WorldWideScience

Sample records for hard drive triage

  1. 2TB hard disk drive

    CERN Multimedia

    This particular object was used up until 2012 in the Data Centre. It slots into one of the Disk Server trays. Hard disks were invented in the 1950s. They started as large disks up to 20 inches in diameter holding just a few megabytes (link is external). They were originally called "fixed disks" or "Winchesters" (a code name used for a popular IBM product). They later became known as "hard disks" to distinguish them from "floppy disks (link is external)." Hard disks have a hard platter that holds the magnetic medium, as opposed to the flexible plastic film found in tapes and floppies.

  2. Visual inspection technology in the hard disc drive industry

    CERN Document Server

    Muneesawang, Paisarn

    2015-01-01

    A presentation of the use of computer vision systems to control manufacturing processes and product quality in the hard disk drive industry. Visual Inspection Technology in the Hard Disk Drive Industry is an application-oriented book borne out of collaborative research with the world's leading hard disk drive companies. It covers the latest developments and important topics in computer vision technology in hard disk drive manufacturing, as well as offering a glimpse of future technologies.

  3. Failure analysis and shock protection of external hard disk drive ...

    African Journals Online (AJOL)

    Technology for processing and storage of data in portable external storage hard disks has increasingly improved over the years. Currently, terabytes of data can be stored in one portable external storage hard disk drive. Storing such amount of data on a single disk on itself is a risk. Several instances of data lost by big ...

  4. failure analysis and shock protection of external hard disk drive

    African Journals Online (AJOL)

    user

    model its structural responses to free fall drop-impact shock and vibration. Secondly, the hard ... Keywords: Free fall, impact force, Shock, Vibration, Stress, Reliability, Modeling, Simulation External Hard disk drive. 1. ..... on the disk, it could initiate process which could .... [19] Katta, P.: MATLAB Guide to Finite Elements - An.

  5. Sensorless optimal sinusoidal brushless direct current for hard disk drives

    Science.gov (United States)

    Soh, C. S.; Bi, C.

    2009-04-01

    Initiated by the availability of digital signal processors and emergence of new applications, market demands for permanent magnet synchronous motors have been surging. As its back-emf is sinusoidal, the drive current should also be sinusoidal for reducing the torque ripple. However, in applications like hard disk drives, brushless direct current (BLDC) drive is adopted instead of sinusoidal drive for simplification. The adoption, however, comes at the expense of increased harmonics, losses, torque pulsations, and acoustics. In this paper, we propose a sensorless optimal sinusoidal BLDC drive. First and foremost, the derivation for an optimal sinusoidal drive is presented, and a power angle control scheme is proposed to achieve an optimal sinusoidal BLDC. The scheme maintains linear relationship between the motor speed and drive voltage. In an attempt to execute the sensorless drive, an innovative power angle measurement scheme is devised, which takes advantage of the freewheeling diodes and measures the power angle through the detection of diode voltage drops. The objectives as laid out will be presented and discussed in this paper, supported by derivations, simulations, and experimental results. The proposed scheme is straightforward, brings about the benefits of sensorless sinusoidal drive, negates the need for current sensors by utilizing the freewheeling diodes, and does not incur additional cost.

  6. Robust design of head interconnect for hard disk drive

    Science.gov (United States)

    Gao, X. K.; Liu, Q. H.; Liu, Z. J.

    2005-05-01

    Design of head interconnect is one of the important issues for hard disk drives with higher data rate and storage capacity. The impedance of interconnect and electromagnetic coupling influence the quality level of data communication. Thus an insightful study on how the trace configuration affects the impedance and crosstalk is necessary. An effective design approach based on Taguchi's robust design method is employed therefore in an attempt to realize impedance matching and crosstalk minimization with the effects of uncontrollable sources taken into consideration.

  7. Contemporary Obstetric Triage.

    Science.gov (United States)

    Sandy, Edward Allen; Kaminski, Robert; Simhan, Hygriv; Beigi, Richard

    2016-03-01

    The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. This study is for obstetricians and gynecologists as well as family physicians. After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

  8. An Evolutionary Algorithm for Feature Subset Selection in Hard Disk Drive Failure Prediction

    Science.gov (United States)

    Bhasin, Harpreet

    2011-01-01

    Hard disk drives are used in everyday life to store critical data. Although they are reliable, failure of a hard disk drive can be catastrophic, especially in applications like medicine, banking, air traffic control systems, missile guidance systems, computer numerical controlled machines, and more. The use of Self-Monitoring, Analysis and…

  9. Use of Software Programs as Zero Fill Help in Overcoming the Problem Around Hard Drive

    OpenAIRE

    Eko Prasetyo Nugroho; Fivtatianti Fivtatianti, Skom, MM

    2003-01-01

    Zero Fill, is a software tool programs that are designed for hard disk drive specially branded Quantum. This software is a tool programs that function to format the hard drive. Where is the type of format here is the first format or in other words the software to format the hard drive is working under conditions of low- level or commonly referred to as a low- level format. The advantages of this software is able to fix and remove all existing data within the disk, such as files...

  10. Disposal of waste computer hard disk drive: data destruction and resources recycling.

    Science.gov (United States)

    Yan, Guoqing; Xue, Mianqiang; Xu, Zhenming

    2013-06-01

    An increasing quantity of discarded computers is accompanied by a sharp increase in the number of hard disk drives to be eliminated. A waste hard disk drive is a special form of waste electrical and electronic equipment because it holds large amounts of information that is closely connected with its user. Therefore, the treatment of waste hard disk drives is an urgent issue in terms of data security, environmental protection and sustainable development. In the present study the degaussing method was adopted to destroy the residual data on the waste hard disk drives and the housing of the disks was used as an example to explore the coating removal process, which is the most important pretreatment for aluminium alloy recycling. The key operation points of the degaussing determined were: (1) keep the platter plate parallel with the magnetic field direction; and (2) the enlargement of magnetic field intensity B and action time t can lead to a significant upgrade in the degaussing effect. The coating removal experiment indicated that heating the waste hard disk drives housing at a temperature of 400 °C for 24 min was the optimum condition. A novel integrated technique for the treatment of waste hard disk drives is proposed herein. This technique offers the possibility of destroying residual data, recycling the recovered resources and disposing of the disks in an environmentally friendly manner.

  11. Chemoreception drives plastic consumption in a hard coral.

    Science.gov (United States)

    Allen, Austin S; Seymour, Alexander C; Rittschof, Daniel

    2017-11-15

    The drivers behind microplastic (up to 5mm in diameter) consumption by animals are uncertain and impacts on foundational species are poorly understood. We investigated consumption of weathered, unfouled, biofouled, pre-production and microbe-free National Institute of Standards plastic by a scleractinian coral that relies on chemosensory cues for feeding. Experiment one found that corals ingested many plastic types while mostly ignoring organic-free sand, suggesting that plastic contains phagostimulents. Experiment two found that corals ingested more plastic that wasn't covered in a microbial biofilm than plastics that were biofilmed. Additionally, corals retained ~8% of ingested plastic for 24h or more and retained particles appeared stuck in corals, with consequences for energetics, pollutant toxicity and trophic transfer. The potential for chemoreception to drive plastic consumption in marine taxa has implications for conservation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Optimization of Smart Structure for Improving Servo Performance of Hard Disk Drive

    Science.gov (United States)

    Kajiwara, Itsuro; Takahashi, Masafumi; Arisaka, Toshihiro

    Head positioning accuracy of the hard disk drive should be improved to meet today's increasing performance demands. Vibration suppression of the arm in the hard disk drive is very important to enhance the servo bandwidth of the head positioning system. In this study, smart structure technology is introduced into the hard disk drive to suppress the vibration of the head actuator. It has been expected that the smart structure technology will contribute to the development of small and light-weight mechatronics devices with the required performance. First, modeling of the system is conducted with finite element method and modal analysis. Next, the actuator location and the control system are simultaneously optimized using genetic algorithm. Vibration control effect with the proposed vibration control mechanisms has been evaluated by some simulations.

