanism for upward Pu migration (4) Realistic xylem cross-sectional areas imply high flow velocities under hot, wet conditions. Such flow velocities produce the correct shape for the observed activity distributions in the top 20 cm of the lysimeter soil. (5) Simulations imply that Pu should have moved into the above-ground grass tissue each year during the duration of the experiments, resulting in an activity residual accumulating on the soil surface. An isotope ratio analysis showed that

Subsurface transport with emphasis on hydrology: research needs. Subsurface Transport Program

International Nuclear Information System (INIS)

Zachara, J.M.; Wildung, R.E.

1982-03-01

A number of energy technologies presently in operation or under development generate solid wastes in large quantities as a major byproduct. These wastes will, for the most part, be disposed to the ground in landfills or inactive mine sites. Although the waste materials differ significantly among technologies, most contain residual, water-soluble chemical components which are of ecological and human health concern. Thus, in ground disposal may have a significant long-term impact on water supplies and human health if not properly conducted. With the growing magnitude of solid waste disposal operations, it becomes imperative to establish common ground between technologies such that research in this complex area can be efficiently managed to benefit a variety of users. This report develops the concept of multitechnology or generic research in subsurface transport with emphasis on hydrogeochemistry. Initially, a generic research approach was developed independent of waste characteristics. This approach both identified and prioritized the research information or experimentation and data management tools (models) required to resolve major technical concerns for in ground disposal. Waste characteristics were then evaluated to identify the common, cross-technology information needs. This evaluation indicated that solid wastes from energy producing technologies have physiocochemical properties in common which serve as a useful basis for identification of fundamental, generic research needs. Priority research projects are suggested for addressing contaminant identification, solubilization, transformation and transport. 38 references, 3 tables

Emergency medical service systems in Japan : Past, present, and future

OpenAIRE

Tanigawa, Koichi; Tanaka, Keiichi

2006-01-01

Emergency medical services are provided by the fire defense headquarter of the local government in Japan. We have a one-tiered EMS system. The ambulance is staffed by three crews trained in rescue, stabilization, transportation, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class one, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergenc...

First pediatric transatlantic air ambulance transportation on a Berlin Heart EXCOR left ventricular assist device as a bridge to transplantation.

Science.gov (United States)

Tissot, Cecile; Buchholz, Holger; Mitchell, Max B; da Cruz, Eduardo; Miyamoto, Shelley D; Pietra, Bill A; Charpentier, Arnaud; Ghez, Olivier

2010-03-01

Mechanical circulatory devices are indicated in patients with refractory cardiac failure as a bridge to recovery or to transplantation. Whenever required, transportation while on mechanical support is a challenge and still limited by technical restrictions or distance. We report the first pediatric case of transatlantic air transportation on a Berlin Heart EXCOR ventricular assist device (Berlin Heart, Berlin, Germany) of a 13-yr-old American female who presented in cardiogenic shock with severe systolic dysfunction while vacationing in France. Rapid hemodynamic deterioration occurred despite maximal medical treatment, and she was supported initially with extracorporeal membrane oxygenation converted to a Berlin Heart EXCOR left ventricular assist device. Long-distance air transportation of the patient was accomplished 3 wks after implantation from Marseille, France, to Denver, Colorado. No adverse hemodynamic effects were encountered during the 13.5-hr flight (8770 km). The patient did not recover sufficient cardiac function and underwent successful orthotopic heart transplantation 3 months after the initial event. Our experience suggests that long-distance air transportation of pediatric patients using the Berlin Heart EXCOR mobile unit as a bridge to recovery or transplantation is feasible and appears safe.

Preliminary development of a wing in ground effect vehicle

Science.gov (United States)

Abidin, Razali; Ahamat, Mohamad Asmidzam; Ahmad, Tarmizi; Saad, Mohd Rasdan; Hafizi, Ezzat

2018-02-01

Wing in ground vehicle is one of the mode of transportation that allows high speed movement over water by travelling few meters above the water level. Through this manouver strategy, a cushion of compressed air exists between the wing in ground vehicle wings and water. This significantly increase the lift force, thus reducing the necessity in having a long wing span. Our project deals with the development of wing in ground vehicle with the capability of transporting four people. The total weight of this wing in ground vehicle was estimated at 5.4 kN to enable the prediction on required wing area, minimum takeoff velocity, drag force and engine power requirement. The required takeoff velocity is decreases as the lift coefficient increases, and our current mathematical model shows the takeoff velocity at 50 m/s avoid the significant increase in lift coefficient for the wing area of 5 m2. At the velocity of 50 m/s, the drag force created by this wing in ground vehicle is well below 1 kN, which required a 100-120 kW of engine power if the propeller has the efficiency of 0.7. Assessment on the stresses and deflection of the hull structural indicate the capability of plywood to withstand the expected load. However, excessive deflection was expected in the rear section which requires a minor structural modification. In the near future, we expect that the wind tunnel tests of this wing in ground vehicle model would enable more definite prediction on the important parameters related to its performance.

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

Science.gov (United States)

Gałazkowski, Robert

2010-01-01

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

How many oxygen cylinders do you need to take on transport? A nomogram for cylinder size and duration.

Science.gov (United States)

Lutman, D; Petros, A J

2006-09-01

When undertaking patient retrieval, it is important to take adequate supplies of oxygen to ensure patient safety. Oxygen can be delivered via a flowmeter into a facemask or used to drive pneumatic ventilators. Given the lack of space in the back of an ambulance or helicopter, the numbers of cylinders that can be taken is limited, hence the number needed to complete the journey must be carefully calculated prior to embarking. We have produced nomograms to predict how many oxygen cylinders will be consumed during a given journey when using either a flowmeter or a commonly used transport ventilator.

A Manual Transportable Instrument Platform for Ground-Based Spectro-Directional Observations (ManTIS and the Resultant Hyperspectral Field Goniometer System

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Marcel Buchhorn

2013-11-01

Full Text Available This article presents and technically describes a new field spectro-goniometer system for the ground-based characterization of the surface reflectance anisotropy under natural illumination conditions developed at the Alfred Wegener Institute (AWI. The spectro-goniometer consists of a Manual Transportable Instrument platform for ground-based Spectro-directional observations (ManTIS, and a hyperspectral sensor system. The presented measurement strategy shows that the AWI ManTIS field spectro-goniometer can deliver high quality hemispherical conical reflectance factor (HCRF measurements with a pointing accuracy of ±6 cm within the constant observation center. The sampling of a ManTIS hemisphere (up to 30° viewing zenith, 360° viewing azimuth needs approx. 18 min. The developed data processing chain in combination with the software used for the semi-automatic control provides a reliable method to reduce temporal effects during the measurements. The presented visualization and analysis approaches of the HCRF data of an Arctic low growing vegetation showcase prove the high quality of spectro-goniometer measurements. The patented low-cost and lightweight ManTIS instrument platform can be customized for various research needs and is available for purchase.

Crew Transportation Operations Standards

Science.gov (United States)

Mango, Edward J.; Pearson, Don J. (Compiler)

2013-01-01

The Crew Transportation Operations Standards contains descriptions of ground and flight operations processes and specifications and the criteria which will be used to evaluate the acceptability of Commercial Providers' proposed processes and specifications.

Predictors of workplace violence among ambulance personnel: a longitudinal study.

Science.gov (United States)

van der Velden, Peter G; Bosmans, Mark W G; van der Meulen, Erik

2016-04-01

To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE's are WPV-related and their abilities to prevent escalations. A longitudinal study with a 6 months' time interval ( N  =   103). At T1 demographics, workplace violence and potentially traumatic events in the past year, mental health, personality, handling of rules, coping and social organizational stressors were assessed. Confrontations with aggression were also examined at T2. Multivariate logistic regression analyses showed that only problems with superiors independently predicted repeated verbal aggression and that only the (absence of the) ability to compromise very easily predicted repeatedly being on guard and repeatedly confronted with any form of aggression. Due to very low prevalences, we could not examine predictors of repeated confrontations with physical aggression ( N  =   5) and serious threat ( N  =   7). A large majority reported that in most workplace violence cases they could prevent further escalations. About 2% reported a potentially traumatic event in the year before T1 that was WPV related and perceived as very stressful.

Severity-Adjusted Mortality in Trauma Patients Transported by Police

Science.gov (United States)

Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

2018-01-01

Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

Integral Transportation Systems in Military Transport Aircraft Supply

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Dražen Kovačević

2012-10-01

Full Text Available Supply of goods, equipment and soldiers by militwy transportaircraft can serve as a support to airborne landing operation,support to encircled forces, and support to forces leadinga gue1rilla war. Transport aircraft are designed in such a wayas to be able to cany containers, pallets, most of land vehiclesand helicopters. Militwy transport aircraft can be grouped intothose that were originally designed for military transp01t andthose that are modified civilian aircraft and helicopters. Supplypallets can be wooden, metal, can be airdropped in "taxiing","low-flight", and can also be fitted with a parachute or"retrorocket" for reducing the ground impact. Pallets canamong other things carry liquids, heavy combat and ca1rier vehicles,artillery and rocket weapons and valious containers.Pallets are usually pe1manently deformed at ground impact.Nowadays, high precision of airdrop has been achieved. Containersare used to carry various equipment, food, fue~ weapons,ammunition etc. It is to be expected that the containers,wmoured combat and other vehicles will be redesigned so asto provide more efficient transport and fast a!Tangement ofhigh-mobility units, whereas the form of the future militarytransport aircraft will not undergo substantial changes. By adjustingand standardising the transporlation vehicles, integraltransportation means and cwgo, the overall combat efficiencywill be increased, the a~rangement time especially shortenedand the air supply safety increased.

Eight months of emergency services by ambulance (with doctor on board) of the Emergency Department of Prato, Italy.

Science.gov (United States)

Olia, P M; Mollica, T V; Querci, A

2002-11-01

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.

Seasonal variation of spherical aerosols distribution in East Asia based on ground and space Lidar observation and a Chemical transport model

Science.gov (United States)

Hara, Y.; Yumimoto, K.; Uno, I.; Shimizu, A.; Sugimoto, N.; Ohara, T.

2009-12-01

The anthropogenic aerosols largely impact on not only human health but also global climate system, therefore air pollution in East Asia due to a rapid economic growth has been recognized as a significant environmental problem. Several international field campaigns had been conducted to elucidate pollutant gases, aerosols characteristics and radiative forcing in East Asia. (e.g., ACE-Asia, TRACE-P, ADEC, EAREX 2005). However, these experiments were mainly conducted in springtime, therefore seasonal variation of aerosols distribution has not been clarified well yet. National Institute for Environmental Studies (NIES) has been constructing a lidar networks by automated dual wavelength / polarization Mie-lidar systems to observe the atmospheric environment in Asian region since 2001. Furthermore, from June 2006, space-borne backscatter lidar, Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP), onboard NASA/CALIPSO satellite, measures continuous global aerosol and cloud vertical distribution with very high spatial resolution. In this paper, we will show the seasonal variation of aerosols distribution in East Asia based on the NIES lidar network observation, Community Multi-scale Air Quality Modeling System (CMAQ) chemical transport model simulation and CALIOP observation over the period from July 2006 to December 2008. We found that CMAQ result explains the typical seasonal aerosol characteristics by lidar observations. For example, CMAQ and ground lidar showed a summertime peak of aerosol optical thickness (AOT) at Beijing, an autumn AOT peak at Guangzhou and summertime AOT trough at Hedo, Okinawa. These characteristics are mainly controlled by seasonal variations of Asian summer/winter monsoon system. We also examined the CMAQ seasonal average aerosol extinction profiles with ground lidar and CALIOP extinction data. These comparisons clarified that the CMAQ reproduced the observed aerosol layer depth well in the downwind region. Ground lidar and CALIOP seasonal

Ambulance Clinical Triage for Acute Stroke Treatment: Paramedic Triage Algorithm for Large Vessel Occlusion.

Science.gov (United States)

Zhao, Henry; Pesavento, Lauren; Coote, Skye; Rodrigues, Edrich; Salvaris, Patrick; Smith, Karen; Bernard, Stephen; Stephenson, Michael; Churilov, Leonid; Yassi, Nawaf; Davis, Stephen M; Campbell, Bruce C V

2018-04-01

Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen. ACT-FAST examination steps were retrospectively validated, and then prospectively validated by paramedics transporting culturally and linguistically diverse patients with suspected stroke in the emergency department, for the identification of internal carotid or proximal middle cerebral artery occlusion. The diagnostic performance of the full ACT-FAST algorithm was then validated for patients accepted for thrombectomy. In retrospective (n=565) and prospective paramedic (n=104) validation, ACT-FAST displayed higher overall accuracy and specificity, when compared with existing LVO triage scales. Agreement of ACT-FAST between paramedics and doctors was excellent (κ=0.91; 95% confidence interval, 0.79-1.0). The full ACT-FAST algorithm (n=60) assessed by paramedics showed high overall accuracy (91.7%), sensitivity (85.7%), specificity (93.5%), and positive predictive value (80%) for recognition of endovascular-eligible LVO. The 3-step ACT-FAST algorithm shows higher specificity and reliability than existing scales for clinical LVO recognition, despite requiring just 2 examination steps. The inclusion of an eligibility step allowed recognition of endovascular-eligible patients with high accuracy. Using a sequential algorithmic approach eliminates scoring confusion and reduces assessment time. Future

Green tree frog (Hyla cinerea) and ground squirrel (Xerospermophilus spilosoma) mortality attributed to inland brevetoxin transportation at Padre Island National Seashore, Texas, 2015

Science.gov (United States)

Buttke, Danielle E.; Walker, Alicia; Huang, I-Shuo; Flewelling, Leanne; Lankton, Julia S.; Ballmann, Anne E.; Clapp, Travis; Lindsay, James; Zimba, Paul V.

2018-01-01

On 16 September 2015, a red tide (Karenia brevis) bloom impacted coastal areas of Padre Island National Seashore Park. Two days later and about 0.9 km inland, 30–40 adult green tree frogs (Hyla cinerea) were found dead after displaying tremors, weakness, labored breathing, and other signs of neurologic impairment. A rainstorm, accompanied by high winds, rough surf, and high tides, which could have aerosolized brevetoxin, occurred on the morning of the mortality event. Frog carcasses were healthy but contained significant brevetoxin in tissues. Tissue brevetoxin was also found in two dead or dying spotted ground squirrels (Xerospermophilus spilosoma) and a coyote (Canis latrans). Rainwater collected from the location of the mortality event contained brevetoxin. Mortality of green tree frog and ground squirrel mortality has not been previously attributed to brevetoxin exposure and such mortality suggested that inland toxin transport, possibly through aerosols, rainfall, or insects, may have important implications for coastal species.

Creative prosthetic foot selection enables successful ambulation in stiletto high heels.

Science.gov (United States)

Russell Esposito, Elizabeth; Lipe, Delbert H; Rábago, Christopher A

2017-11-01

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.

Ambulance services in London and Great Britain from 1860 until today: a glimpse of history gleaned mainly from the pages of contemporary journals.

Science.gov (United States)

Pollock, Alexander

2013-03-01

Little has been published on the subject of civil ambulance services and their development from the mid-19th century in the UK until modern times. There is limited secondary literature available which provides useful background information on the subject and most organisations may give brief histories of their early days but these sources lack historical adequacy in terms of detail. This article shows part of the uncertain path which the history followed towards the service which we enjoy today. From the pages of the British Medical Journal and the Lancet and Hansard, the battle to set up the service is followed and an indication of the drivers towards change over the period is revealed in the attitudes expressed. In particular, the two World Wars are seen to be the stepwise stimuli to providing a necessary service to the British population where the will to achieve this had hitherto been lacking at a parliamentary level. The history of the London Ambulance Service is chosen because more is written about it in these journals but services in other British cities and the USA are mentioned since they played a part in influencing change.

Community-acquired pneumonia; Ambulant erworbene Pneumonien

Energy Technology Data Exchange (ETDEWEB)

Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)

2017-01-15

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

USING GIS AND AHP FOR PLANNING PRIMER TRANSPORTATION OF FOREST PRODUCTS

Directory of Open Access Journals (Sweden)

A. E. Akay

2017-11-01

Full Text Available Primer transportation is one of the most costly and time consuming forestry activities in extraction of timber from forest lands. Transportation methods are essentially determined based on terrain characteristics, especially ground slope. Besides, unsuitable machine selection and unplanned operations may cause ecological damages such as soil disturbance. Soil damage can lead to long term impacts on forest ecosystem. Thus, the optimum transportation methods should be determined by considering not only economic factors but also topographical factors and soil conditions. In recent decades, some of the advanced features of Geographical Information System (GIS assist decision makers to solve such complex transportation problems with various constraints. In this study, it was aimed to plan forest transportation operation by using GIS integrated Analytical Hierarchy Process (AHP method, considering ground slope, soil type, and available transportation equipment in the region. This method was implemented within the border of İnegöl Forest Enterprise Chief in the city of Bursa in Turkey. Alternative transportation method included cable system, chute system, skidder, and farm tractor. GIS-based method integrated with AHP found that skidder was the optimal transportation method for about 60% of the study area, while farm tractor was the second most suitable method with 25% ground cover. The results indicated that GIS-based decision support systems can be effectively used as rational, quick, and economic tool for forest transportation planning.

Adverse events during air and ground neonatal transport: 13 years' experience from a neonatal transport team in Northern Sweden.

Science.gov (United States)

van den Berg, Johannes; Olsson, Linn; Svensson, Amelie; Håkansson, Stellan

2015-07-01

To study the prevalence of adverse events (AEs) associated with neonatal transport, and to categorize, classify and assess the risk estimation of these events. Written comments in 1082 transport records during the period 1999-2011 were reviewed. Comments related to events that infringed on patient and staff safety were included as AEs, and categorized and further classified as complaint, imminent risk of incident/negative event, actual incident or actual negative event. AEs were also grouped into emergency or planned transports, and risk estimation was calculated according to a risk assessment tool and defined as low, intermediate, high or extreme risk. AEs (N = 883) were divided into five categories: logistics (n = 337), organization (n = 177), equipment (n = 165), vehicle (n = 129) and medical/nursing care (n = 75). Eighty-five percent of AEs were classified as incidents or negative events. The majority of AEs were estimated to be of low or intermediate risk in both planned and emergency transports. AEs estimated to be of high or extreme risk were significantly more frequent in emergency transports (OR = 10.1; 95% CI: 5.0-20.9; p transport, often related to imperfect transport logistics or equipment failure. AEs of high or extreme risk were more frequent in emergency transports.

Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 1. Guideline approach

Energy Technology Data Exchange (ETDEWEB)

Simmons, C.S.; Cole, C.R.

1985-05-01

This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. This volume includes specific recommendations for decision-making managers and site operators on how to use these guidelines. The more detailed discussions about the code selection approach are provided. 242 refs., 6 figs.

Guidelines for selecting codes for ground-water transport modeling of low-level waste burial sites. Volume 1. Guideline approach

International Nuclear Information System (INIS)

Simmons, C.S.; Cole, C.R.

1985-05-01

This document was written for the National Low-Level Waste Management Program to provide guidance for managers and site operators who need to select ground-water transport codes for assessing shallow-land burial site performance. The guidance given in this report also serves the needs of applications-oriented users who work under the direction of a manager or site operator. The guidelines are published in two volumes designed to support the needs of users having different technical backgrounds. An executive summary, published separately, gives managers and site operators an overview of the main guideline report. This volume includes specific recommendations for decision-making managers and site operators on how to use these guidelines. The more detailed discussions about the code selection approach are provided. 242 refs., 6 figs

Charge transport problem

International Nuclear Information System (INIS)

Lee, E.P.

1977-01-01

In a recent report (UCID 17346, ''Relativistic Particle Beam in a Semi-Infinite Axially Symmetric conducting channel extending from a perfectly conducting plane,'' Dec. 13, 1976) Cooper and Neil demonstrate that the net charge transported by a beam pulse injected into a channel of finite conductivity equals the charge of the beam itself. The channel is taken to be infinite in the positive z direction, has finite radius and is terminated by a conducting ground plane at z =0. This result is not an obvious one, and it is restricted in its applicability by the special model assumed for the channel. It is the purpose to explain the result of Cooper and Neil in more qualitative terms and to make similar calculations using several other channel models. It must be emphasized that these calculations are not concerned with the fate of the transported charge after the pulse has stopped, but rather with how much charge leaves the ground plane assuming the pulse does not stop

Lived experience of involuntary transport under mental health legislation.

Science.gov (United States)

Bradbury, Joanne; Hutchinson, Marie; Hurley, John; Stasa, Helen

2017-12-01

Police have historically been responsible for transporting people during a mental health crisis in Australia. A major change to the New South Wales (NSW) Mental Health Act (MHA) in 2007 expanded the range of coercive transportation agencies to include NSW Ambulance (paramedics) and NSW Health (mental health nurses). Anecdotal reports, however, describe a lack of clarity around how these changes should be implemented in practice. This research aims to explore this lack of clarity through qualitative analysis of interviews with people with the lived experience of involuntary transport under the MHA. Sixteen interviews were conducted; most (n = 14) interviews in northern NSW regions: six with people who had been transported (consumers), four with carers, and six with service providers (two police, one paramedic, and three mental health nurses). For consumers and carers, the police response was often perceived as too intense, particularly if the person was not violent. Carers were often conflicted by having to call for emergency intervention. Service providers were frustrated by a lack of a coordinated interagency response, resourcing issues, delays at emergency departments, and lack of adequate training. A central theme across all groups was the importance of communication styles. As one participant (consumer) said: 'Everybody needs a lesson in kindness'. All groups agreed that high-risk situations necessitate police involvement. However, invocation of the MHA during a high-risk situation is fraught with stress and difficulties, leaving little room for empathetic communications. Effective and diverse, evidence-based, early intervention strategies - both consensual and non-consensual - are necessary to reduce the requirement for police involvement in mental health transports. © 2016 Australian College of Mental Health Nurses Inc.

Adding Theoretical Grounding to Grounded Theory: Toward Multi-Grounded Theory

OpenAIRE

Göran Goldkuhl; Stefan Cronholm

2010-01-01

The purpose of this paper is to challenge some of the cornerstones of the grounded theory approach and propose an extended and alternative approach for data analysis and theory development, which the authors call multi-grounded theory (MGT). A multi-grounded theory is not only empirically grounded; it is also grounded in other ways. Three different grounding processes are acknowledged: theoretical, empirical, and internal grounding. The authors go beyond the pure inductivist approach in GT an...

Análise da configuração de SAMU utilizando múltiplas alternativas de localização de ambulâncias Analysis of SAMU configuration using multiple alternatives of ambulance location

Directory of Open Access Journals (Sweden)

Regiane Máximo de Souza

2013-06-01

Full Text Available O Sistema de Atendimento Móvel de Urgência (SAMU no Brasil é um sistema médico emergencial de responsabilidade do poder público, em que a demanda de usuários em uma região urbana é usualmente separada por subregiões e classes de chamados emergenciais. Essa demanda pode mudar de forma significativa ao longo do dia, geograficamente e temporalmente, devido à sua natureza aleatória, mas também devido aos diferentes padrões de comportamentos da população ao longo do dia. Por exemplo, tipicamente há menos demanda durante a noite do que de dia. Os objetivos deste trabalho são: verificar se o conhecido modelo hipercubo de filas espacialmente distribuídas é adequado para analisar medidas de desempenho do SAMU, tais como tempos médios de resposta aos usuários, e utilizar este modelo para analisar múltiplas alternativas de localização das ambulâncias, explorando variações importantes da demanda e do serviço ao longo do dia. Para verificar a viabilidade e a aplicabilidade desta abordagem, foi realizado um estudo de caso no SAMU de Ribeirão Preto-SP.The Brazilian emergency medical system SAMU (Sistema de Atendimento Móvel de Urgência is an emergency medical system of public government liability, in which the users' service demand in an urban region is usually separated into subregions and classes of emergency calls. This demand can change substantially during the day, geographically and temporally, due to its random nature and also to the different behavior patterns of the population throughout the day. For instance, typically there is less demand during the night hours than during the day. The goals of this study are to verify whether the hypercube queuing model is adequate to analyze performance measures of SAMU, such as mean response times to the users, and use this model to analyze multiple alternatives of ambulance location considering significant variations in the demand and service throughout the day. In order to verify

MODFLOW-2000, The U.S. Geological Survey Modular Ground-Water Model - User Guide to Modularization Concepts and the Ground-Water Flow Process

Science.gov (United States)

Harbaugh, Arlen W.; Banta, Edward R.; Hill, Mary C.; McDonald, Michael G.

2000-01-01

MODFLOW is a computer program that numerically solves the three-dimensional ground-water flow equation for a porous medium by using a finite-difference method. Although MODFLOW was designed to be easily enhanced, the design was oriented toward additions to the ground-water flow equation. Frequently there is a need to solve additional equations; for example, transport equations and equations for estimating parameter values that produce the closest match between model-calculated heads and flows and measured values. This report documents a new version of MODFLOW, called MODFLOW-2000, which is designed to accommodate the solution of equations in addition to the ground-water flow equation. This report is a user's manual. It contains an overview of the old and added design concepts, documents one new package, and contains input instructions for using the model to solve the ground-water flow equation.

An Updated Site Scale Saturated Zone Ground Water Transport Model For Yucca Mountain

International Nuclear Information System (INIS)

S. Kelkar; H. Viswanathan; A. Eddebbarrh; M. Ding; P. Reimus; B. Robinson; B. Arnold; A. Meijer

2006-01-01

The Yucca Mountain site scale saturated zone transport model has been revised to incorporate the updated flow model based on a hydrogeologic framework model using the latest lithology data, increased grid resolution that better resolves the geology within the model domain, updated Kd distributions for radionuclides of interest, and updated retardation factor distributions for colloid filtration. The resulting numerical transport model is used for performance assessment predictions of radionuclide transport and to guide future data collection and modeling activities. The transport model results are validated by comparing the model transport pathways with those derived from geochemical data, and by comparing the transit times from the repository footprint to the compliance boundary at the accessible environment with those derived from 14 C-based age estimates. The transport model includes the processes of advection, dispersion, fracture flow, matrix diffusion, sorption, and colloid-facilitated transport. The transport of sorbing radionuclides in the aqueous phase is modeled as a linear, equilibrium process using the Kd model. The colloid-facilitated transport of radionuclides is modeled using two approaches: the colloids with irreversibly embedded radionuclides undergo reversible filtration only, while the migration of radionuclides that reversibly sorb to colloids is modeled with modified values for sorption coefficient and matrix diffusion coefficients. Model breakthrough curves for various radionuclides at the compliance boundary are presented along with their sensitivity to various parameters

Launch and Landing Effects Ground Operations (LLEGO) Model

Science.gov (United States)

2008-01-01

LLEGO is a model for understanding recurring launch and landing operations costs at Kennedy Space Center for human space flight. Launch and landing operations are often referred to as ground processing, or ground operations. Currently, this function is specific to the ground operations for the Space Shuttle Space Transportation System within the Space Shuttle Program. The Constellation system to follow the Space Shuttle consists of the crewed Orion spacecraft atop an Ares I launch vehicle and the uncrewed Ares V cargo launch vehicle. The Constellation flight and ground systems build upon many elements of the existing Shuttle flight and ground hardware, as well as upon existing organizations and processes. In turn, the LLEGO model builds upon past ground operations research, modeling, data, and experience in estimating for future programs. Rather than to simply provide estimates, the LLEGO model s main purpose is to improve expenses by relating complex relationships among functions (ground operations contractor, subcontractors, civil service technical, center management, operations, etc.) to tangible drivers. Drivers include flight system complexity and reliability, as well as operations and supply chain management processes and technology. Together these factors define the operability and potential improvements for any future system, from the most direct to the least direct expenses.

Summary of ground water and surface water flow and contaminant transport computer codes used at the Idaho National Engineering Laboratory (INEL)

International Nuclear Information System (INIS)

Bandy, P.J.; Hall, L.F.

1993-03-01

This report presents information on computer codes for numerical and analytical models that have been used at the Idaho National Engineering Laboratory (INEL) to model ground water and surface water flow and contaminant transport. Organizations conducting modeling at the INEL include: EG ampersand G Idaho, Inc., US Geological Survey, and Westinghouse Idaho Nuclear Company. Information concerning computer codes included in this report are: agency responsible for the modeling effort, name of the computer code, proprietor of the code (copyright holder or original author), validation and verification studies, applications of the model at INEL, the prime user of the model, computer code description, computing environment requirements, and documentation and references for the computer code

Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

Science.gov (United States)

Carl, J. G.; Furukawa, S.

1975-01-01

A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

A state-of-the-art review of transportation systems evaluation techniques relevant to air transportation, volume 1. [urban planning and urban transportation using decision theory

Science.gov (United States)

Haefner, L. E.