  13. Triage Drift:

    DEFF Research Database (Denmark)

    Bjørn, Pernille; Rødje, Kjetil

    2008-01-01

    This paper presents a workplace study of triage work practices within an emergency department (ED). We examine the practices, procedures, and organization in which ED staff uses tools and technologies when coordinating the essential activity of assessing and sorting patients arriving at the ED...

  14. Note: A simple vibrating orifice monodisperse droplet generator using a hard drive actuator arm

    Energy Technology Data Exchange (ETDEWEB)

    Kosch, Sebastian, E-mail: skosch@mie.utoronto.ca, E-mail: ashgriz@mie.utoronto.ca; Ashgriz, Nasser, E-mail: skosch@mie.utoronto.ca, E-mail: ashgriz@mie.utoronto.ca [Department of Industrial and Mechanical Engineering, University of Toronto, Toronto, Ontario M5S 3G8 (Canada)

    2015-04-15

    We propose that the rotary voice coil actuators found in magnetic hard drives are fit to supercede loudspeakers as expedient vibration sources in the laboratory setting. A specific use case is the excitation of a liquid jet to induce controlled breakup into monodisperse droplets. Like loudspeakers, which are typically used for prototyping such devices, hard drive actuators are cheap and ubiquitous, but they are less unwieldy and supply greater amplitudes without producing noise. Frequencies between 0 and 17 kHz, and likely beyond, can be reproduced reliably. No machining tools or amplifying electronics are needed for the construction and operation of the presented droplet generator.

  15. High-content phenotypic screening and triaging strategy to identify small molecules driving oligodendrocyte progenitor cell differentiation.

    Science.gov (United States)

    Peppard, Jane V; Rugg, Catherine A; Smicker, Matthew A; Powers, Elaine; Harnish, Erica; Prisco, Joy; Cirovic, Dragan; Wright, Paul S; August, Paul R; Chandross, Karen J

    2015-03-01

    Multiple Sclerosis is a demyelinating disease of the CNS and the primary cause of neurological disability in young adults. Loss of myelinating oligodendrocytes leads to neuronal dysfunction and death and is an important contributing factor to this disease. Endogenous oligodendrocyte precursor cells (OPCs), which on differentiation are responsible for replacing myelin, are present in the adult CNS. As such, therapeutic agents that can stimulate OPCs to differentiate and remyelinate demyelinated axons under pathologic conditions may improve neuronal function and clinical outcome. We describe the details of an automated, cell-based, morphometric-based, high-content screen that is used to identify small molecules eliciting the differentiation of OPCs after 3 days. Primary screening was performed using rat CG-4 cells maintained in culture conditions that normally support a progenitor cell-like state. From a library of 73,000 diverse small molecules within the Sanofi collection, 342 compounds were identified that increased OPC morphological complexity as an indicator of oligodendrocyte maturation. Subsequent to the primary high-content screen, a suite of cellular assays was established that identified 22 nontoxic compounds that selectively stimulated primary rat OPCs but not C2C12 muscle cell differentiation. This rigorous triaging yielded several chemical series for further expansion and bio- or cheminformatics studies, and their compelling biological activity merits further investigation. © 2014 Society for Laboratory Automation and Screening.

  16. 77 FR 8284 - Western Digital Technologies, Inc., Hard Drive Development Engineering Group Irvine (Formerly at...

    Science.gov (United States)

    2012-02-14

    ... business model of the subject firm is to develop new products domestically and carry out the manufacturing... that the new designs are functional. SAR 8, 20, 26. The subject firm stated that prototype creation is... Technologies, Inc., Hard Drive Development Engineering Group Irvine (Formerly at Lake Forest), CA; Notice of...

  17. Analysis of a biphase-based servo format for hard-disk drives

    NARCIS (Netherlands)

    Makinwa, K.A.A.; Bergmans, J.W.M.; Voorman, J.O.

    2000-01-01

    Biphase modulation in an embedded-servo format for hard-disk drives is investigated. It is shown that for biphase, at the low linear densities typical of servo information, near-maximum-likelihood performance can be attained by a simple bit detector consisting of a full-response linear equalizer and

  18. On the Dynamics of Rocking Motion of the Hard-Disk Drive Spindle Motor System

    Science.gov (United States)

    Wang, Joseph

    Excessive rocking motion of the spindle motor system can cause track misregistration resulting in poor throughput or even drive failure. The chance of excessive disk stack rocking increases as a result of decreasing torsional stiffness of spindle motor bearing system due to the market demand for low profile hard drives. As the track density increases and the vibration specification becomes increasingly stringent, rocking motion of a spindle motor system deserves even more attention and has become a primary challenge for a spindle motor system designer. Lack of understanding of the rocking phenomenon combined with misleading paradox has presented a great difficulty in the effort of avoiding the rocking motion in the hard-disk drive industry. This paper aims to provide fundamental understanding of the rocking phenomenon of a rotating spindle motor system, to clarify the paradox in disk-drive industry and to provide a design guide to an optimized spindle system. This paper, theoretically and experimentally, covers a few important areas of industrial interest including the prediction of rocking natural frequencies and mode shape of a rotating spindle, free vibration, and frequency response under common forcing functions such as rotating and fixed-plane forcing functions. The theory presented here meets with agreeable experimental observation.

  19. A production throughput forecasting system in an automated hard disk drive test operation using GRNN

    Energy Technology Data Exchange (ETDEWEB)

    Samattapapong, N.; Afzulpurkar, N.

    2016-07-01

    The goal of this paper is to develop a pragmatic system of a production throughput forecasting system for an automated test operation in a hard drive manufacturing plant. The accurate forecasting result is necessary for the management team to response to any changes in the production processes and the resources allocations. In this study, we design a production throughput forecasting system in an automated test operation in hard drive manufacturing plant. In the proposed system, consists of three main stages. In the first stage, a mutual information method was adopted for selecting the relevant inputs into the forecasting model. In the second stage, a generalized regression neural network (GRNN) was implemented in the forecasting model development phase. Finally, forecasting accuracy was improved by searching the optimal smoothing parameter which selected from comparisons result among three optimization algorithms: particle swarm optimization (PSO), unrestricted search optimization (USO) and interval halving optimization (IHO). The experimental result shows that (1) the developed production throughput forecasting system using GRNN is able to provide forecasted results close to actual values, and to projected the future trends of production throughput in an automated hard disk drive test operation; (2) An IHO algorithm performed as superiority appropriate optimization method than the other two algorithms. (3) Compared with current forecasting system in manufacturing, the results show that the proposed system’s performance is superior to the current system in prediction accuracy and suitable for real-world application. The production throughput volume is a key performance index of hard disk drive manufacturing systems that need to be forecast. Because of the production throughput forecasting result is useful information for management team to respond to any changing in production processes and resources allocation. However, a practically forecasting system for

  20. Low Molecular Weight Z-Tetraol Boundary Lubricant Films in Hard Disk Drives

    Directory of Open Access Journals (Sweden)

    R. J. Waltman

    2012-01-01

    Full Text Available Lower molecular weight Z-Tetraol films exhibit increased mechanical spacing in the slider-disk interface due to a lower z-profile. An increased resistance to lubricant disturbance on the disk surface (e.g., lube moguls with decreasing film thickness is attributed to an increasing contribution from the polar component of the disjoining pressure. Evaporative loss at temperatures typically encountered in a hard-disk drive also increases with decreasing molecular weight but is strongly dependent on the initial bonded fraction.

  1. Finite Element Analysis of Flexural Vibrations in Hard Disk Drive Spindle Systems

    Science.gov (United States)

    LIM, SEUNGCHUL

    2000-06-01

    This paper is concerned with the flexural vibration analysis of the hard disk drive (HDD) spindle system by means of the finite element method. In contrast to previous research, every system component is here analytically modelled taking into account its structural flexibility and also the centrifugal effect particularly on the disk. To prove the effectiveness and accuracy of the formulated models, commercial HDD systems with two and three identical disks are selected as examples. Then their major natural modes are computed with only a small number of element meshes as the shaft rotational speed is varied, and subsequently compared with the existing numerical results obtained using other methods and newly acquired experimental ones. Based on such a series of studies, the proposed method can be concluded as a very promising tool for the design of HDDs and various other high-performance computer disk drives such as floppy disk drives, CD ROM drives, and their variations having spindle mechanisms similar to those of HDDs.

  2. Ethics of conservation triage

    Directory of Open Access Journals (Sweden)

    Kerrie A Wilson

    2016-09-01

    Full Text Available Conservation triage seems to be at a stalemate between those who accept triage based on utilitarian rationalization, and those that reject it based on a number of ethical principles. We argue that without considered attention to the ethics of conservation triage we risk further polarization in the field of conservation. We draw lessons from the medical sector, where triage is more intuitive and acceptable, and also from disaster planning, to help navigate the challenges that triage entails for conservation science, practice, and policy. We clarify the consequentialist, deontological, and virtue ethical stances that influence the level of acceptance of triage. We emphasize the ethical dimensions of conservation triage in principle and in practice, particularly in the context of stakeholder diversity, a wide range of possible objectives and actions, broader institutions, and significant uncertainties. A focus on a more diverse set of ethics, more considered choice of triage as a conservation tool, open communication of triage objectives and protocols, greater consideration of risk preferences, and regular review and adaptation of triage protocols is required for conservation triage to become more acceptable among diverse conservation practitioners, institutions, and the general public. Accepting conservation triage as fundamentally an ethical problem would foster more open dialogue and constructive debate about the role of conservation triage in a wider system of care.

  3. Neodymium as the main feature of permanent magnets from hard disk drives (HDDs).

    Science.gov (United States)

    München, Daniel Dotto; Veit, Hugo Marcelo

    2017-03-01

    As a way to manage neodymium-iron-boron (NdFeB) magnets wasted in end-of-life hard disk drives (HDDs), a waste characterization is needed prior to a recycling process. Due to their magnetic properties, NdFeB magnets are essential in technological applications nowadays, thus causing an increase in the industrial demand for rare earth metals. However, these metals have a short supply, since they are difficult to obtain from ores, creating a critical market. In this work, a study of the characterization of sintered neodymium-iron-boron magnets was undertaken by qualitatively and quantitatively uncovering the neodymium recovery potential from this type of electronic waste. From the collection and disassembly of hard disk drives, in which the magnet represents less than 3% of the total weight, an efficient demagnetization process was proceeded at 320°C. Then, the magnet was ground and screened for an X-ray diffraction (XRD) analysis, which showed the Nd 2 Fe 14 B tetragonal phase as the dominant constituent of the sample. An analysis was also carried out in a scanning electron microscope (SEM) and an inductively coupled plasma optical emission spectrometer (ICP-OES), where the magnet composition showed 21.5wt% of neodymium and 65.1wt% of iron, among other chemicals. This Nd content is higher than the one found in Nd ores, enhancing the recyclability and the importance of waste management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. The Copenhagen Triage Algorithm

    DEFF Research Database (Denmark)

    Hasselbalch, Rasmus Bo; Plesner, Louis Lind; Pries-Heje, Mia

    2016-01-01

    is non-inferior to an existing triage model in a prospective randomized trial. METHODS: The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years...

  5. Recycling potential of neodymium: the case of computer hard disk drives.

    Science.gov (United States)

    Sprecher, Benjamin; Kleijn, Rene; Kramer, Gert Jan

    2014-08-19

    Neodymium, one of the more critically scarce rare earth metals, is often used in sustainable technologies. In this study, we investigate the potential contribution of neodymium recycling to reducing scarcity in supply, with a case study on computer hard disk drives (HDDs). We first review the literature on neodymium production and recycling potential. From this review, we find that recycling of computer HDDs is currently the most feasible pathway toward large-scale recycling of neodymium, even though HDDs do not represent the largest application of neodymium. We then use a combination of dynamic modeling and empirical experiments to conclude that within the application of NdFeB magnets for HDDs, the potential for loop-closing is significant: up to 57% in 2017. However, compared to the total NdFeB production capacity, the recovery potential from HDDs is relatively small (in the 1-3% range). The distributed nature of neodymium poses a significant challenge for recycling of neodymium.

  6. Reliability evaluation of hard disk drive failures based on counting processes

    International Nuclear Information System (INIS)

    Ye, Zhi-Sheng; Xie, Min; Tang, Loon-Ching

    2013-01-01

    Reliability assessment for hard disk drives (HDDs) is important yet difficult for manufacturers. Motivated by the fact that the particle accumulation in the HDDs, which accounts for most HDD catastrophic failures, is contributed from the internal and external sources, a counting process with two arrival sources is proposed to model the particle cumulative process in HDDs. This model successfully explains the collapse of traditional ALT approaches for accelerated life test data. Parameter estimation and hypothesis tests for the model are developed and illustrated with real data from a HDD test. A simulation study is conducted to examine the accuracy of large sample normal approximations that are used to test existence of the internal and external sources.

  7. Study of flow induce vibration inside 3.5 inch hard disk drives

    Directory of Open Access Journals (Sweden)

    Wichitpon Seepangmon

    2014-06-01

    Full Text Available This study focused on flow induced vibration of head stack assembly (HSA in a 3.5 inch hard disk drive with 5 disks and 10 read/write heads. We studied the effects of air flow on gimbal flex and resonance on arm. The comparison of vibrations on slider between the normal model and the experiment has been done for verifying the model. The peaks of frequency in experiment match the normal model at 1,040 1,320 and 1,400 Hz respectively. After that, the RNG K-ε turbulence model was used to determine the turbulent air flow of 7,200 rpm hard disk drive. The comparison between the normal model and the model with spoiler was investigated by using, computational fluid dynamics software (ANSYS and FLUENT. The results shown velocity magnitudes at the arm were decreased by 0.725 - 57.689 % and pressure dropped by 74.028 - 87.222 %. The velocity magnitudes at the gimbal flex were decreased by 5.522 - 14.291 % and pressure dropped by 48.440 - 82.947 %. The peak of vibrations on arm and gimbal flex was occurred at the frequency 1200 Hz. The model with spoiler could reduce vibration at arm by 2.56 - 95.601 % and reduce vibration at gimbal flex by 4.065 - 95.503 %. In the conclusion, the model with a spoiler could decrease the vibration at all surface of the arm and gimbal flex due to the velocity and pressure reduction[1][4].