1975-01-01

Mathematical and philosophical approaches are presented for evaluation and implementation of ground and air transportation systems. Basic decision processes are examined that are used for cost analyses and planning (i.e, statistical decision theory, linear and dynamic programming, optimization, game theory). The effects on the environment and the community that a transportation system may have are discussed and modelled. Algorithmic structures are examined and selected bibliographic annotations are included. Transportation dynamic models were developed. Citizen participation in transportation projects (i.e, in Maryland and Massachusetts) is discussed. The relevance of the modelling and evaluation approaches to air transportation (i.e, airport planning) is examined in a case study in St. Louis, Missouri.

Patients in prehospital transport to the emergency department

DEFF Research Database (Denmark)

Bech, Camilla Louise Nørgaard; Brabrand, Mikkel; Mikkelsen, Søren

2018-01-01

in the prehospital setting and 7-day mortality. RESULTS: A total of 32 076 ambulance transfers were recorded. Of these, 20 328 were first-time transfers, including 2692 that received assistance from a physician-staffed mobile emergency care unit (MECU). The 7-day mortality was 5.3% [95% confidence interval (CI): 5...... the strongest association (OR: 17, 95% CI: 14.7-19.7). MECU assistance showed an adjusted OR of 5.3 (95% CI: 4.6-6.1). CONCLUSION: The overall 7-day mortality was 5.3%, but differed in the two subgroups, with 15.4% in the MECU-assisted ambulance transfers and 3.8% in non-MECU-assisted transfers. Older age...

Semi-Automated Analysis of Diaphragmatic Motion with Dynamic Magnetic Resonance Imaging in Healthy Controls and Non-Ambulant Subjects with Duchenne Muscular Dystrophy

Directory of Open Access Journals (Sweden)

Courtney A. Bishop

2018-01-01

Full Text Available Subjects with Duchenne Muscular Dystrophy (DMD suffer from progressive muscle damage leading to diaphragmatic weakness that ultimately requires ventilation. Emerging treatments have generated interest in better characterizing the natural history of respiratory impairment in DMD and responses to therapy. Dynamic (cine Magnetic Resonance Imaging (MRI may provide a more sensitive measure of diaphragm function in DMD than the commonly used spirometry. This study presents an analysis pipeline for measuring parameters of diaphragmatic motion from dynamic MRI and its application to investigate MRI measures of respiratory function in both healthy controls and non-ambulant DMD boys. We scanned 13 non-ambulant DMD boys and 10 age-matched healthy male volunteers at baseline, with a subset (n = 10, 10, 8 of the DMD subjects also assessed 3, 6, and 12 months later. Spirometry-derived metrics including forced vital capacity were recorded. The MRI-derived measures included the lung cross-sectional area (CSA, the anterior, central, and posterior lung lengths in the sagittal imaging plane, and the diaphragm length over the time-course of the dynamic MRI. Regression analyses demonstrated strong linear correlations between lung CSA and the length measures over the respiratory cycle, with a reduction of these correlations in DMD, and diaphragmatic motions that contribute less efficiently to changing lung capacity in DMD. MRI measures of pulmonary function were reduced in DMD, controlling for height differences between the groups: at maximal inhalation, the maximum CSA and the total distance of motion of the diaphragm were 45% and 37% smaller. MRI measures of pulmonary function were correlated with spirometry data and showed relationships with disease progression surrogates of age and months non-ambulatory, suggesting that they provide clinically meaningful information. Changes in the MRI measures over 12 months were consistent with weakening of

High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie

2009-01-01

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....... SETTING: An acute 20-bed orthopaedic hip fracture unit. SUBJECTS: Fifty consecutive patients with a median age of 83 (25-75% quartile, 68-86) years. INTERVENTIONS: The CAS, which describes the patient's independency in three activities - (1) getting in and out of bed, (2) sit to stand from a chair, and (3...

Ground-water contribution to dose from past Hanford Operations

International Nuclear Information System (INIS)

Freshley, M.D.; Thorne, P.D.

1992-08-01

The Hanford Environmental Dose Reconstruction (HEDR) Project is being conducted to estimate radiation doses that populations and individuals could have received from Hanford Site operations from 1944 to the present. Four possible pathways by which radionuclides migrating in ground water on the Hanford Site could have reached the public have been identified: (1) through contaminated ground water migrating to the Columbia River; (2) through wells on or adjacent to the Hanford Site; (3) through wells next to the Columbia River downstream of Hanford that draw some or all of their water from the river (riparian wells); and (4) through atmospheric deposition resulting in contamination of a small watershed that, in turn, results in contamination of a shallow well or spring by transport in the ground water. These four pathways make up the ''ground-water pathway,'' which is the subject of this study. Assessment of the ground-water pathway was performed by (1) reviewing the existing extensive literature on ground water and ground-water monitoring at Hanford and (2) performing calculations to estimate radionuclide concentrations where no monitoring data were collected. Radiation doses that would result from exposure to these radionuclides were calculated

Experimental Investigation of a Wing-in-Ground Effect Craft

Directory of Open Access Journals (Sweden)

M. Mobassher Tofa

2014-01-01

Full Text Available The aerodynamic characteristics of the wing-in-ground effect (WIG craft model that has a noble configuration of a compound wing was experimentally investigated and Universiti Teknologi Malaysia (UTM wind tunnel with and without endplates. Lift and drag forces, pitching moment coefficients, and the centre of pressure were measured with respect to the ground clearance and the wing angle of attack. The ground effect and the existence of the endplates increase the wing lift-to-drag ratio at low ground clearance. The results of this research work show new proposed design of the WIG craft with compound wing and endplates, which can clearly increase the aerodynamic efficiency without compromising the longitudinal stability. The use of WIG craft is representing an ambitious technology that will help in reducing time, effort, and money of the conventional marine transportation in the future.

Experimental investigation of a wing-in-ground effect craft.

Science.gov (United States)

Tofa, M Mobassher; Maimun, Adi; Ahmed, Yasser M; Jamei, Saeed; Priyanto, Agoes; Rahimuddin

2014-01-01

The aerodynamic characteristics of the wing-in-ground effect (WIG) craft model that has a noble configuration of a compound wing was experimentally investigated and Universiti Teknologi Malaysia (UTM) wind tunnel with and without endplates. Lift and drag forces, pitching moment coefficients, and the centre of pressure were measured with respect to the ground clearance and the wing angle of attack. The ground effect and the existence of the endplates increase the wing lift-to-drag ratio at low ground clearance. The results of this research work show new proposed design of the WIG craft with compound wing and endplates, which can clearly increase the aerodynamic efficiency without compromising the longitudinal stability. The use of WIG craft is representing an ambitious technology that will help in reducing time, effort, and money of the conventional marine transportation in the future.

The roles of transportation and transportation hubs in the propagation of influenza and coronaviruses: a systematic review.

Science.gov (United States)

Browne, Annie; Ahmad, Sacha St-Onge; Beck, Charles R; Nguyen-Van-Tam, Jonathan S

2016-01-01

Respiratory viruses spread in humans across wide geographical areas in short periods of time, resulting in high levels of morbidity and mortality. We undertook a systematic review to assess the evidence that air, ground and sea mass transportation systems or hubs are associated with propagating influenza and coronaviruses. Healthcare databases and sources of grey literature were searched using pre-defined criteria between April and June 2014. Two reviewers screened all identified records against the protocol, undertook risk of bias assessments and extracted data using a piloted form. Results were analysed using a narrative synthesis. Forty-one studies met the eligibility criteria. Risk of bias was high in the observational studies, moderate to high in the reviews and moderate to low in the modelling studies. In-flight influenza transmission was identified substantively on five flights with up to four confirmed and six suspected secondary cases per affected flight. Five studies highlighted the role of air travel in accelerating influenza spread to new areas. Influenza outbreaks aboard cruise ships affect 2-7% of passengers. Influenza transmission events have been observed aboard ground transport vehicles. High heterogeneity between studies and the inability to exclude other sources of infection means that the risk of influenza transmission from an index case to other passengers cannot be accurately quantified. A paucity of evidence was identified describing severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus transmission events associated with transportation systems or hubs. Air transportation appears important in accelerating and amplifying influenza propagation. Transmission occurs aboard aeroplanes, at the destination and possibly at airports. Control measures to prevent influenza transmission on cruise ships are needed to reduce morbidity and mortality. There is no recent evidence of sea transport accelerating influenza

TNX Burying Ground: Environmental information document

International Nuclear Information System (INIS)

Dunaway, J.K.W.; Johnson, W.F.; Kingley, L.E.; Simmons, R.V.; Bledsoe, H.W.

1987-03-01

The TNX Burying Ground, located within the TNX Area of the Savannah River Plant (SRP), was originally built to dispose of debris from an experimental evaporator explosion at TNX in 1953. This evaporator contained approximately 590 kg of uranyl nitrate. From 1980 to 1984, much of the waste material buried at TNX was excavated and sent to the SRP Radioactive Waste Burial Grounds for reburial. An estimated 27 kg of uranyl nitrate remains buried at TNX. The TNX Burying Ground consists of three sites known to contain waste and one site suspected of containing waste material. All four sites are located within the TNX security fenceline. Groundwater at the TNX Burying Ground was not evaluated because there are no groundwater monitoring wells installed in the immediate vicinity of this waste site. The closure options considered for the TNX Burying Ground are waste removal and closure, no waste removal and closure, and no action. The predominant pathways for human exposure to chemical and/or radioactive constituents are through surface, subsurface, and atmospheric transport. Modeling calculations were made to determine the risks to human population via these general pathways for the three postulated closure options. An ecological assessment was conducted to predict the environmental impacts on aquatic and terrestrial biota. The relative costs for each of the closure options were estimated

River as a part of ground battlefield

Science.gov (United States)

Vračar, Miodrag S.; Pokrajac, Ivan; Okiljević, Predrag

2013-05-01

The rivers are in some circumstances part of the ground battlefield. Microseisms induced at the riverbed or ground at the river surrounding might be consequence of military activities (military ground transports, explosions, troop's activities, etc). Vibrations of those fluid-solid structures are modeled in terms of solid displacement and change of fluid pressure. This time varying fluid pressure in river, which originates from ground microseisms, is possible to detect with hydrophones. Therefore, hydroacoustic measurements in rivers enables detecting, identification and localization various types of military noisy activities at the ground as and those, which origin is in the river water (hydrodynamics of water flow, wind, waves, river vessels, etc). In this paper are presented river ambient noise measurements of the three great rivers: the Danube, the Sava and the Tisa, which flows in north part of Serbia in purpose to establish limits in detection of the ground vibrations in relatively wide frequency range from zero to 20 kHz. To confirm statement that the river is a part of ground battlefield, and that hydroacoustic noise is possible to use in detecting and analyzing ground microseisms induced by civil or military activities, some previous collected data of hydroacoustic noise measurement in the rivers are used. The data of the river ambient noise include noise induced by civil engineering activities, that ordinary take place in large cities, noise that produced ships and ambient noise of the river when human activities are significantly reduced. The poly spectral method was used in analysis such events.

Uranium-series isotopes transport in surface, vadose and ground waters at San Marcos uranium bearing basin, Chihuahua, Mexico

International Nuclear Information System (INIS)

Burillo Montúfar, Juan Carlos; Reyes Cortés, Manuel; Reyes Cortés, Ignacio Alfonso; Espino Valdez, Ma. Socorro; Hinojosa de la Garza, Octavio Raúl; Nevárez Ronquillo, Diana Pamela; Herrera Peraza, Eduardo; Rentería Villalobos, Marusia; Montero Cabrera, María Elena

2012-01-01

In the U deposit area at San Marcos in Chihuahua, Mexico, hydrogeological and climatic conditions are very similar to the Nopal I, Peña Blanca U deposit, 50 km away. The physicochemical parameters and activity concentrations of several 238 U-series isotopes have been determined in surface, vadose and ground waters at San Marcos. The application of some published models to activity ratios of these isotopes has allowed assessing the order of magnitude of transport parameters in the area. Resulting retardation factors in San Marcos area are R f238 ≈ 250–14,000 for the unsaturated zone and ≈110–1100 for the saturated zone. The results confirm that the mobility of U in San Marcos is also similar to that of the Nopal I U deposit and this area can be considered as a natural analog of areas suitable for geologic repositories of high-level nuclear waste.

Component design challenges for the ground-based SP-100 nuclear assembly test

International Nuclear Information System (INIS)

Markley, R.A.; Disney, R.K.; Brown, G.B.

1989-01-01

The SP-100 ground engineering system (GES) program involves a ground test of the nuclear subsystems to demonstrate their design. The GES nuclear assembly test (NAT) will be performed in a simulated space environment within a vessel maintained at ultrahigh vacuum. The NAT employs a radiation shielding system that is comprised of both prototypical and nonprototypical shield subsystems to attenuate the reactor radiation leakage and also nonprototypical heat transport subsystems to remove the heat generated by the reactor. The reactor is cooled by liquid lithium, which will operate at temperatures prototypical of the flight system. In designing the components for these systems, a number of design challenges were encountered in meeting the operational requirements of the simulated space environment (and where necessary, prototypical requirements) while also accommodating the restrictions of a ground-based test facility with its limited available space. This paper presents a discussion of the design challenges associated with the radiation shield subsystem components and key components of the heat transport systems

Police Mental Health Partnership project: Police Ambulance Crisis Emergency Response (PACER) model development.

Science.gov (United States)

Huppert, David; Griffiths, Matthew

2015-10-01

To review internationally recognized models of police interactions with people experiencing mental health crises that are sometimes complex and associated with adverse experience for the person in crisis, their family and emergency service personnel. To develop, implement and review a partnership model trial between mental health and emergency services that offers alternative response pathways with improved outcomes in care. Three unique models of police and mental health partnership in the USA were reviewed and used to develop the PACER (Police Ambulance Crisis Emergency Response) model. A three month trial of the model was implemented and evaluated. Significant improvements in response times, the interactions with and the outcomes for people in crisis were some of the benefits shown when compared with usual services. The pilot showed that a partnership involving mental health and police services in Melbourne, Australia could be replicated based on international models. Initial data supported improvements compared with usual care. Further data collection regarding usual care and this new model is required to confirm observed benefits. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Near-ground ozone source attributions and outflow in central eastern China during MTX2006

Science.gov (United States)

Li, J.; Wang, Z.; Akimoto, H.; Yamaji, K.; Takigawa, M.; Pochanart, P.; Liu, Y.; Tanimoto, H.; Kanaya, Y.

2008-12-01

A 3-D regional chemical transport model, the Nested Air Quality Prediction Model System (NAQPMS), with an on-line tracer tagging module was used to study the source of the near-ground (pollutants, and it captured highly polluted and clean cases well. The simulated near-ground ozone level over CEC was 60-85 ppbv (parts per billion by volume), which was higher than values in Japan and over the North Pacific (20-50 ppbv). The simulated tagged tracer data indicated that the regional-scale transport of chemically produced ozone over other areas in CEC contributed to the greatest fraction (49%) of the near-ground mean ozone at Mt. Tai in June; in situ photochemistry contributed only 12%. Due to high anthropogenic and biomass burning emissions that occurred in the southern part of the CEC, the contribution to ground ozone levels from this area played the most important role (32.4 ppbv, 37.9% of total ozone) in the monthly mean ozone concentration at Mt. Tai; values reached 59 ppbv (62%) on 6-7 June 2006. The monthly mean horizontal distribution of chemically produced ozone from various ozone production regions indicated that photochemical reactions controlled the spatial distribution of O3 over CEC. The regional-scale transport of pollutants also played an important role in the spatial and temporal distribution of ozone over CEC. Chemically produced ozone from the southern part of the study region can be transported northeastwardly to the northern rim of CEC; the mean contribution was 5-10 ppbv, and it reached 25 ppbv during high ozone events. Studies of the outflow of CEC ozone and its precursors, as well as their influences and contributions to the ozone level over adjacent regions/countries, revealed that the contribution of CEC ozone to mean ozone mixing ratios over the Korean Peninsula and Japan was 5-15 ppbv, of which about half was due to the direct transport of ozone from CEC and half was produced locally by ozone precursors transported from CEC.

Are they really refusing to travel? A qualitative study of prehospital records

Directory of Open Access Journals (Sweden)

Christopher Sarah

2006-09-01

Full Text Available Abstract Background Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county. Methods Written records made by ambulance crews for patients (n = 397 who were not transported to hospital following an emergency call-out during October 2004 were retrospectively analysed. Results Twelve main themes emerged for RTT which included non injury or minor injury, falls and recovery after treatment on scene; other themes included alternative supervision, follow-up and treatment arrangements or patients arranging their own transport. Importantly, only 8% of the sample was recorded by ambulance crews as truly refusing to travel against advice. Conclusion A system that facilitates standardised recording of RTT information including social reasons for non-transportation needs to be designed. 'Refused to travel' disclaimers need to reflect instances when crew and patient are satisfied that not going to hospital is the right outcome. These recommendations should be considered within the context of the plans for widening the role of ambulance services.

Violence against ambulance personnel: a retrospective cohort study of national data from Safe Work Australia

Directory of Open Access Journals (Sweden)

Brian J Maguire

2018-03-01

Full Text Available Objectives and importance: Paramedics have high rates of occupational injury and fatality. The objective of this study is to describe their specific risks of violence-related injury. Study type: This retrospective cohort study is an examination of retrospective data provided by Safe Work Australia (SWA. Methods: An examination of the 300 cases of serious claims of injury related to assaults, violence, harassment and bullying that occurred among individuals identified as ambulance officers and paramedics in Australia from 2001 to 2014. Paramedic risks likely vary by exposures such as hours worked and call volume. To examine how those exposures may influence risk, the available data were used to estimate rates based on hours worked and call volume. Results: The data show that, for serious injuries among paramedics in Australia between 2001 and 2014, the total number of violence-related cases increased from 5 to 40 per year; the number of cases of injury secondary to assault tripled from 10 to 30; and the rate of cases by call volume doubled from 6 to 12. The cost of these injuries was approximately AUD$250 000 for the year 2013–14. The median time at work lost per individual case of ‘work-related harassment and/or workplace bullying’ was 9.6 weeks. Although females comprised 32% of the paramedic workforce, they were the victims in 42% of cases of exposure to violence and 40% of harassment cases. Conclusions: Although anecdotal reports indicate that some interventions have been attempted, violence against paramedics continues to be a growing problem in Australia. The data presented in this study allow for a better understanding of the problem and can support efforts by ambulance service administrators, physicians, paramedics and university researchers to work together to develop and publish evidence based, cost-effective solutions to reduce the risk of workplace violence. Effective solutions will likely be multifaceted and include training

Coupling of transport and geochemical models

International Nuclear Information System (INIS)

Noy, D.J.

1986-01-01

This report considers mass transport in the far-field of a radioactive waste repository, and detailed geochemical modelling of the ground-water in the near-field. A parallel approach to this problem of coupling transport and geochemical codes is the subject of another CEC report (ref. EUR 10226). Both studies were carried out in the framework of the CEC project MIRAGE. (Migration of radionuclides in the geosphere)

Environmental isotopes as early warning tools to control the abstraction of deep ground waters

International Nuclear Information System (INIS)

Seiler, K.P.; Maloszewski, P.; Weise, S.M.; Loosli, H.H.

1999-01-01

Early warning system for the exploitation of ground water from the passive zone can not be based on the measurement of pollutant concentrations itself. The environmental tracer data are suggested to be used as indicators for changes in conservative mass transport processes from shallow to deep or very deep to deep ground waters

Approach for delineation of contributing areas and zones of transport to selected public-supply wells using a regional ground-water flow model, Palm Beach County, Florida

Science.gov (United States)

Renken, R.A.; Patterson, R.D.; Orzol, L.L.; Dixon, Joann

2001-01-01

Rapid urban development and population growth in Palm Beach County, Florida, have been accompanied with the need for additional freshwater withdrawals from the surficial aquifer system. To maintain water quality, County officials protect capture areas and determine zones of transport of municipal supply wells. A multistep process was used to help automate the delineation of wellhead protection areas. A modular ground-water flow model (MODFLOW) Telescopic Mesh Refinement program (MODTMR) was used to construct an embedded flow model and combined with particle tracking to delineate zones of transport to supply wells; model output was coupled with a geographic information system. An embedded flow MODFLOW model was constructed using input and output file data from a preexisting three-dimensional, calibrated model of the surficial aquifer system. Three graphical user interfaces for use with the geographic information software, ArcView, were developed to enhance the telescopic mesh refinement process. These interfaces include AvMODTMR for use with MODTMR; AvHDRD to build MODFLOW river and drain input files from dynamically segmented linear (canals) data sets; and AvWELL Refiner, an interface designed to examine and convert well coverage spatial data layers to a MODFLOW Well package input file. MODPATH (the U.S. Geological Survey particle-tracking postprocessing program) and MODTOOLS (the set of U.S. Geological Survey computer programs to translate MODFLOW and MODPATH output to a geographic information system) were used to map zones of transport. A steady-state, five-layer model of the Boca Raton area was created using the telescopic mesh refinement process and calibrated to average conditions during January 1989 to June 1990. A sensitivity analysis of various model parameters indicates that the model is most sensitive to changes in recharge rates, hydraulic conductivity for layer 1, and leakance for layers 3 and 4 (Biscayne aquifer). Recharge (58 percent); river (canal

Organic Wastewater Compounds, Pharmaceuticals, andColiphage in Ground Water Receiving Discharge from OnsiteWastewater Treatment Systems near La Pine, Oregon:Occurrence and Implications for Transport

Science.gov (United States)

Hinkle, Stephen J.; Weick, Rodney J.; Johnson, Jill M.; Cahill, Jeffery D.; Smith, Steven G.; Rich, Barbara J.

2005-01-01

The occurrence of organic wastewater compounds (components of 'personal care products' and other common household chemicals), pharmaceuticals (human prescription and nonprescription medical drugs), and coliphage (viruses that infect coliform bacteria, and found in high concentrations in municipal wastewater) in onsite wastewater (septic tank effluent) and in a shallow, unconfined, sandy aquifer that serves as the primary source of drinking water for most residents near La Pine, Oregon, was documented. Samples from two types of observation networks provided basic occurrence data for onsite wastewater and downgradient ground water. One observation network was a group of 28 traditional and innovative (advanced treatment) onsite wastewater treatment systems and associated downgradient drainfield monitoring wells, referred to as the 'innovative systems network'. The drainfield monitoring wells were located adjacent to or under onsite wastewater treatment system drainfield lines. Another observation network, termed the 'transect network', consisted of 31 wells distributed among three transects of temporary, stainless-steel-screened, direct-push monitoring wells installed along three plumes of onsite wastewater. The transect network, by virtue of its design, also provided a basis for increased understanding of the transport of analytes in natural systems. Coliphage were frequently detected in onsite wastewater. Coliphage concentrations in onsite wastewater were highly variable, ranging from less than 1 to 3,000,000 plaque forming units per 100 milliliters. Coliphage were occasionally detected (eight occurrences) at low concentrations in samples from wells located downgradient from onsite wastewater treatment system drainfield lines. However, coliphage concentrations were below method detection limits in replicate or repeat samples collected from the eight sites. The consistent absence of coliphage detections in the replicate or repeat samples is interpreted to indicate

Impact of an implanted neuroprosthesis on community ambulation in incomplete SCI.

Science.gov (United States)

Lombardo, Lisa M; Kobetic, Rudolf; Pinault, Gilles; Foglyano, Kevin M; Bailey, Stephanie N; Selkirk, Stephen; Triolo, Ronald J

2018-03-01

Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). Single subject research design with repeated measures. Hospital-based biomechanics laboratory and user assessment of community use. Female with C6 AIS C SCI 30 years post injury. Lower extremity muscle activation with an implanted pulse generator and gait training. Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.

Objectively measured work load, health status and sickness absence among Danish ambulance personnel. A longitudinal study

DEFF Research Database (Denmark)

Hansen, Claus D.

2013-01-01

Background: Reviews show that ambulance personnel (AP) have an increased risk of work-related health problems especially musculoskeletal disorders. Because of the unpredictable character of the AP’s work environment, standard measures of work environment exposures are imprecise. The aim...... of this presentation is to examine the associations between objectively measured work load taken from the company register, health and long-term sickness absence (LTSA) in 1-year follow up period. Methods: Data is taken from the first round of MARS – Men, accidents, risk and safety, a two wave panel study of AP...... workers in Denmark (n = 1606) collected in winter 2010/11. The response rate to the questionnaire was 62% in the baseline. The respondents were asked about health status, physical (DMQ) and psychosocial work environment factors (COPSOQ). Information from the company register about work load (e.g. mean...

An effective support system of emergency medical services with tablet computers.

Science.gov (United States)

Yamada, Kosuke C; Inoue, Satoshi; Sakamoto, Yuichiro

2015-02-27

There were over 5,000,000 ambulance dispatches during 2010 in Japan, and the time for transportation has been increasing, it took over 37 minutes from dispatch to the hospitals. A way to reduce transportation time by ambulance is to shorten the time of searching for an appropriate facility/hospital during the prehospital phase. Although the information system of medical institutions and emergency medical service (EMS) was established in 2003 in Saga Prefecture, Japan, it has not been utilized efficiently. The Saga Prefectural Government renewed the previous system in an effort to make it the real-time support system that can efficiently manage emergency demand and acceptance for the first time in Japan in April 2011. The objective of this study was to evaluate if the new system promotes efficient emergency transportation for critically ill patients and provides valuable epidemiological data. The new system has provided both emergency personnel in the ambulance, or at the scene, and the medical staff in each hospital to be able to share up-to-date information about available hospitals by means of cloud computing. All 55 ambulances in Saga are equipped with tablet computers through third generation/long term evolution networks. When the emergency personnel arrive on the scene and discern the type of patient's illness, they can search for an appropriate facility/hospital with their tablet computer based on the patient's symptoms and available medical specialists. Data were collected prospectively over a three-year period from April 1, 2011 to March 31, 2013. The transportation time by ambulance in Saga was shortened for the first time since the statistics were first kept in 1999; the mean time was 34.3 minutes in 2010 (based on administrative statistics) and 33.9 minutes (95% CI 33.6-34.1) in 2011. The ratio of transportation to the tertiary care facilities in Saga has decreased by 3.12% from the year before, 32.7% in 2010 (regional average) and 29.58% (9085

Leg Lengthening as a Means of Improving Ambulation Following an Internal Hemipelvectomy

Directory of Open Access Journals (Sweden)

Wakyo Sato

2016-01-01

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.

Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments.

Science.gov (United States)

Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip

2012-01-01

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.

Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

Science.gov (United States)

Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

2015-02-27

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 Tweather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

High-speed civil transport issues and technology program

Science.gov (United States)

Hewett, Marle D.

1992-01-01

A strawman program plan is presented, consisting of technology developments and demonstrations required to support the construction of a high-speed civil transport. The plan includes a compilation of technology issues related to the development of a transport. The issues represent technical areas in which research and development are required to allow airframe manufacturers to pursue an HSCT development. The vast majority of technical issues presented require flight demonstrated and validated solutions before a transport development will be undertaken by the industry. The author believes that NASA is the agency best suited to address flight demonstration issues in a concentrated effort. The new Integrated Test Facility at NASA Dryden Flight Research Facility is considered ideally suited to the task of supporting ground validations of proof-of-concept and prototype system demonstrations before night demonstrations. An elaborate ground hardware-in-the-loop (iron bird) simulation supported in this facility provides a viable alternative to developing an expensive fill-scale prototype transport technology demonstrator. Drygen's SR-71 assets, modified appropriately, are a suitable test-bed for supporting flight demonstrations and validations of certain transport technology solutions. A subscale, manned or unmanned flight demonstrator is suitable for flight validation of transport technology solutions, if appropriate structural similarity relationships can be established. The author contends that developing a full-scale prototype transport technology demonstrator is the best alternative to ensuring that a positive decision to develop a transport is reached by the United States aerospace industry.

Crew Configuration, Ingress/Egress Procedures, and In-Flight Caregiving Capacity in a Space Ambulance Based on the Boeing X-37B

Science.gov (United States)

Halberg, Ephriam Etan

This study proposes that a Boeing X-37B space plane, its dimensions and performance characteristics estimated from publicly available documents, diagrams, and photographs, could be internally redesigned as a medical evacuation (ambulance) vehicle for the International Space Station. As of 2017, there is currently no spacecraft designed to accommodate a contingency medical evacuation wherein a crew member aboard the ISS is injured or ailing and must be returned to Earth for immediate medical attention. The X-37B is an unmanned vehicle with a history of success in both sub-orbital testing and all four of its long-duration orbital missions to date. Research conducted at UC Davis suggests that it is possible to retain the outer mold line of the X-37B while expanding the internal payload compartment to a volume sufficient for a crew of three--pilot, crew medical officer, and injured crew member--throughout ISS un-dock and atmospheric entry, descent, and landing. In addition to crew life support systems, this re-purposed X-37B, hereafter referred to as the X-37SA (Space Ambulance), includes medical equipment for stabilization of a patient in-transit. This study suggests an optimal, ergonomic crew configuration and berthing port location, procedures for microgravity ingress and 1G egress, a minimum medical equipment list and location within the crew cabin for the medical care and monitoring equipment. Conceptual crew configuration, ingress/egress procedures, and patient/equipment access are validated via physical simulation in a full-scale mockup of the proposed X-37SA crew cabin.