  8. Economic Assessment for Recycling Critical Metals From Hard Disk Drives Using a Comprehensive Recovery Process

    Science.gov (United States)

    Nguyen, Ruby Thuy; Diaz, Luis A.; Imholte, D. Devin; Lister, Tedd E.

    2017-09-01

    Since the 2011 price spike of rare earth elements (REEs), research on permanent magnet recycling has blossomed globally in an attempt to reduce future REE criticality. Hard disk drives (HDDs) have emerged as one feasible feedstock for recovering valuable REEs such as praseodymium, neodymium, and dysprosium. Nevertheless, current processes for recycling electronic waste only focus on certain metals as a result of feedstock and metal price uncertainties. In addition, there is a perception that recycling REEs is unprofitable. To shed some light on the economic viability of REE recycling from U.S. HDDs, this article combines techno-economic information of an electro-hydrometallurgical process with end-of-life HDD availability in a simulation model. The results showed that adding REE recovery to an HDD base and precious metal recovery process was profitable given current prices. Recovered REEs from U.S. HDDs could meet up to 5.2% rest-of-world (excluding China) neodymium magnet demand. Feedstock, aluminum, and gold prices are key factors to recycling profitability. REEs contributed 13% to the co-recycling profit.

  9. Active-passive hybrid piezoelectric actuators for high-precision hard disk drive servo systems

    Science.gov (United States)

    Chan, Kwong Wah; Liao, Wei-Hsin

    2006-03-01

    Positioning precision is crucial to today's increasingly high-speed, high-capacity, high data density, and miniaturized hard disk drives (HDDs). The demand for higher bandwidth servo systems that can quickly and precisely position the read/write head on a high track density becomes more pressing. Recently, the idea of applying dual-stage actuators to track servo systems has been studied. The push-pull piezoelectric actuated devices have been developed as micro actuators for fine and fast positioning, while the voice coil motor functions as a large but coarse seeking. However, the current dual-stage actuator design uses piezoelectric patches only without passive damping. In this paper, we propose a dual-stage servo system using enhanced active-passive hybrid piezoelectric actuators. The proposed actuators will improve the existing dual-stage actuators for higher precision and shock resistance, due to the incorporation of passive damping in the design. We aim to develop this hybrid servo system not only to increase speed of track seeking but also to improve precision of track following servos in HDDs. New piezoelectrically actuated suspensions with passive damping have been designed and fabricated. In order to evaluate positioning and track following performances for the dual-stage track servo systems, experimental efforts are carried out to implement the synthesized active-passive suspension structure with enhanced piezoelectric actuators using a composite nonlinear feedback controller.

  10. What drives the efficiency of hard coal fuelled electricity generation? : an empirical assessment

    OpenAIRE

    Hoffmann, Tim; Voigt, Sebastian

    2009-01-01

    The efficiency of electricity generation in hard coal fired power plants varies considerably from country to country and over time. These differences occur both between developing and developed countries and between industrialised nations. The econometric analysis presented in this paper tests for the reasons of these discrepancies. In this examination abundance of hard coal and the price of hard coal are the two variables of our major interest. We assume that countries with an abundance of h...

  11. Cleaner Technology in the Hard Disk Drive Manufacturing Industry: A Case Study

    Science.gov (United States)

    Moolla, Premchai; Chompu-inwai, Rungchat

    2010-10-01

    The objectives of this research are to improve raw material and energy consumption efficiency, as well as reduce defects and the use of chemicals in the arm coil assembly process of hard disk drive manufacturing in the case study company by applying the Cleaner Technology concepts. The four main sequential steps used in this research were: (1) pre-assessment, (2) assessment, (3) feasibility study, and (4) implementation. In the first step, raw data, such as process flows, raw material usage and defects data were collected. In the second step, the loss during production and causes of loss were analyzed. Opportunities to reduce raw material, chemical and energy wastage could then be recommended. The next step was to evaluate the feasibility and potential benefits of a particular Cleaner Technology opportunity. Finally, in the last step, after a thorough evaluation and implementation of the opportunities to apply Cleaner Technology, the results showed that arm coil defects could be reduced by improving the production process using the ECRS technique. ECRS stands for Eliminate, Combine, Rearrange and Simplify. This improvement reduced arm coil defect rates from 0.48% to 0.15%, thus saving approximately 139,638 Thai Baht per month. In addition, production stoppage decision made by workers was used to increase employee involvement in defect detection. Allowing workers to participate in such a decision was an effective way to reduce defect rate and could motivate workers to produce a better quality job. This resulted in arm coil defects reducing from 0.41% to 0.025%, with about 74,562 Thai Baht per month saving. Additionally, an increase in the efficiency of electricity consumption occurred, by increasing the speed of the infrared oven conveyor belt, improving average productivity from 533 pieces/hour to 560 pieces/hour, without adversely affecting product costs and quality, thus producing products of up to the value of 206,242 Thai Baht per month. Furthermore, the new

  12. Deep machine learning based Image classification in hard disk drive manufacturing (Conference Presentation)

    Science.gov (United States)

    Rana, Narender; Chien, Chester

    2018-03-01

    A key sensor element in a Hard Disk Drive (HDD) is the read-write head device. The device is complex 3D shape and its fabrication requires over thousand process steps with many of them being various types of image inspection and critical dimension (CD) metrology steps. In order to have high yield of devices across a wafer, very tight inspection and metrology specifications are implemented. Many images are collected on a wafer and inspected for various types of defects and in CD metrology the quality of image impacts the CD measurements. Metrology noise need to be minimized in CD metrology to get better estimate of the process related variations for implementing robust process controls. Though there are specialized tools available for defect inspection and review allowing classification and statistics. However, due to unavailability of such advanced tools or other reasons, many times images need to be manually inspected. SEM Image inspection and CD-SEM metrology tools are different tools differing in software as well. SEM Image inspection and CD-SEM metrology tools are separate tools differing in software and purpose. There have been cases where a significant numbers of CD-SEM images are blurred or have some artefact and there is a need for image inspection along with the CD measurement. Tool may not report a practical metric highlighting the quality of image. Not filtering CD from these blurred images will add metrology noise to the CD measurement. An image classifier can be helpful here for filtering such data. This paper presents the use of artificial intelligence in classifying the SEM images. Deep machine learning is used to train a neural network which is then used to classify the new images as blurred and not blurred. Figure 1 shows the image blur artefact and contingency table of classification results from the trained deep neural network. Prediction accuracy of 94.9 % was achieved in the first model. Paper covers other such applications of the deep neural

  13. Hard X-ray intensity reduction during lower hybrid current drive experiments

    International Nuclear Information System (INIS)

    Mlynar, J.; Stoeckel, J.; Magula, P.

    1993-01-01

    A strong hard X-ray intensity reduction during a standard LHCD at the CASTOR tokamak was studied. From discussion it followed that the magnetic fluctuations level decrease is likely to be responsible for this effect beside the loop voltage decrease. To verify this idea, the connection between the magnetic fluctuation level and the hard X-ray intensity was studied in a nonstandard LHCD regime with a zero loop voltage reduction. These measurements strongly supported the concept that magnetic fluctuations level substantially influences the runaway electrons cross-field transport. Though, more data and a good code for modelling the anomalous transport and hard X-rays production would be of high value. Similar measurements especially for higher RF power should be carried out soon. Besides, the reduction of hard X-rays was observed in the experiments with edge plasma polarization lately; therefore, the magnetic fluctuations level in these experiments should be studied soon. (author) 6 figs., 6 refs

  14. Field Triage Decision Scheme: The National Trauma Triage Protocol

    Centers for Disease Control (CDC) Podcasts

    In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.

  15. Simultaneous measurements of disk vibration and pressure fluctuation in turbulent flow developing in a model hard disk drive

    Energy Technology Data Exchange (ETDEWEB)

    Kurashima, D.; Naka, Y.; Fukagata, K. [Department of Mechanical Engineering, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522 (Japan); Obi, S., E-mail: obsn@mech.keio.ac.jp [Department of Mechanical Engineering, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522 (Japan)

    2011-06-15

    The complex flow features inside hard disk drive models are investigated in an axisymmetric and a semi-open shroud configurations. For the axisymmetric case, we have employed both experimental and computational approaches. The experiment focuses on both flow dynamics and the disk vibration, where measurements of the fluctuating pressure and velocity are undertaken at some representative points. The correlation between the disk vibration and the fluctuating pressure in the turbulent flow between disks is evident from the spectral analysis. The experimentally observed fluctuating pressure and velocity are partly due to the disk vibration and its contribution could be estimated by comparing the experiment with the results of a large eddy simulation. For the semi-open shroud case, although the characteristic peaks attributable to the large-scale vortical structure are still observed in the power spectra, the pressure fluctuation and the disk vibration are suppressed when the arm is inserted.

  16. Impact of radius and skew angle on areal density in heat assisted magnetic recording hard disk drives

    Science.gov (United States)

    Cordle, Michael; Rea, Chris; Jury, Jason; Rausch, Tim; Hardie, Cal; Gage, Edward; Victora, R. H.

    2018-05-01

    This study aims to investigate the impact that factors such as skew, radius, and transition curvature have on areal density capability in heat-assisted magnetic recording hard disk drives. We explore a "ballistic seek" approach for capturing in-situ scan line images of the magnetization footprint on the recording media, and extract parametric results of recording characteristics such as transition curvature. We take full advantage of the significantly improved cycle time to apply a statistical treatment to relatively large samples of experimental curvature data to evaluate measurement capability. Quantitative analysis of factors that impact transition curvature reveals an asymmetry in the curvature profile that is strongly correlated to skew angle. Another less obvious skew-related effect is an overall decrease in curvature as skew angle increases. Using conventional perpendicular magnetic recording as the reference case, we characterize areal density capability as a function of recording position.

  17. Design and Analysis of Shock and Random Vibration Isolation of Operating Hard Disk Drive in Harsh Environment

    Directory of Open Access Journals (Sweden)

    Hendri Harmoko

    2009-01-01

    Full Text Available An effective vibration isolation system is important for hard disk drives (HDD used in a harsh mechanical environment. This paper describes how to design, simulate, test and evaluate vibration isolation systems for operating HDD subjected to severe shock and random vibrations based on military specifications MIL-STD-810E. The well-defined evaluation criteria proposed in this paper can be used to effectively assess the performance of HDD vibration isolation system. Design concepts on how to achieve satisfactory shock and vibration isolation for HDD are described. The concepts are tested and further enhanced by the two design case studies presented here. It is shown that an effective vibration isolation system, that will allow a HDD to operate well when subjected to severe shock and random vibration, is feasible.

  18. The successful of finite element to invent particle cleaning system by air jet in hard disk drive

    Science.gov (United States)

    Jai-Ngam, Nualpun; Tangchaichit, Kaitfa

    2018-02-01

    Hard Disk Drive manufacturing has faced very challenging with the increasing demand of high capacity drives for Cloud-based storage. Particle adhesion has also become increasingly important in HDD to gain more reliability of storage capacity. The ability to clean on surfaces is more complicated in removing such particles without damaging the surface. This research is aim to improve the particle cleaning in HSA by using finite element to develop the air flow model then invent the prototype of air cleaning system to remove particle from surface. Surface cleaning by air pressure can be applied as alternative for the removal of solid particulate contaminants that is adhering on a solid surface. These technical and economic challenges have driven the process development from traditional way that chemical solvent cleaning. The focus of this study is to develop alternative way from scrub, ultrasonic, mega sonic on surface cleaning principles to serve as a foundation for the development of new processes to meet current state-of-the-art process requirements and minimize the waste from chemical cleaning for environment safety.

  19. Radial profiles of hard X-ray emission during steady state current drive in the TRIAM-1M tokamak

    International Nuclear Information System (INIS)

    Nakamura, Y.; Takabatake, Y.; Jotaki, E.; Moriyama, S.; Nagao, A.; Nakamura, K.; Hiraki, N.; Itoh, S.

    1990-01-01

    The hard X-ray emission from the TRIAM-1M tokamak plasma during steady state lower hybrid current drive with a discharge duration of a few minutes was measured with sodium iodide scintillation spectrometers. The radial profiles of the X-ray emission were also measured and indicate that, in the low density regime (n e =(1-3)x10 12 cm -3 ), the current carrying high energy electrons are mainly in the inner region of the plasma column and their radial profile remains unchanged during current drive. On the other hand, high density discharges (n e =(3-6)x10 12 cm -3 ) are always accompanied by an abrupt drop of the plasma current, and the X-ray emission profile changes from peaked to broad. This change can be attributed to the conditions of wave accessibility. As the electron density increases, the accessibility of the plasma to lower hybrid waves with low values of the parallel wave number n parallel is significantly reduced and high energy electrons resonating with the waves are produced at the plasma periphery. Interaction of these electrons with the limiters causes an increase of the electron density in this region; waves with low n parallel then become completely excluded from the inner part of the plasma column. This interpretation is supported by measurements of the density profile and impurity radiation, and has been confirmed in an investigation of discharges with additional gas puffing. (author). 17 refs, 21 figs

  20. A simple method to prevent hard X-ray-induced preheating effects inside the cone tip in indirect-drive fast ignition implosions

    International Nuclear Information System (INIS)

    Liu, Dongxiao; Shan, Lianqiang; Zhou, Weimin; Wu, Yuchi; Zhu, Bin; Zhang, Feng; Bi, Bi; Zhang, Bo; Zhang, Zhimeng; Shui, Min; He, Yingling; Gu, Yuqiu; Zhang, Baohan; Peng, Xiaoshi; Xu, Tao; Wang, Feng; Yang, Zhiwen; Chen, Tao; Chen, Li; Chen, Ming

    2016-01-01

    During fast-ignition implosions, preheating of inside the cone tip caused by hard X-rays can strongly affect the generation and transport of hot electrons in the cone. Although indirect-drive implosions have a higher implosion symmetry, they cause stronger preheating effects than direct-drive implosions. To control the preheating of the cone tip, we propose the use of indirect-drive fast-ignition targets with thicker tips. Experiments carried out at the ShenGuang-III prototype laser facility confirmed that thicker tips are effective for controlling preheating. Moreover, these results were consistent with those of 1D radiation hydrodynamic simulations.