TFTR grounding scheme and ground-monitor system

International Nuclear Information System (INIS)

Viola, M.

1983-01-01

The Tokamak Fusion Test Reactor (TFTR) grounding system utilizes a single-point ground. It is located directly under the machine, at the basement floor level, and is tied to the building perimeter ground. Wired to this single-point ground, via individual 500 MCM insulated cables, are: the vacuum vessel; four toroidal field coil cases/inner support structure quadrants; umbrella structure halves; the substructure ring girder; radial beams and columns; and the diagnostic systems. Prior to the first machine operation, a ground-loop removal program was initiated. It required insulation of all hangers and supports (within a 35-foot radius of the center of the machine) of the various piping, conduits, cable trays, and ventilation systems. A special ground-monitor system was designed and installed. It actively monitors each of the individual machine grounds to insure that there are no inadvertent ground loops within the machine structure or its ground and that the machine grounds are intact prior to each pulse. The TFTR grounding system has proven to be a very manageable system and one that is easy to maintain

MODFLOW-2000, the U.S. Geological Survey Modular Ground-Water Model--Documentation of the SEAWAT-2000 Version with the Variable-Density Flow Process (VDF) and the Integrated MT3DMS Transport Process (IMT)

Science.gov (United States)

Langevin, Christian D.; Shoemaker, W. Barclay; Guo, Weixing

2003-01-01

SEAWAT-2000 is the latest release of the SEAWAT computer program for simulation of three-dimensional, variable-density, transient ground-water flow in porous media. SEAWAT-2000 was designed by combining a modified version of MODFLOW-2000 and MT3DMS into a single computer program. The code was developed using the MODFLOW-2000 concept of a process, which is defined as ?part of the code that solves a fundamental equation by a specified numerical method.? SEAWAT-2000 contains all of the processes distributed with MODFLOW-2000 and also includes the Variable-Density Flow Process (as an alternative to the constant-density Ground-Water Flow Process) and the Integrated MT3DMS Transport Process. Processes may be active or inactive, depending on simulation objectives; however, not all processes are compatible. For example, the Sensitivity and Parameter Estimation Processes are not compatible with the Variable-Density Flow and Integrated MT3DMS Transport Processes. The SEAWAT-2000 computer code was tested with the common variable-density benchmark problems and also with problems representing evaporation from a salt lake and rotation of immiscible fluids.

Forældres oplevelse af genindlæggelse af deres nyfødte barn efter ambulant fødsel

DEFF Research Database (Denmark)

Feenstra, Maria Monberg; Nilsson, Ingrid; Danbjørg, Dorthe Boe

. telefon i døgnets 24 timer. Derudover kommer familien til ambulant opfølgning på sygehuset 48-72 timer efter fødslen. Til trods for den tætte kontakt til sundhedspersonalet, oplever stadig flere familier at blive genindlagt kort tid efter udskrivelsen grundet komplikationer vedrørende deres nyfødte barns...... fødslen og hvis nyfødte barn blev genindlagt på grund af manglende trivsel, blev inviteret til at deltage i undersøgelsen. Forældre, der ikke talte dansk, norsk eller svensk blev ekskluderet. Familierne blev interviewet via telefon efter de havde haft 1. sundhedsplejerskebesøg efter genindlæggelsen. Mødre...

Hydrogeologic Settings and Ground-Water Flow Simulations for Regional Studies of the Transport of Anthropogenic and Natural Contaminants to Public-Supply Wells - Studies Begun in 2001

Science.gov (United States)

Paschke, Suzanne S.

2007-01-01

This study of the Transport of Anthropogenic and Natural Contaminants to public-supply wells (TANC study) is being conducted as part of the U.S. Geological Survey National Water Quality Assessment (NAWQA) Program and was designed to increase understanding of the most important factors to consider in ground-water vulnerability assessments. The seven TANC studies that began in 2001 used retrospective data and ground-water flow models to evaluate hydrogeologic variables that affect aquifer susceptibility and vulnerability at a regional scale. Ground-water flow characteristics, regional water budgets, pumping-well information, and water-quality data were compiled from existing data and used to develop conceptual models of ground-water conditions for each study area. Steady-state regional ground-water flow models were used to represent the conceptual models, and advective particle-tracking simulations were used to compute areas contributing recharge and traveltimes from recharge to selected public-supply wells. Retrospective data and modeling results were tabulated into a relational database for future analysis. Seven study areas were selected to evaluate a range of hydrogeologic settings and management practices across the Nation: the Salt Lake Valley, Utah; the Eagle Valley and Spanish Springs Valley, Nevada; the San Joaquin Valley, California; the Northern Tampa Bay region, Florida; the Pomperaug River Basin, Connecticut; the Great Miami River Basin, Ohio; and the Eastern High Plains, Nebraska. This Professional Paper Chapter presents the hydrogeologic settings and documents the ground-water flow models for each of the NAWQA TANC regional study areas that began work in 2001. Methods used to compile retrospective data, determine contributing areas of public-supply wells, and characterize oxidation-reduction (redox) conditions also are presented. This Professional Paper Chapter provides the foundation for future susceptibility and vulnerability analyses in the TANC

Towards a reference architecture for a collaborative intelligent transport system infrastructure

NARCIS (Netherlands)

Osório, A.L.; Afsarmanesh, H.; Camarinha-Matos, L.M.

2010-01-01

The intelligent transport systems, which aim at providing smarter transport infrastructures and sustainable mobility, are deeply grounded on the Information and Communication Technologies. Current trends in the development of integrated complex systems, such as integrated road/highway concessions

High spin polarization and the origin of unique ferromagnetic ground state in CuFeSb

International Nuclear Information System (INIS)

Sirohi, Anshu; Saha, Preetha; Gayen, Sirshendu; Gaurav, Abhishek; Jyotsna, Shubhra; Sheet, Goutam; Singh, Chandan K.; Kabir, Mukul; Thakur, Gohil S.; Haque, Zeba; Gupta, L. C.; Ganguli, Ashok K.

2016-01-01

CuFeSb is isostructural to the ferro-pnictide and chalcogenide superconductors and it is one of the few materials in the family that are known to stabilize in a ferromagnetic ground state. Majority of the members of this family are either superconductors or antiferromagnets. Therefore, CuFeSb may be used as an ideal source of spin polarized current in spin-transport devices involving pnictide and the chalcogenide superconductors. However, for that the Fermi surface of CuFeSb needs to be sufficiently spin polarized. In this paper we report direct measurement of transport spin polarization in CuFeSb by spin-resolved Andreev reflection spectroscopy. From a number of measurements using multiple superconducting tips we found that the intrinsic transport spin polarization in CuFeSb is high (∼47%). In order to understand the unique ground state of CuFeSb and the origin of large spin polarization at the Fermi level, we have evaluated the spin-polarized band structure of CuFeSb through first principles calculations. Apart from supporting the observed 47% transport spin polarization, such calculations also indicate that the Sb-Fe-Sb angles and the height of Sb from the Fe plane are strikingly different for CuFeSb than the equivalent parameters in other members of the same family thereby explaining the origin of the unique ground state of CuFeSb.

High spin polarization and the origin of unique ferromagnetic ground state in CuFeSb

Energy Technology Data Exchange (ETDEWEB)

Sirohi, Anshu; Saha, Preetha; Gayen, Sirshendu; Gaurav, Abhishek; Jyotsna, Shubhra; Sheet, Goutam, E-mail: goutam@iisermohali.ac.in [Department of Physical Sciences, Indian Institute of Science Education and Research Mohali, Sector 81, S. A. S. Nagar, Manauli PO 140306 (India); Singh, Chandan K.; Kabir, Mukul [Department of Physics, Indian Institute of Science Education and Research, Pune 411008 (India); Thakur, Gohil S.; Haque, Zeba; Gupta, L. C. [Department of Chemistry, Indian Institute of Technology, New Delhi 110016 (India); Ganguli, Ashok K. [Department of Chemistry, Indian Institute of Technology, New Delhi 110016 (India); Institute of Nano Science & Technology, Mohali 160064 (India)

2016-06-13

CuFeSb is isostructural to the ferro-pnictide and chalcogenide superconductors and it is one of the few materials in the family that are known to stabilize in a ferromagnetic ground state. Majority of the members of this family are either superconductors or antiferromagnets. Therefore, CuFeSb may be used as an ideal source of spin polarized current in spin-transport devices involving pnictide and the chalcogenide superconductors. However, for that the Fermi surface of CuFeSb needs to be sufficiently spin polarized. In this paper we report direct measurement of transport spin polarization in CuFeSb by spin-resolved Andreev reflection spectroscopy. From a number of measurements using multiple superconducting tips we found that the intrinsic transport spin polarization in CuFeSb is high (∼47%). In order to understand the unique ground state of CuFeSb and the origin of large spin polarization at the Fermi level, we have evaluated the spin-polarized band structure of CuFeSb through first principles calculations. Apart from supporting the observed 47% transport spin polarization, such calculations also indicate that the Sb-Fe-Sb angles and the height of Sb from the Fe plane are strikingly different for CuFeSb than the equivalent parameters in other members of the same family thereby explaining the origin of the unique ground state of CuFeSb.

Chemical mechanisms of 60Co transport in ground water from intermediate-level liquid waste trench 7: progress report for period ending June 30, 1975

International Nuclear Information System (INIS)

Means, J.L.; Crerar, D.A.; Duguid, J.O.

1976-11-01

A seep approximately 50 meters east of trench 7 within the ORNL restricted area contains 60 Co in concentrations of 10 4 to 10 6 dpm/g in the soil and 10 3 dpm/ml in the water. Traces of 125 Sb and various transuranics have also been detected in the soil. However, because the volume of water discharge from the seep is small, the total radionuclide contribution from the trench 7 area to White Oak Creek and the Clinch River is insignificant. The 60 Co is transported in the ground-water from the trench to the seep as organic complexes and is absorbed by manganese oxides and to a lesser extent by iron sesquioxides in the shale and soil. In the absence of these organic complexing agents, 60 Co mobilization would be negligible because the sediment absorption capacity for inorganic forms of 60 Co is extremely high. The primary objective of this study has been to investigate 60 Co transport and absorption mechanisms as observed in the study area. Because the organic complexing characteristics of transition metals and transuranics are similar, the mechanisms of 60 Co transport determined in this study may also apply to plutonium and other alpha-emitters. Also the experimental and analytical methods employed in this study apply to the identification of other migrating radionuclide complexes from other disposal trenches and pits at ORNL. The increased knowledge of transport and adsorption mechanisms will provide insight into methods of controlling the movement of radionuclides from these and future disposal areas

Multidisciplinary Studies of the Fate and Transport of Contaminants in Ground Water at the U.S. Geological Survey Cape Cod Toxic Substances Hydrology Program Research Site, Massachusetts

Science.gov (United States)

Leblanc, D. R.; Smith, R. L.; Kent, D. B.; Barber, L. B.; Harvey, R. W.

2008-12-01

The U.S. Geological Survey conducts multidisciplinary research on the physical, chemical, and microbiological processes affecting ground-water contaminants of global concern at its Cape Cod Toxic Substances Hydrology Program site in Massachusetts, USA. The work centers on a 6-kilometer-long plume of treated wastewater in a glacial sand and gravel aquifer. The plume is characterized by distinct geochemical zones caused by the biodegradation of organic materials in treated wastewater that was disposed to the aquifer by rapid infiltration during the period 1936-95. A core group of hydrogeologists, geochemists, microbiologists, and geophysicists has been involved in the research effort for more than two decades. The effort has been enhanced by stable funding, a readily accessible site, a relatively simple hydrologic setting, and logistical support from an adjacent military base. The research team uses a three-part approach to plan and conduct research at the site. First, detailed spatial and temporal monitoring of the plume since the late 1970s provides field evidence of important contaminant-transport processes and provides the basis for multidisciplinary, process-oriented studies. Second, ground-water tracer experiments are conducted in various geochemical zones in the plume to study factors that control the rate and extent of contaminant transport. Several arrays of multilevel sampling devices, including an array with more than 15,000 individual sampling points, are used to conduct these experiments. Plume-scale (kilometers) and tracer-test-scale (1- 100 meters) studies are complemented by laboratory experiments and mathematical modeling of flow and reactive transport. Third, results are applied to the treated-wastewater plume, other contaminant plumes at the military base, and other sites nationally to evaluate the applicability of the findings and to point toward further research. Examples of findings to date include that (1) macrodispersivity can be related to

Workshop on technology issues of superconducting Maglev transportation systems

International Nuclear Information System (INIS)

Wegrzyn, J.E.; Shaw, D.T.

1991-01-01

There exists a critical need in the United States to improve its ground transportation system. One suggested system that offers many advantages over the current transportation infrastructure is Maglev. Maglev represents the latest evolution in very high and speed ground transportation, where vehicles are magnetically levitated, guided, and propelled over elevated guideways at speeds of 300 miles per hour. Maglev is not a new concept but is, however, receiving renewed interest. The objective of this workshop was to further promote these interest by bringing together a small group of specialists in Maglev technology to discuss Maglev research needs and to identify key research issues to the development of a successful Maglev system. The workshop was organized into four sessions based on the following technical areas: Materials, Testing, and Shielding; Magnet Design and Cryogenic Systems; Propulsion and Levitation Systems; and, System Control and Integration

Spacelab operations planning. [ground handling, launch, flight and experiments

Science.gov (United States)

Lee, T. J.

1976-01-01

The paper reviews NASA planning in the fields of ground, launch and flight operations and experiment integration to effectively operate Spacelab. Payload mission planning is discussed taking consideration of orbital analysis and the mission of a multiuser payload which may be either single or multidiscipline. Payload analytical integration - as active process of analyses to ensure that the experiment payload is compatible to the mission objectives and profile ground and flight operations and that the resource demands upon Spacelab can be satisfied - is considered. Software integration is touched upon and the major integration levels in ground operational processing of Spacelab and its experimental payloads are examined. Flight operations, encompassing the operation of the Space Transportation System and the payload, are discussed as are the initial Spacelab missions. Charts and diagrams are presented illustrating the various planning areas.