  1. A simple method to prevent hard X-ray-induced preheating effects inside the cone tip in indirect-drive fast ignition implosions

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Dongxiao; Shan, Lianqiang; Zhou, Weimin; Wu, Yuchi; Zhu, Bin; Zhang, Feng; Bi, Bi; Zhang, Bo; Zhang, Zhimeng; Shui, Min; He, Yingling; Gu, Yuqiu, E-mail: yqgu@caep.cn; Zhang, Baohan [Science and Technology on Plasma Physics Laboratory, China Academy of Engineering Physics, Mianyang 621900 (China); Research Center of Laser Fusion, China Academy of Engineering Physics, Mianyang 621900 (China); Peng, Xiaoshi; Xu, Tao; Wang, Feng; Yang, Zhiwen; Chen, Tao; Chen, Li; Chen, Ming [Research Center of Laser Fusion, China Academy of Engineering Physics, Mianyang 621900 (China); and others

    2016-06-15

    During fast-ignition implosions, preheating of inside the cone tip caused by hard X-rays can strongly affect the generation and transport of hot electrons in the cone. Although indirect-drive implosions have a higher implosion symmetry, they cause stronger preheating effects than direct-drive implosions. To control the preheating of the cone tip, we propose the use of indirect-drive fast-ignition targets with thicker tips. Experiments carried out at the ShenGuang-III prototype laser facility confirmed that thicker tips are effective for controlling preheating. Moreover, these results were consistent with those of 1D radiation hydrodynamic simulations.

  2. A three-dimensional model for lubricant depletion under sliding condition on bit patterned media of hard disk drives

    Science.gov (United States)

    Wu, Lin

    2018-05-01

    In this paper, we model the depletion dynamics of the molecularly thin layer of lubricants on a bit patterned media disk of hard disk drives under a sliding air bearing head. The dominant physics and consequently, the lubricant depletion dynamics on a patterned disk are shown to be significantly different from the well-studied cases of a smooth disk. Our results indicate that the surface tension effect, which is negligible on a flat disk, apparently suppresses depletion by enforcing a bottleneck effect around the disk pattern peak regions to thwart the migration of lubricants. When the disjoining pressure is relatively small, it assists the depletion. But, when the disjoining pressure becomes dominant, the disjoining pressure resists depletion. Disk pattern orientation plays a critical role in the depletion process. The effect of disk pattern orientation on depletion originates from its complex interaction with other intermingled factors of external air shearing stress distribution and lubricant particle trajectory. Patterning a disk surface with nanostructures of high density, large height/pitch ratio, and particular orientation is demonstrated to be one efficient way to alleviate the formation of lubricant depletion tracks.

  3. Runaway electron studies with hard x-ray and microwave diagnostics in the FT-2 lower hybrid current drive discharges

    Science.gov (United States)

    Shevelev, A. E.; Khilkevitch, E. M.; Lashkul, S. I.; Rozhdestvensky, V. V.; Pandya, S. P.; Plyusnin, V. V.; Altukhov, A. B.; Kouprienko, D. V.; Chugunov, I. N.; Doinikov, D. N.; Esipov, L. A.; Gin, D. B.; Iliasova, M. V.; Naidenov, V. O.; Polunovsky, I. A.; Sidorov, A. V.; Kiptily, V. G.

    2018-01-01

    Studies of the super-thermal and runaway electron behavior in ohmic and lower hybrid current drive FT-2 tokamak plasmas have been carried out using information obtained from measurements of hard x-ray spectra and non-thermal microwave radiation intensity at the frequency of 10 GHz and in the range of (53 ÷ 78) GHz. A gamma-ray spectrometer based on a scintillation detector with a LaBr3(Ce) crystal was used, which provides measurements at counting rates up to 107 s-1. Reconstruction of the energy distribution of RE interacting with the poloidal limiter of the tokamak chamber was made with application of the DeGaSum code. Super-thermal electrons accelerated up to 2 MeV by the LH waves at the high-frequency pumping of the plasma with low density ≤ft ~ 2  ×  1013 cm-3 and then up to 7 MeV by vortex electric field have been found. Experimental analysis of the runaway electron beam generation and evolution of their energy distribution in the FT-2 plasmas is presented in the article and compared with the numerical calculation of the maximum energy gained by runaway electrons for given plasma parameters. In addition, possible mechanisms for limiting the maximum energy gained by the runaway electrons are also calculated and described for a FT-2 plasma discharge.

  4. Tracking the Flow of Resources in Electronic Waste - The Case of End-of-Life Computer Hard Disk Drives.

    Science.gov (United States)

    Habib, Komal; Parajuly, Keshav; Wenzel, Henrik

    2015-10-20

    Recovery of resources, in particular, metals, from waste flows is widely seen as a prioritized option to reduce their potential supply constraints in the future. The current waste electrical and electronic equipment (WEEE) treatment system is more focused on bulk metals, where the recycling rate of specialty metals, such as rare earths, is negligible compared to their increasing use in modern products, such as electronics. This study investigates the challenges in recovering these resources in the existing WEEE treatment system. It is illustrated by following the material flows of resources in a conventional WEEE treatment plant in Denmark. Computer hard disk drives (HDDs) containing neodymium-iron-boron (NdFeB) magnets were selected as the case product for this experiment. The resulting output fractions were tracked until their final treatment in order to estimate the recovery potential of rare earth elements (REEs) and other resources contained in HDDs. The results further show that out of the 244 kg of HDDs treated, 212 kg comprising mainly of aluminum and steel can be finally recovered from the metallurgic process. The results further demonstrate the complete loss of REEs in the existing shredding-based WEEE treatment processes. Dismantling and separate processing of NdFeB magnets from their end-use products can be a more preferred option over shredding. However, it remains a technological and logistic challenge for the existing system.

  5. Field Triage Decision Scheme: The National Trauma Triage Protocol

    Centers for Disease Control (CDC) Podcasts

    2009-01-22

    In this podcast, Dr. Richard C. Hunt, Director of CDC's Division of Injury Response, provides an overview on the development process and scientific basis for the revised field triage guidelines published in the MMWR Recommendations and Report: Guidelines for Field Triage of Injured Patients, Recommendations of the National Expert Panel on Field Triage.  Created: 1/22/2009 by National Center for Injury Prevention and Control (NCIPC), Division of Injury Response (DIR).   Date Released: 1/22/2009.

  6. A comparative approach for the investigation of biological information processing: An examination of the structure and function of computer hard drives and DNA

    Science.gov (United States)

    2010-01-01

    Background The robust storage, updating and utilization of information are necessary for the maintenance and perpetuation of dynamic systems. These systems can exist as constructs of metal-oxide semiconductors and silicon, as in a digital computer, or in the "wetware" of organic compounds, proteins and nucleic acids that make up biological organisms. We propose that there are essential functional properties of centralized information-processing systems; for digital computers these properties reside in the computer's hard drive, and for eukaryotic cells they are manifest in the DNA and associated structures. Methods Presented herein is a descriptive framework that compares DNA and its associated proteins and sub-nuclear structure with the structure and function of the computer hard drive. We identify four essential properties of information for a centralized storage and processing system: (1) orthogonal uniqueness, (2) low level formatting, (3) high level formatting and (4) translation of stored to usable form. The corresponding aspects of the DNA complex and a computer hard drive are categorized using this classification. This is intended to demonstrate a functional equivalence between the components of the two systems, and thus the systems themselves. Results Both the DNA complex and the computer hard drive contain components that fulfill the essential properties of a centralized information storage and processing system. The functional equivalence of these components provides insight into both the design process of engineered systems and the evolved solutions addressing similar system requirements. However, there are points where the comparison breaks down, particularly when there are externally imposed information-organizing structures on the computer hard drive. A specific example of this is the imposition of the File Allocation Table (FAT) during high level formatting of the computer hard drive and the subsequent loading of an operating system (OS). Biological

  7. A comparative approach for the investigation of biological information processing: an examination of the structure and function of computer hard drives and DNA.

    Science.gov (United States)

    D'Onofrio, David J; An, Gary

    2010-01-21

    The robust storage, updating and utilization of information are necessary for the maintenance and perpetuation of dynamic systems. These systems can exist as constructs of metal-oxide semiconductors and silicon, as in a digital computer, or in the "wetware" of organic compounds, proteins and nucleic acids that make up biological organisms. We propose that there are essential functional properties of centralized information-processing systems; for digital computers these properties reside in the computer's hard drive, and for eukaryotic cells they are manifest in the DNA and associated structures. Presented herein is a descriptive framework that compares DNA and its associated proteins and sub-nuclear structure with the structure and function of the computer hard drive. We identify four essential properties of information for a centralized storage and processing system: (1) orthogonal uniqueness, (2) low level formatting, (3) high level formatting and (4) translation of stored to usable form. The corresponding aspects of the DNA complex and a computer hard drive are categorized using this classification. This is intended to demonstrate a functional equivalence between the components of the two systems, and thus the systems themselves. Both the DNA complex and the computer hard drive contain components that fulfill the essential properties of a centralized information storage and processing system. The functional equivalence of these components provides insight into both the design process of engineered systems and the evolved solutions addressing similar system requirements. However, there are points where the comparison breaks down, particularly when there are externally imposed information-organizing structures on the computer hard drive. A specific example of this is the imposition of the File Allocation Table (FAT) during high level formatting of the computer hard drive and the subsequent loading of an operating system (OS). Biological systems do not have an

  8. A comparative approach for the investigation of biological information processing: An examination of the structure and function of computer hard drives and DNA

    Directory of Open Access Journals (Sweden)

    D'Onofrio David J

    2010-01-01

    Full Text Available Abstract Background The robust storage, updating and utilization of information are necessary for the maintenance and perpetuation of dynamic systems. These systems can exist as constructs of metal-oxide semiconductors and silicon, as in a digital computer, or in the "wetware" of organic compounds, proteins and nucleic acids that make up biological organisms. We propose that there are essential functional properties of centralized information-processing systems; for digital computers these properties reside in the computer's hard drive, and for eukaryotic cells they are manifest in the DNA and associated structures. Methods Presented herein is a descriptive framework that compares DNA and its associated proteins and sub-nuclear structure with the structure and function of the computer hard drive. We identify four essential properties of information for a centralized storage and processing system: (1 orthogonal uniqueness, (2 low level formatting, (3 high level formatting and (4 translation of stored to usable form. The corresponding aspects of the DNA complex and a computer hard drive are categorized using this classification. This is intended to demonstrate a functional equivalence between the components of the two systems, and thus the systems themselves. Results Both the DNA complex and the computer hard drive contain components that fulfill the essential properties of a centralized information storage and processing system. The functional equivalence of these components provides insight into both the design process of engineered systems and the evolved solutions addressing similar system requirements. However, there are points where the comparison breaks down, particularly when there are externally imposed information-organizing structures on the computer hard drive. A specific example of this is the imposition of the File Allocation Table (FAT during high level formatting of the computer hard drive and the subsequent loading of an operating

  9. Triage in psychiatric emergency services in Copenhagen

    DEFF Research Database (Denmark)

    Sæbye, Ditte; Høegh, Erica Bernt; Knop, Joachim

    2017-01-01

    Inspired by the Australasian triage system, a regional psychiatric triage system was introduced in the psychiatric emergency units (PEUs) in Copenhagen in 2011. Our aim of the study is to determine the characteristics of the patient according to the defined triage criteria and check...

  10. Paediatric triage in South Africa

    African Journals Online (AJOL)

    2013-05-07

    May 7, 2013 ... There has been a lot of interest and work in the field of triage of sick children in South Africa over the past few years. Despite this ... So opens the World Health Organization (WHO)'s Countdown to 2015, the .... walk as normal. 27 or more. 160 or more. Unrespon- sive. Reacts to. Pain ... Each time the IMCI or.

  11. Role of telephone triage in obstetrics.

    Science.gov (United States)

    Manning, Nirvana Afsordeh; Magann, Everett F; Rhoads, Sarah J; Ivey, Tesa L; Williams, Donna J

    2012-12-01

    The telephone has become an indispensable method of communication in the practice of obstetrics. The telephone is one of the primary methods by which the patient makes her appointments and contacts her health care provider for advice, reassurance, and referrals. Current methods of telephone triage include personal at the physicians' office, telephone answering services, labor and delivery nurses, and a dedicated telephone triage system using algorithms. Limitations of telephone triage include the inability of the provider to see the patient and receive visual clues from the interaction and the challenges of obtaining a complete history over the telephone. In addition, there are potential safety and legal issues with telephone triage. To date, there is insufficient evidence to either validate or refute the use of a dedicated telephone triage system compared with a traditional system using an answering service or nurses on labor and delivery. Obstetricians and gynecologists, family physicians. After completing this CME activity, physicians should be better able to analyze the scope of variation in telephone triage across health care providers and categorize the components that go into a successful triage system, assess the current scope of research in telephone triage in obstetrics, evaluate potential safety and legal issues with telephone triage in obstetrics, and identify issues that should be addressed in any institution that is using or implementing a system of telephone triage in obstetrics.

  12. Macromolecular 'size' and 'hardness' drives structure in solvent-swollen blends of linear, cyclic, and star polymers.

    Science.gov (United States)

    Gartner, Thomas E; Jayaraman, Arthi

    2018-01-17

    In this paper, we apply molecular simulation and liquid state theory to uncover the structure and thermodynamics of homopolymer blends of the same chemistry and varying chain architecture in the presence of explicit solvent species. We use hybrid Monte Carlo (MC)/molecular dynamics (MD) simulations in the Gibbs ensemble to study the swelling of ∼12 000 g mol -1 linear, cyclic, and 4-arm star polystyrene chains in toluene. Our simulations show that the macroscopic swelling response is indistinguishable between the various architectures and matches published experimental data for the solvent annealing of linear polystyrene by toluene vapor. We then use standard MD simulations in the NPT ensemble along with polymer reference interaction site model (PRISM) theory to calculate effective polymer-solvent and polymer-polymer Flory-Huggins interaction parameters (χ eff ) in these systems. As seen in the macroscopic swelling results, there are no significant differences in the polymer-solvent and polymer-polymer χ eff between the various architectures. Despite similar macroscopic swelling and effective interaction parameters between various architectures, the pair correlation function between chain centers-of-mass indicates stronger correlations between cyclic or star chains in the linear-cyclic blends and linear-star blends, compared to linear chain-linear chain correlations. Furthermore, we note striking similarities in the chain-level correlations and the radius of gyration of cyclic and 4-arm star architectures of identical molecular weight. Our results indicate that the cyclic and star chains are 'smaller' and 'harder' than their linear counterparts, and through comparison with MD simulations of blends of soft spheres with varying hardness and size we suggest that these macromolecular characteristics are the source of the stronger cyclic-cyclic and star-star correlations.

  13. Mental health triage in emergency medicine.

    Science.gov (United States)

    Smart, D; Pollard, C; Walpole, B

    1999-02-01

    The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. A four-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health 'did not waits' showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. A systematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.

  14. Level I center triage and mass casualties.

    Science.gov (United States)

    Hoey, Brian A; Schwab, C William

    2004-05-01

    The world has been marked by a recent series of high-profile terrorist attacks, including the attack of September 11, 2001, in New York City. Similar to natural disasters, these attacks often result in a large number of casualties necessitating triage strategies. The end of the twentieth century was marked by the development of trauma systems in the United States and abroad. By their very nature, trauma centers are best equipped to handle mass casualties resulting from natural and manmade disasters. Triage assessment tools and scoring systems have evolved to facilitate this triage process and to potentially reduce the morbidity and mortality associated with these events.