Active water exchange and life near the grounding line of an Antarctic outlet glacier

Science.gov (United States)

Sugiyama, Shin; Sawagaki, Takanobu; Fukuda, Takehiro; Aoki, Shigeru

2014-08-01

The grounding line (GL) of the Antarctic ice sheet forms the boundary between grounded and floating ice along the coast. Near this line, warm oceanic water contacts the ice shelf, producing the ice sheet's highest basal-melt rate. Despite the importance of this region, water properties and circulations near the GL are largely unexplored because in-situ observations are difficult. Here we present direct evidence of warm ocean-water transport to the innermost part of the subshelf cavity (several hundred meters seaward from the GL) of Langhovde Glacier, an outlet glacier in East Antarctica. Our measurements come from boreholes drilled through the glacier's ∼400-m-thick grounding zone. Beneath the grounding zone, we find a 10-24-m-deep water layer of uniform temperature and salinity (-1.45 °C; 34.25 PSU), values that roughly equal those measured in the ocean in front of the glacier. Moreover, living organisms are found in the thin subglacial water layer. These findings indicate active transport of water and nutrients from the adjacent ocean, meaning that the subshelf environment interacts directly and rapidly with the ocean.

Atomic carbon chains as spin-transmitters: An ab initio transport study

DEFF Research Database (Denmark)

Fürst, Joachim Alexander; Brandbyge, Mads; Jauho, Antti-Pekka

2010-01-01

An atomic carbon chain joining two graphene flakes was recently realized in a ground-breaking experiment by Jin et al. (Phys. Rev. Lett., 102 (2009) 205501). We present ab initio results for the electron transport properties of such chains and demonstrate complete spin-polarization of the transmi......An atomic carbon chain joining two graphene flakes was recently realized in a ground-breaking experiment by Jin et al. (Phys. Rev. Lett., 102 (2009) 205501). We present ab initio results for the electron transport properties of such chains and demonstrate complete spin...

Evacuation of a Tertiary Neonatal Centre: Lessons from the 2016 Kumamoto Earthquakes.

Science.gov (United States)

Iwata, Osuke; Kawase, Akihiko; Iwai, Masanori; Wada, Kazuko

2017-01-01

Newborn infants hospitalised in the neonatal intensive care unit (NICU) are vulnerable to natural disasters. However, publications on evacuation from NICUs are sparse. The 2016 Kumamoto Earthquakes caused serious damage to Kumamoto City Hospital and its level III regional core NICU. Local/neighbour NICU teams and the disaster-communication team of a neonatal academic society cooperated to evacuate 38 newborn infants from the ward. The aim of this paper was to highlight potential key factors to improve emergency NICU evacuation and coordination of hospital transportation following natural disasters. Background variables including clinical risk scores and timing/destination of transportation were compared between infants, who subsequently were transferred to destinations outside of Kumamoto Prefecture, and their peers. All but 1 of the infants were successfully evacuated from their NICU within 8 h. One very-low-birth-weight infant developed moderate hypothermia following transportation. Fourteen infants were transferred to NICUs outside of Kumamoto Prefecture, which was associated with the diagnosis of congenital heart disease, dependence on respiratory support, higher risk scores, and longer elapsed time from the decision to departure. There was difficulty in arranging helicopter transportation because the coordination office of the Disaster Medical Assistance Team had requisitioned most air/ground ambulances and only helped arrange ground transportations for 13 low-risk infants. Transportation for all 10 high-risk infants (risk scores greater than or equal to the upper quartile) was arranged by local/neighbour NICUs. Although the overall evacuation process was satisfactory, potential risks of relying on the adult-based emergency transportation system were highlighted. A better system needs to be developed urgently to put appropriate priority on vulnerable infants. © 2017 S. Karger AG, Basel.

Monitoring and characterization of radionuclide transport in the hydrogeologic system

International Nuclear Information System (INIS)

Phillips, S.J.; Raymond, J.R.

1975-01-01

The groundwater monitoring program provides information and data on groundwater quality required to evaluate the impact of waste disposal practices on the Hanford Reservation. The program includes: collection and analysis of groundwater samples on a routine basis; data processing, analysis and reporting; design, construction and maintenance of well sampling structures; and design and implementation of supporting research studies. Within the overall framework of the Groundwater Monitoring Program, the 300 Area and Wye Burial Ground Characterization Program was initiated to evaluate transport of radionuclides in the partially saturated zone above the water table and to provide site characterization at solid waste burial locations on the Reservation. Methods for collecting and analyzing program data include geophysical exploration by ground penetrating radar, refraction and reflection acoustics, magnetics, and metal detection; stratigraphic investigations by drilling and sample collection techniques; evaluation of transport phenomena by in situ psychrometric and gamma-neutron techniques; laboratory characterization of fluid and vapor transport-controlling mechanisms; and evaluation of biological radionuclide transport by organisms inhabiting contaminated areas

Using operations research to plan improvement of the transport of critically ill patients.

Science.gov (United States)

Chen, Jing; Awasthi, Anjali; Shechter, Steven; Atkins, Derek; Lemke, Linda; Fisher, Les; Dodek, Peter

2013-01-01

Operations research is the application of mathematical modeling, statistical analysis, and mathematical optimization to understand and improve processes in organizations. The objective of this study was to illustrate how the methods of operations research can be used to identify opportunities to reduce the absolute value and variability of interfacility transport intervals for critically ill patients. After linking data from two patient transport organizations in British Columbia, Canada, for all critical care transports during the calendar year 2006, the steps for transfer of critically ill patients were tabulated into a series of time intervals. Statistical modeling, root-cause analysis, Monte Carlo simulation, and sensitivity analysis were used to test the effect of changes in component intervals on overall duration and variation of transport times. Based on quality improvement principles, we focused on reducing the 75th percentile and standard deviation of these intervals. We analyzed a total of 3808 ground and air transports. Constraining time spent by transport personnel at sending and receiving hospitals was projected to reduce the total time taken by 33 minutes with as much as a 20% reduction in standard deviation of these transport intervals in 75% of ground transfers. Enforcing a policy of requiring acceptance of patients who have life- or limb-threatening conditions or organ failure was projected to reduce the standard deviation of air transport time by 63 minutes and the standard deviation of ground transport time by 68 minutes. Based on findings from our analyses, we developed recommendations for technology renovation, personnel training, system improvement, and policy enforcement. Use of the tools of operations research identifies opportunities for improvement in a complex system of critical care transport.

Monitoring and sampling perched ground water in a basaltic terrain

International Nuclear Information System (INIS)

Hubbell, J.M.

1990-01-01

Perched ground water zones can provide significant information on water and contaminant movement. This paper presents information about perched ground water obtained from drilling and monitoring at a hazardous and radioactive waste disposal site at the Idaho National Engineering Laboratory. Six of forty-five wells drilled at the Radioactive Waste Management Complex have detected perched water in basalts above sedimentary interbeds. This paper describes the distribution and characteristics of perched ground water. It discusses perched water below the surficial sediments in wells at the RWMC, the characteristics of chemical constituents found in perched water, the implications for contaminant transport in the unsaturated zone of water, and the lateral extent of perched water. Recommendations are made to increase the probability of detecting and sampling low yield perched water zones. 6 refs., 6 figs., 2 tabs

Automatic Barometric Updates from Ground-Based Navigational Aids

Science.gov (United States)

1990-03-12

ro fAutomatic Barometric Updates US Department from of Transportation Ground-Based Federal Aviation Administration Navigational Aids Office of Safety...tighter vertical spacing controls , particularly for operations near Terminal Control Areas (TCAs), Airport Radar Service Areas (ARSAs), military climb and...E.F., Ruth, J.C., and Williges, B.H. (1987). Speech Controls and Displays. In Salvendy, G., E. Handbook of Human Factors/Ergonomics, New York, John

Consistent treatment of ground deposition together with species growth and decay during atmospheric transport

International Nuclear Information System (INIS)

Murphy, B.D.; Nelson, C.B.; Ohr, S.Y.

1981-01-01

We discuss the adaptation of a trajectory model to an initial pollutant species and a series of successor species at mesoscale distances. The effect of source height is discussed since it is important in determining close-in ground level concentration, which influences plume depletion due to dry deposition. A scheme is outlined which handles deposition and species decay in a consistent manner and which does so for an arbitrary number of successor pollutant species. This scheme is discussed in terms of a Lagrangian trajectory model which accounts for initial source height and which calculates ground-level concentrations out to mesoscale distances

Bringing humanity into view: action research with Qatar's ambulance service.

Science.gov (United States)

Coleman, Gill; Wiggins, Liz

2017-08-21

Purpose The purpose of this paper is to argue for the widening of attention in healthcare improvement efforts, to include an awareness of the humanity of people who work in the sector and an appreciation of the part human connection plays in engagement around good quality work. Theoretical frameworks and research approaches which draw on action-based, interpretive and systemic thinking are proposed, as a complement to current practices. Design/methodology/approach The paper describes the early stages of an action research (AR) project, which used the appreciative inquiry "4D" framework to conduct participative inquiry in Hamad Medical Corporation's ambulance service in Qatar, in which staff became co-researchers. Findings The co-researchers were highly motivated to work with improvement goals as a result of their participation in the AR. They, and their managers, saw each other and the work in new ways and discovered that they had much to offer. Research limitations/implications This was a small-scale pilot project, from which findings must be considered tentative. The challenges of establishing good collaboration across language, culture and organisational divides are considerable. Practical implications Appreciative and action-oriented inquiry methods can serve not only to find things out, but also to highlight and give value to aspects of humanity in the workplace that are routinely left invisible in formal processes. This, in turn, can help with quality improvement. Originality/value This paper is a challenge to the orthodox way of viewing healthcare organisations, and improvement processes within them, as reliant on control rather than empowerment. An alternative is to actively include the agency, sense-making capacity and humanity of those involved.

Wind uplift of radioactive dust from the ground

International Nuclear Information System (INIS)

Makhon'ko, K.P.

1992-01-01

Near nuclear power plants the recontamination of the atmosphere near the ground becomes dangerous, if a radioactive zone has formed at the site. Wind can easily carry toxic dust from the polluted territory of neighboring industrial enterprises. Moreover, wind erosion of the soil during the summer or transport of radioactive snow by a snowstorm during the winter can displace the boundaries of the contaminated radioactive zone. In Russia the investigation of wind pickup of radioactive dust from the ground began after a radiation accident occurred at a storage facility in the Southern Urals in 1957, as a result of which a contaminated zone formed in the area. Since the direct mechanism of detachment of dust particles from the ground is not important in studying the results of the raising of radioactive dust into the atmosphere by wind, the authors do not distinguish between wind pickup and wind erosion, and the entire process wind pickup of radioactivity from the ground. After the radiation accident at the Chernobyl nuclear power plant a new generation of investigators began to study wind pickup of radioactive dust from the ground, and the process under consideration was sometimes referred to as wind uplift. The intensity of the process of wind pickup of radioactive dust from the ground is characterized by the wind pickup coefficient α, which is the coefficient of proportionality between the upward flux Q of radioactivity from the ground and the density A of radioactive contamination of the ground: α = Q/A. Physically, the coefficient α is the upward flux of the impurity from the ground with unit contamination density, i.e., the intensity of dust contamination or the fraction of radioactivity picked up by the wind from the ground per unit time. The greatest difficulty in determining α experimentally under dusty conditions is measuring correctly the upward radioactivity flux Q. The author discusses three methods for determining this quantity

Chemical mechanisms of /sup 60/Co transport in ground water from intermediate-level liquid waste trench 7: progress report for period ending June 30, 1975

Energy Technology Data Exchange (ETDEWEB)

Means, J.L.; Crerar, D.A.; Duguid, J.O.

1976-11-01

A seep approximately 50 meters east of trench 7 within the ORNL restricted area contains /sup 60/Co in concentrations of 10/sup 4/ to 10/sup 6/ dpm/g in the soil and 10/sup 3/ dpm/ml in the water. Traces of /sup 125/Sb and various transuranics have also been detected in the soil. However, because the volume of water discharge from the seep is small, the total radionuclide contribution from the trench 7 area to White Oak Creek and the Clinch River is insignificant. The /sup 60/Co is transported in the ground-water from the trench to the seep as organic complexes and is absorbed by manganese oxides and to a lesser extent by iron sesquioxides in the shale and soil. In the absence of these organic complexing agents, /sup 60/Co mobilization would be negligible because the sediment absorption capacity for inorganic forms of /sup 60/Co is extremely high. The primary objective of this study has been to investigate /sup 60/Co transport and absorption mechanisms as observed in the study area. Because the organic complexing characteristics of transition metals and transuranics are similar, the mechanisms of /sup 60/Co transport determined in this study may also apply to plutonium and other alpha-emitters. Also the experimental and analytical methods employed in this study apply to the identification of other migrating radionuclide complexes from other disposal trenches and pits at ORNL. The increased knowledge of transport and adsorption mechanisms will provide insight into methods of controlling the movement of radionuclides from these and future disposal areas.

Fate and transport of petroleum hydrocarbons in soil and ground water at Big South Fork National River and Recreation Area, Tennessee and Kentucky, 2002-2003

Science.gov (United States)

Williams, Shannon D.; Ladd, David E.; Farmer, James

2006-01-01

In 2002 and 2003, the U.S. Geological Survey (USGS), by agreement with the National Park Service (NPS), investigated the effects of oil and gas production operations on ground-water quality at Big South Fork National River and Recreation Area (BISO) with particular emphasis on the fate and transport of petroleum hydrocarbons in soils and ground water. During a reconnaissance of ground-water-quality conditions, samples were collected from 24 different locations (17 springs, 5 water-supply wells, 1 small stream, and 1 spring-fed pond) in and near BISO. Benzene, toluene, ethylbenzene, and xylene (BTEX) compounds were not detected in any of the water samples, indicating that no widespread contamination of ground-water resources by dissolved petroleum hydrocarbons probably exists at BISO. Additional water-quality samples were collected from three springs and two wells for more detailed analyses to obtain additional information on ambient water-quality conditions at BISO. Soil gas, soil, water, and crude oil samples were collected at three study sites in or near BISO where crude oil had been spilled or released (before 1993). Diesel range organics (DRO) were detected in soil samples from all three of the sites at concentrations greater than 2,000 milligrams per kilogram. Low concentrations (less than 10 micrograms per kilogram) of BTEX compounds were detected in lab-analyzed soil samples from two of the sites. Hydrocarbon-degrading bacteria counts in soil samples from the most contaminated areas of the sites were not greater than counts for soil samples from uncontaminated (background) sites. The elevated DRO concentrations, the presence of BTEX compounds, and the low number of -hydrocarbon-degrading bacteria in contaminated soils indicate that biodegradation of petroleum hydrocarbons in soils at these sites is incomplete. Water samples collected from the three study sites were analyzed for BTEX and DRO. Ground-water samples were collected from three small springs at the

Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected.

Science.gov (United States)

Vercruysse, Gary A; Friese, Randall S; Khalil, Mazhar; Ibrahim-Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; Tang, Andrew; O'Keeffe, Terrence; Kulvatunyou, Narong; Green, Donald J; Gries, Lynn; Joseph, Bellal; Rhee, Peter M

2015-03-01

Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground. We performed a 6-year (2007-2013) retrospective analysis of all trauma patients presenting to our center. Patients with a known mode of transfer were included in the study. Patients with missing data and those who were dead on arrival were excluded from the study. Patients were then dichotomized into helicopter transfer and ground transfer groups. A subanalysis was performed between minimally injured patients (ISS helicopter and 76.7% (3,992) were transferred via ground transport. Helicopter-transferred patients had longer hospital (p = 0.001) and intensive care unit (p = 0.001) stays. There was no difference in mortality between the groups (p = 0.6).On subanalysis of minimally injured patients there was no difference in hospital length of stay (p = 0.1) and early discharge (p = 0.6) between the helicopter transfer and ground transfer group. Average helicopter transfer cost at our center was $18,000, totaling $4,860,000 for 270 minimally injured helicopter-transferred patients. Nearly one third of patients transported by helicopter were minimally injured. Policies to identify patients who do not benefit from helicopter transport should be developed. Significant reduction in transport cost can be made by judicious selection of patients. Education to physicians calling for transport and identification of alternate means of transportation would be both safe and financially beneficial to our system. Epidemiologic study, level III. Therapeutic study, level IV.

Probabilistic safety analysis of waste transports to the Konrad repository

International Nuclear Information System (INIS)

Lange, F.; Fett, H.J.; Gruendler, D.; Schwarz, G.

1993-01-01

Potential radiological consequences, such as radiation exposure of persons and ground contamination, are calculated by using the accident consequence code UFOMOD for a 100% rail transportation, and for a 80% rail plus 20% road transportation in the region of KONRAD radioactive waste disposal site with five exposure pathways: cloud shine, inhalation, ground shine, ingestion and resuspension. The chances that a traffic accident without counter measures would lead to an effective dose, in 250 m down wind distance, equivalent to or exceeding the natural radiation exposure of one year are about 1 to 70 for a 40 years period. (A.B.). 4 refs., 4 figs

Simulator-based crew resource management training for interhospital transfer of critically ill patients by a mobile ICU

NARCIS (Netherlands)

Droogh, Joep M; Kruger, H. L.; Ligtenberg, Jack J M; Zijlstra, Jan G

2012-01-01

BACKGROUND: Transporting critically ill ICU patients by standard ambulances, with or without an accompanying physician, imposes safety risks. In 2007 the Dutch Ministry of Public Health required that all critically ill patients transferred between ICUs in different hospitals be transported by a

Use of tree-ring chemistry to document historical ground-water contamination events

Science.gov (United States)

Vroblesky, Don A.; Yanosky, Thomas M.

1990-01-01

The annual growth rings of tulip trees (Liriodendron tulipifera L.) appear to preserve a chemical record of ground-water contamination at a landfill in Maryland. Zones of elevated iron and chlorine concentrations in growth rings from trees immediately downgradient from the landfill are closely correlated temporally with activities in the landfill expected to generate iron and chloride contamination in the ground water. Successively later iron peaks in trees increasingly distant from the landfill along the general direction of ground-water flow imply movement of iron-contaminated ground water away from the landfill. The historical velocity of iron movement (2 to 9 m/yr) and chloride movement (at least 40 m/yr) in ground water at the site was estimated from element-concentration trends of trees at successive distances from the landfill. The tree-ring-derived chloride-transport velocity approximates the known ground-water velocity (30 to 80 m/yr). A minimum horizontal hydraulic conductivity (0.01 to .02 cm/s) calculated from chloride velocity agrees well with values derived from aquifer tests (about 0.07 cm/s) and from ground-water modeling results (0.009 to 0.04 cm/s).

The National Neonatal Transport Programme (NNTP) 2004-2009.

LENUS (Irish Health Repository)

Noone, D

2011-09-01

A retrospective analysis of all National Neonatal Transport Programme (NNTP) transport data from 2004-2009 was performed. 1621 transports were conducted during this period with a yearly average of 271. The majority (96%) were ground transports. 1118 (69%) were forward transfers. Of the 446 (27.5%) retrotransfers, 411 (91%.) were to tertiary centres. When transported, 592 infants (36.5%) were <48 hours old and 770 (47.5%) were <1 week old. 902 transports (55%) involved infants <32 wks birth-gestation and 720 (44%) involved infants weighing <1500gms. Transport for management of patent ductus arteriosus accounted for 357 (22%). The average mobilisation time was 34 minutes. 54% of transports were completed after scheduled service hours. The NNTP currently transports similar numbers of critically ill infants during its 8hr service compared with neonatal transport services that operate 24hr services. Performing PDA ligations in a tertiary neonatal unit would significantly reduce the number of neonatal transports required annually.

The Application of Ground-Penetrating Radar to Transportation Engineering: Recent Advances and New Perspectives (GI Division Outstanding ECS Award Lecture)

Science.gov (United States)

Tosti, Fabio; Benedetto, Andrea; Pajewski, Lara; Alani, Amir M.

2017-04-01

Ground-penetrating radar (GPR) is one of the most acknowledged and established non-destructive testing (NDT) techniques within the context of the health monitoring and assessment of transportation infrastructures. GPR is being increasingly used for the effective management of infrastructural assets as it weakens the case for using other destructive monitoring methods, such as digging holes, and allows for rapid and reliable detection of many causes of the subsurface damage. Thereby, its usage favours the optimisation of the economical expenditure for the effective maintenance of great infrastructures as well as it improves the public safety by preventing or not raising the risk of accidents. GPR has been used in highway, railway and airfield engineering as well as for the monitoring of critical infrastructures, such as bridges and tunnels. It has found established use in the assessment of the geometric properties of the subsurface, such as in the case of the evaluation of the pavement layer thicknesses, or the size of the rebars in concrete-made structural components. Major physical-based investigations have been focused on the evaluation of the moisture ingress in flexible road pavements and in concrete structures, as well as on the detection of the rebars corrosion caused by the ingress of chloride. The majority of these parameters are evaluated using methods of signal analysis and data processing based on the signal in the time domain. The sophistication of the hardware and software of the GPR systems over the last few years as well as the recent advances achieved in the research have contributed to raise the high potential of this non-destructive technique and paved the way towards new application areas in transportation engineering. In particular, GPR is nowadays finding major application when used with complementary non-destructive testing techniques, although it has still proved to provide reliable results in various self-standing applications. This work

Inhibiting Cadmium Transport Process in Root Cells of Plants: A Review

Directory of Open Access Journals (Sweden)

ZHAO Yan-ling

2016-05-01

Full Text Available Cadmium(Cd is the most common element found in the heavy-metal contaminated soils in China. Roots of rice and vegetables can concentrate Cd from acid soils, and then transport Cd to above-ground parts. Cd in edible part of plants directly influences the food safety. Cellwall, plasma membrane and organells of root cells in plant can discriminate Cd from other elements. A lot of Cd can be fixed in root cells by precipitation, complexation, compartmentation, and so on, to inhibit its transport from roots to shoot and guarantee the physiological activities in above-ground parts carrying out normally. This paper summarized recent advance on inhibiting Cd transport process in subcellular fractions of root cells of plants, which is in advantage of exploring excellent germplasms and gene resources in the future.

Maryland's Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients' Outcomes.

Science.gov (United States)

Hirshon, Jon Mark; Galvagno, Samuel M; Comer, Angela; Millin, Michael G; Floccare, Douglas J; Alcorta, Richard L; Lawner, Benjamin J; Margolis, Asa M; Nable, Jose V; Bass, Robert R

2016-03-01

Helicopter emergency medical services (EMS) has become a well-established component of modern trauma systems. It is an expensive, limited resource with potential safety concerns. Helicopter EMS activation criteria intended to increase efficiency and reduce inappropriate use remain elusive and difficult to measure. This study evaluates the effect of statewide field trauma triage changes on helicopter EMS use and patient outcomes. Data were extracted from the helicopter EMS computer-aided dispatch database for in-state scene flights and from the state Trauma Registry for all trauma patients directly admitted from the scene or transferred to trauma centers from July 1, 2000, to June 30, 2011. Computer-aided dispatch flights were analyzed for periods corresponding to field triage protocol modifications intended to improve system efficiency. Outcomes were separately analyzed for trauma registry patients by mode of transport. The helicopter EMS computer-aided dispatch data set included 44,073 transports. There was a statewide decrease in helicopter EMS usage for trauma patients of 55.9%, differentially affecting counties closer to trauma centers. The Trauma Registry data set included 182,809 patients (37,407 helicopter transports, 128,129 ambulance transports, and 17,273 transfers). There was an increase of 21% in overall annual EMS scene trauma patients transported; ground transports increased by 33%, whereas helicopter EMS transports decreased by 49%. Helicopter EMS patient acuity increased, with an attendant increase in patient mortality. However, when standardized with W statistics, both helicopter EMS- and ground-transported trauma patients showed sustained improvement in mortality. Modifications to state protocols were associated with decreased helicopter EMS use and overall improved trauma patient outcomes. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report.

Science.gov (United States)

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Saotome, Kousaku; Ueno, Tomoyuki; Abe, Tetsuya; Marushima, Aiki; Watanabe, Hiroki; Endo, Ayumu; Tsurumi, Kazue; Ishimoto, Ryu; Matsushita, Akira; Koda, Masao; Matsumura, Akira; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2018-01-19

We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury. A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient's manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees. Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.

Mapping the depth to ice-cemented ground in the high elevation Dry Valleys, Antarctica

Science.gov (United States)

Marinova, M.; McKay, C. P.; Heldmann, J. L.; Davila, A. F.; Andersen, D. T.; Jackson, A.; Lacelle, D.; Paulsen, G.; Pollard, W. H.; Zacny, K.

2011-12-01

The high elevation Dry Valleys of Antarctica provide a unique location for the study of permafrost distribution and stability. In particular, the extremely arid and cold conditions preclude the presence of liquid water, and the exchange of water between the ice-cemented ground and the atmosphere is through vapour transport (diffusion). In addition, the low atmospheric humidity results in the desiccation of the subsurface, forming a dry permafrost layer (i.e., cryotic soils which are dry and not ice-cemented). Weather data suggests that subsurface ice is unstable under current climatic conditions. Yet we do find ice-cemented ground in these valleys. This contradiction provides insight into energy balance modeling, vapour transport, and additional climate effects which stabilize subsurface ice. To study the driving factors in the stability and distribution of ice-cemented ground, we have extensively mapped the depth to ice-cemented ground in University Valley (1730 m; 77°S 51.8', 160°E 43'), and three neighbouring valleys in the Beacon Valley area. We measured the depth to ice-cemented ground at 15-40 locations per valley by digging soil pits and drilling until ice was reached; for each location 3-5 measurements within a ~1 m2 area were averaged (see figure). This high-resolution mapping of the depth to ice-cemented ground provides new insight on the distribution and stability of subsurface ice, and shows significant variability in the depth to ground ice within each valley. We are combining data from mapping the depth to ice-cemented ground with year-round, in situ measurements of the atmospheric and subsurface conditions, such as temperature, humidity, wind, and light, to model the local stability of ice-cemented ground. We are using this dataset to examine the effects of slopes, shading, and soil properties, as well as the suggested importance of snow recurrence, to better understand diffusion-controlled subsurface ice stability.

Analysis of an Affordability Index Model for Marine Corps Ground Combat Equipment

Science.gov (United States)

2004-12-01

percentage of sales at standard price • Inventory turns Readiness and Sustainability Perspectives: • Upside production flexibility In addition to the...400 Gal, M149A2 D0881 35 Trailer, Ribbon, MK18 /A1 D1001 30 Truck, Ambulance, 4 Litter, Armored, 1 1/4-Ton, HMMWV, M997 D1002 30 Truck

Optimal transportation networks models and theory

CERN Document Server

Bernot, Marc; Morel, Jean-Michel

2009-01-01

The transportation problem can be formalized as the problem of finding the optimal way to transport a given measure into another with the same mass. In contrast to the Monge-Kantorovitch problem, recent approaches model the branched structure of such supply networks as minima of an energy functional whose essential feature is to favour wide roads. Such a branched structure is observable in ground transportation networks, in draining and irrigation systems, in electrical power supply systems and in natural counterparts such as blood vessels or the branches of trees. These lectures provide mathematical proof of several existence, structure and regularity properties empirically observed in transportation networks. The link with previous discrete physical models of irrigation and erosion models in geomorphology and with discrete telecommunication and transportation models is discussed. It will be mathematically proven that the majority fit in the simple model sketched in this volume.

Effect of high pressure on the ground state of low doped manganite: a neutron diffraction and transport property study

International Nuclear Information System (INIS)

Ghosh, Barnali; Raychaudhuri, A.K.; Siruguri, V.; Chatterji, Tapan; Thomas, Hansen; Mukovskii, Ya.M.

2013-01-01

Depending on the doping level x the hole-doped perovskite manganites, like La 1-x Ca x MnO 3 exhibit a wide variety of physical properties. These compounds lead their high sensitivity to thermodynamic variables like temperature, magnetic field and pressure. The structure can be modified by application of high pressure and it can be quantitative that changes the Mn-O bond length and increases the Mn-O-Mn bond angle. In some cases the pressure can bring about qualitative changes in the structure like change in the lattice structure or its symmetry. These structural factors can contribute to the effective electron transfer integral between Mn ions, which in turn can change the magnetic exchanges like the double-exchange as well as the super exchange. For low hole doping (0.15 ≤ x ≤ 0.2), the low temperature ground state is Ferromagnetic insulator (FMI). The ground state of the low doped manganite La 0.79 Ca 0.21 MnO 3 (LCMO) can be destabilized by external hydrostatic pressure. We have done electrical transport measurement under magnetic field and under high pressure for understanding the nature of the resulting phase(s) that arise from the applied hydrostatic pressure. We find that the metallic phase so created under pressure has no appreciable magnetoresistance (MR). The Neutron powder diffraction measurement done on D20 diffractometer (λ=1.3Å) at ILL, Grenoble, France under high hydrostatic pressure up to 10GPa shows that the pressure leads to a change in the crystal structure from orthorhombic to rhombohedral and leading to a change in magnetic structure also; and most importantly collapse of the magnetic moment to a low value that leads to absence of any MR under pressure induced metallization. (author)

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

International Nuclear Information System (INIS)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G.

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys

Evaluation of depleted uranium in the environment at Aberdeen Proving Grounds, Maryland and Yuma Proving Grounds, Arizona. Final report

Energy Technology Data Exchange (ETDEWEB)

Kennedy, P.L.; Clements, W.H.; Myers, O.B.; Bestgen, H.T.; Jenkins, D.G. [Colorado State Univ., Fort Collins, CO (United States). Dept. of Fishery and Wildlife Biology

1995-01-01

This report represents an evaluation of depleted uranium (DU) introduced into the environment at the Aberdeen Proving Grounds (APG), Maryland and Yuma Proving Grounds (YPG) Arizona. This was a cooperative project between the Environmental Sciences and Statistical Analyses Groups at LANL and with the Department of Fishery and Wildlife Biology at Colorado State University. The project represents a unique approach to assessing the environmental impact of DU in two dissimilar ecosystems. Ecological exposure models were created for each ecosystem and sensitivity/uncertainty analyses were conducted to identify exposure pathways which were most influential in the fate and transport of DU in the environment. Research included field sampling, field exposure experiment, and laboratory experiments. The first section addresses DU at the APG site. Chapter topics include bioenergetics-based food web model; field exposure experiments; bioconcentration by phytoplankton and the toxicity of U to zooplankton; physical processes governing the desorption of uranium from sediment to water; transfer of uranium from sediment to benthic invertebrates; spead of adsorpion by benthic invertebrates; uptake of uranium by fish. The final section of the report addresses DU at the YPG site. Chapters include the following information: Du transport processes and pathway model; field studies of performance of exposure model; uptake and elimination rates for kangaroo rates; chemical toxicity in kangaroo rat kidneys.

Ground-freezing experience on the east side access Northern Boulevard crossing, New York

OpenAIRE

Schmall, Paul; Dawson, Andrew

2017-01-01

A brief review is given of ground freezing technology as a means of providing groundwater cut-off and temporary structural support in weak ground for transportation tunnelling and shaft-sinking operations. Then detailed coverage of a particular case history is reported in variable soils in Queens, New York. As part of the upgrading of rail access from Long Island into Manhattan, a tunnel was required that necessitated a frozen arch structure under a ‘live’ roadway and rail lines. The installa...

Plowshares or Swords? Fostering Common Ground Across Difference

Directory of Open Access Journals (Sweden)

Karen Trapenberg Frick

2017-10-01

Full Text Available With political polarization challenging forward progress on public policy and planning processes, it is critical to examine possibilities for finding common ground across difference between community participants. In my research on contentious planning processes in the United States, I found four areas of convergence between participants over transportation policy and process related to public process and substantive matters. These convergences warrant planners’ attention because they united stakeholders coming from different vantage points.

Advective isotope transport by mixing cell and particle tracking algorithms

International Nuclear Information System (INIS)

Tezcan, L.; Meric, T.

1999-01-01

The 'mixing cell' algorithm of the environmental isotope data evaluation is integrated with the three dimensional finite difference ground water flow model (MODFLOW) to simulate the advective isotope transport and the approach is compared with the 'particle tracking' algorithm of the MOC3D, that simulates three-dimensional solute transport with the method of characteristics technique

Communication grounding facility

International Nuclear Information System (INIS)

Lee, Gye Seong

1998-06-01

It is about communication grounding facility, which is made up twelve chapters. It includes general grounding with purpose, materials thermal insulating material, construction of grounding, super strength grounding method, grounding facility with grounding way and building of insulating, switched grounding with No. 1A and LCR, grounding facility of transmission line, wireless facility grounding, grounding facility in wireless base station, grounding of power facility, grounding low-tenton interior power wire, communication facility of railroad, install of arrester in apartment and house, install of arrester on introduction and earth conductivity and measurement with introduction and grounding resistance.

Use of isotopically labeled fertilizer to trace nitrogen fertilizer contributions to surface, soil, and ground water

Science.gov (United States)

Wilkison, D.H.; Blevins, D.W.; Silva, S.R.

2000-01-01

The fate and transport of a single N fertilizer application through plants, soil, runoff, and the unsaturated and saturated zones was determined for four years at a field site under continuous corn (Zea mays L.) management. Claypan soils, which underlie the site, were hypothesized to restrict the movement of agrichemicals from the soil surface to ground water. However, N fertilizer moved rapidly through preferential flow paths in the soil and into the underlying glacial till aquifer. Most N transport occurred during the fall and winter when crops were not available to use excess N. Forty months after application, 33 percent of the fertilizer had been removed by grain harvests, 30 percent had been transpired to the atmosphere, and 33 percent had migrated to ground water. Although runoff volumes were 50 percent greater than infiltration, less than 2 percent of the fertilizer was lost to runoff. Small measured denitrification rates and large measured dissolved oxygen concentrations in ground water favor the long-term stability of NO3-1 in ground water. Successive fertilizer applications, in areas that lack the ability to moderate N concentrations through consumptive N reactions, risk the potential of N-saturated ecosystems.

Electronic and transport properties of Cobalt-based valence tautomeric molecules and polymers

Science.gov (United States)

Chen, Yifeng; Calzolari, Arrigo; Buongiorno Nardelli, Marco

2011-03-01

The advancement of molecular spintronics requires further understandings of the fundamental electronic structures and transport properties of prototypical spintronics molecules and polymers. Here we present a density functional based theoretical study of the electronic structures of Cobalt-based valence tautomeric molecules Co III (SQ)(Cat)L Co II (SQ)2 L and their polymers, where SQ refers to the semiquinone ligand, and Cat the catecholate ligand, while L is a redox innocent backbone ligand. The conversion from low-spin Co III ground state to high-spin Co II excited state is realized by imposing an on-site potential U on the Co atom and elongating the Co-N bond. Transport properties are subsequently calculated by extracting electronic Wannier functions from these systems and computing the charge transport in the ballistic regime using a Non-Equilibrium Green's Function (NEGF) approach. Our transport results show distinct charge transport properties between low-spin ground state and high-spin excited state, hence suggesting potential spintronics devices from these molecules and polymers such as spin valves.

Use of a unipedal standing test to assess the ambulation reacquisition time during the early postoperative stage after hip fracture in elderly Japanese: prospective study.

Science.gov (United States)

Murata, Koichi; Sugitani, Shigeki; Yoshioka, Hiroki; Noguchi, Takashi; Aoto, Toshiyuki; Nakamura, Takashi

2010-01-01

The aim of this study was to predict the ambulation reacquisition time after hip fracture in elderly people using the unipedal standing test during the early postoperative stage. Patients with an intertrochanteric fracture treated with internal fixation (n = 35) and patients with a femoral neck fracture treated with hemiarthroplasty (n = 22) were included. A unipedal standing test using the nonoperated leg was performed on days 3 and 7 after the operation. Among the patients with an intertrochanteric fracture, those with a positive result on the unipedal standing test on postoperative day (POD) 3 attained gait with parallel guide bars (BG) and walker-assisted gait (WG) significantly earlier than did patients with a negative result on the unipedal standing test. Patients with a positive result on the unipedal standing test on POD 7 attained BG, WG, and cane-assisted gait (CG) significantly earlier than did patients with a negative test. Among patients with a femoral neck fracture, those with a positive unipedal standing test result on POD 3 attained BG, WG, and CG significantly earlier than did patients with a negative test. Those with a positive test result on POD 7 attained BG, WG, and CG significantly earlier than did patients with a negative test. The unipedal standing test given during the early postoperative stage is a good test for predicting the ambulation reacquisition time. Moreover, it gives information that can help determine the need for subacute rehabilitation and about discharge planning and health service provision.

Colloid Detection in Natural Ground Water from Ruprechtov by Laser-Induced Breakdown Detection

Energy Technology Data Exchange (ETDEWEB)

Hauser, W.; Geckeis, H.; Goetz, R. [FZK - Inst. fuer Nukleare Entsorgung, Ka rlsruhe (Germany)]. e-mail: hauser@ine.fzk.de; Noseck, U. [Gesellschaft fuer Anlagen- und Reaktorsicherheit, D-38122 Braunschweig (Germany); Laciok, A. [Nuclear Research Inst. Rez plc, Waste and Environmental Management Dept., Husinec-Rez, PSC 250 68 (Czech Republic)

2007-06-15

A borehole ground water sampling system and a mobile laser-induced breakdown detection (LIBD) equipment for colloid detection combined with a geomonitoring unit have been applied to characterize the natural background colloid concentration in ground waters of the Ruprechtov natural analogue site (Czech Republic). Ground water has been sampled using steel cylinders. To minimize artifacts during ground water sampling the contact to atmospheric oxygen has been excluded. The ground water samples collected in this way are transported to the laboratory where they have been connected to a series of flow-through detection cells. Argon gas is used to press the ground water through these detection cells for colloid analysis (LIBD), pH, Eh, electrical conductivity and oxygen content. After the above mentioned analysis additional samples are taken for chemical analysis by ICP-AES, ICP-MS, IC- and DOC-detection. Our data obtained by in-situ- and laboratory- measurements point out that the natural colloid concentration found at the Ruprechtov site is a strong function of the ground water ionic strength. The LIBD determined natural background colloid concentrations found at Ruprechtov are compared with data of studies performed in Aespoe (Sweden) and Grimsel (Switzerland)

The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine.

LENUS (Irish Health Repository)

Gilligan, P

2018-06-01

Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.

Land subsidence due to groundwater pumping and recharge: considering the particle-deposition effect in ground-source heat-pump engineering

Science.gov (United States)

Cui, Xianze; Liu, Quansheng; Zhang, Chengyuan; Huang, Yisheng; Fan, Yong; Wang, Hongxing

2018-01-01

With the rapid development and use of ground-source heat-pump (GSHP) systems in China, it has become imperative to research the effects of associated long-term pumping and recharge processes on ground deformation. During groundwater GSHP operation, small particles can be transported and deposited, or they can become detached in the grain skeleton and undergo recombination, possibly causing a change in the ground structure and characteristics. This paper presents a mathematical ground-deformation model that considers particle transportation and deposition in porous media based on the geological characteristics of a dual-structure stratum in Wuhan, eastern China. Thermal effects were taken into consideration because the GSHP technology used involves a device that uses heat from a shallow layer of the ground. The results reveal that particle deposition during the long-term pumping and recharge process has had an impact on ground deformation that has significantly increased over time. In addition, there is a strong correlation between the deformation change (%) and the amount of particle deposition. The position of the maximum deformation change is also the location where most of the particles are deposited, with the deformation change being as high as 43.3%. The analyses also show that flow of groundwater can have an effect on the ground deformation process, but the effect is very weak.

Land subsidence due to groundwater pumping and recharge: considering the particle-deposition effect in ground-source heat-pump engineering

Science.gov (United States)

Cui, Xianze; Liu, Quansheng; Zhang, Chengyuan; Huang, Yisheng; Fan, Yong; Wang, Hongxing

2018-05-01

With the rapid development and use of ground-source heat-pump (GSHP) systems in China, it has become imperative to research the effects of associated long-term pumping and recharge processes on ground deformation. During groundwater GSHP operation, small particles can be transported and deposited, or they can become detached in the grain skeleton and undergo recombination, possibly causing a change in the ground structure and characteristics. This paper presents a mathematical ground-deformation model that considers particle transportation and deposition in porous media based on the geological characteristics of a dual-structure stratum in Wuhan, eastern China. Thermal effects were taken into consideration because the GSHP technology used involves a device that uses heat from a shallow layer of the ground. The results reveal that particle deposition during the long-term pumping and recharge process has had an impact on ground deformation that has significantly increased over time. In addition, there is a strong correlation between the deformation change (%) and the amount of particle deposition. The position of the maximum deformation change is also the location where most of the particles are deposited, with the deformation change being as high as 43.3%. The analyses also show that flow of groundwater can have an effect on the ground deformation process, but the effect is very weak.

Hydrogeologic controls on ground-water and contaminant discharge to the Columbia River near the Hanford Townsite

International Nuclear Information System (INIS)

Luttrell, S.P.; Newcomer, D.R.; Teel, S.S.; Vermeul, V.R.

1992-11-01

The purpose of this study is to quantify ground-water and contaminant discharge to the Columbia River in the Hanford Townsite vicinity. The primary objectives of the work are to: describe the hydrogeologic setting and controls on ground-water movement and contaminant discharge to the Columbia River; understand the river/aquifer relationship and its effects on contaminant discharge to the Columbia River; quantify the ground-water and contaminant mass discharge to the Columbia River; and provide data that may be useful for a three-dimensional model of ground-water flow and contaminant transport in the Hanford Townsite study area. The majority of ground-water contamination occurs within the unconfined aquifer; therefore, ground-water and contaminant discharge from the unconfined aquifer is the emphasis of this study. The period of study is primarily from June 1990 through March 1992

Helicopter vs. ground transportation of patients bound for primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Funder, K S; Rasmussen, L S; Siersma, V

2018-01-01

BACKGROUND: Implementation of the first Danish helicopter emergency medical service (HEMS) was associated with reduced time from first medical contact to treatment at a specialized centre for patients with suspected ST elevation myocardial infarction (STEMI). We aimed to investigate effects of HEMS...... was 22.1% (HEMS) vs. 21.2% (adjusted OR = 1.10, 0.64-1.90, P = 0.73). CONCLUSION: In an observational study of patients with suspected STEMI in eastern Denmark, no significant beneficial effect of helicopter transport could be detected on mortality, premature labour market exit or work ability. Only...... a study with random allocation to one system vs. another, along with a large sample size, will allow determination of superiority of helicopter transport....

Ground Pollution Science

International Nuclear Information System (INIS)

Oh, Jong Min; Bae, Jae Geun

1997-08-01

This book deals with ground pollution science and soil science, classification of soil and fundamentals, ground pollution and human, ground pollution and organic matter, ground pollution and city environment, environmental problems of the earth and ground pollution, soil pollution and development of geological features of the ground, ground pollution and landfill of waste, case of measurement of ground pollution.

Comparison of in-flight and ground-based simulator derived flying qualities and pilot performance for approach and landing tasks

Science.gov (United States)

Grantham, William D.; Williams, Robert H.

1987-01-01

For the case of an approach-and-landing piloting task emphasizing response to the landing flare, pilot opinion and performance parameters derived from jet transport aircraft six-degree-of-freedom ground-based and in-flight simulators were compared in order to derive data for the flight-controls/flying-qualities engineers. The data thus obtained indicate that ground simulation results tend to be conservative, and that the effect of control sensitivity is more pronounced for ground simulation. The pilot also has a greater tendency to generate pilot-induced oscillation in ground-based simulation than in flight.

METHODS OF INTEGRATED OPTIMIZATION MAGLEV TRANSPORT SYSTEMS