  15. Rate dependent direct inverse hysteresis compensation of piezoelectric micro-actuator used in dual-stage hard disk drive head positioning system.

    Science.gov (United States)

    Rahman, Md Arifur; Al Mamun, Abdullah; Yao, Kui

    2015-08-01

    The head positioning servo system in hard disk drive is implemented nowadays using a dual-stage actuator—the primary stage consisting of a voice coil motor actuator providing long range motion and the secondary stage controlling the position of the read/write head with fine resolution. Piezoelectric micro-actuator made of lead zirconate titanate (PZT) has been a popular choice for the secondary stage. However, PZT micro-actuator exhibits hysteresis—an inherent nonlinear characteristic of piezoelectric material. The advantage expected from using the secondary micro-actuator is somewhat lost by the hysteresis of the micro-actuator that contributes to tracking error. Hysteresis nonlinearity adversely affects the performance and, if not compensated, may cause inaccuracy and oscillation in the response. Compensation of hysteresis is therefore an important aspect for designing head-positioning servo system. This paper presents a new rate dependent model of hysteresis along with rigorous analysis and identification of the model. Parameters of the model are found using particle swarm optimization. Direct inverse of the proposed rate-dependent generalized Prandtl-Ishlinskii model is used as the hysteresis compensator. Effectiveness of the overall solution is underscored through experimental results.

  16. Work Hard / Play Hard

    OpenAIRE

    Burrows, J.; Johnson, V.; Henckel, D.

    2016-01-01

    Work Hard / Play Hard was a participatory performance/workshop or CPD experience hosted by interdisciplinary arts atelier WeAreCodeX, in association with AntiUniversity.org. As a socially/economically engaged arts practice, Work Hard / Play Hard challenged employees/players to get playful, or go to work. 'The game changes you, you never change the game'. Employee PLAYER A 'The faster the better.' Employer PLAYER B

  17. Do prehospital providers and emergency nurses agree on triage assignment?

    DEFF Research Database (Denmark)

    Skjøt-Arkil, Helene; Pontoppidan, Louise L; Laursen, Jens O

    2018-01-01

    OBJECTIVES: The aim of this study was to investigate the agreement on triage level between prehospital providers and emergency department (ED) nurses in clinical practice when using the same triage system. The objectives were as follows: (a) What is the agreement of triage between prehospital...... providers and ED nurses, when using Danish Emergency Process Triage (DEPT) correctly? (b) Which part of the triage process yields the highest agreement regarding the final triage? METHODS: The study was a prospective and observational efficacy study. Patients transported to the ED by ambulances were...... included. They were triaged by prehospital providers while being transported by ambulance to the ED, and by ED nurses upon arrival. Triage was done using the DEPT - a five-level triage system based on vital signs and a presenting complaint algorithm. An agreement analysis was performed. RESULTS: DEPT...

  18. A pivot nurse at triage.

    Science.gov (United States)

    Martin, Marie

    2012-01-01

    According to Drs Thom Mayer and Kirk Jensen, widely recognized experts in leadership, management, and customer service, "Improving patient flow essentially means patients spend exactly the right amount of time at every juncture in their journey through an organization, when you improve flow, you can serve more patients, with less effort and you can serve them better." 2 Recognizing that backups in the emergency department are a result of broken processes throughout the hospital is the first step in solving these problems. The most significant challenges are the prevailing attitudes that team triage and immediate bedding could not be done. Another challenge is the broad reaching nature of the issue. ED throughput is truly a system problem. As ED crowding worsens, it is important for departments to improve operations to promote patient throughput. No doubt, operational bottlenecks at the back end of the emergency department will ultimately lead to front-end delays. However, proficient patient processing at the ED front end can minimize the time to physician evaluation, increase patient satisfaction, and decrease totalED length of stay.

  19. Adaptive process triage system cannot identify patients with gastrointestinal perforation

    DEFF Research Database (Denmark)

    Bohm, Aske Mathias; Tolstrup, Mai-Britt; Gögenur, Ismail

    2017-01-01

    INTRODUCTION: Adaptive process triage (ADAPT) is a triage tool developed to assess the severity and address the priority of emergency patients. In 2009-2011, ADAPT was the most frequently used triage system in Denmark. Until now, no Danish triage system has been evaluated based on a selective group...... triaged as green or yellow had a GIP that was not identified by the triage system. CONCLUSION: ADAPT is incapable of identifying one of the most critically ill patient groups in need of emergency abdominal surgery. FUNDING: none. TRIAL REGISTRATION: HEH-2013-034 I-Suite: 02336....

  20. [Emergency department triage: independent nursing intervention?].

    Science.gov (United States)

    Corujo Fontes, Sergio José

    2014-03-01

    The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.

  1. Higher Education: A Time for Triage?

    Science.gov (United States)

    Lagowski, J. J.

    1995-10-01

    Higher education faces unprecedented challenges. The confluence of changing economic and demographic tends; new patterns of federal and state spending; more explicit expectations by students and their families for affordable, accessible education; and heightened scrutiny by those who claim a legitimate interest in higher education is inescapably altering the environment in which this system operates. Higher education will never again be as it was before. Further, many believe that tinkering around the margins is no longer an adequate response to the new demands. Fundamental change is deemed necessary to meet the challenge of this melange of pressures. A number of commentators have observed that political and corporate America have responded to their challenges by instituting a fundamental restructuring of those institutions. The medical community is also in the midst of a similar basic restructuring of the health care delivery system in this country. Now its education's turn. People are questioning the historically expressed mission of higher education. They make the claim that we cost too much, spend carelessly, teach poorly, plan myopically, and when questioned, act defensively. Educational administrators, from department chairs up, are confronted with the task of simultaneously reforming and cutting back. They have no choice. They must establish politically sophisticated priority settings and effect a hard-nosed reallocation of resources in a social environment where competing public needs have equivalent--or stronger--emotional pulls. Triage in a medical context involves confronting an emergency in which the demand for attention far outstrips available assistance by establishing a sequence of care in which one key individual orchestrates the application of harsh priorities which have been designed to maximize the number of survivors. In recent years, the decisions that have been made in some centers of higher education bear a striking similarity. The literature

  2. Implementing a structured triage system at a community health ...

    African Journals Online (AJOL)

    Implementing a structured triage system at a community health centre using Kaizen. ... and a resultant increased workload for doctors; management is concerned ... Aim: We set out to standardise the triage process and to manage unbooked ...

  3. Hard electronics; Hard electronics

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    Hard material technologies were surveyed to establish the hard electronic technology which offers superior characteristics under hard operational or environmental conditions as compared with conventional Si devices. The following technologies were separately surveyed: (1) The device and integration technologies of wide gap hard semiconductors such as SiC, diamond and nitride, (2) The technology of hard semiconductor devices for vacuum micro- electronics technology, and (3) The technology of hard new material devices for oxides. The formation technology of oxide thin films made remarkable progress after discovery of oxide superconductor materials, resulting in development of an atomic layer growth method and mist deposition method. This leading research is expected to solve such issues difficult to be easily realized by current Si technology as high-power, high-frequency and low-loss devices in power electronics, high temperature-proof and radiation-proof devices in ultimate electronics, and high-speed and dense- integrated devices in information electronics. 432 refs., 136 figs., 15 tabs.

  4. Mass casualty triage after an airplane crash near Amsterdam

    NARCIS (Netherlands)

    Postma, Ingri L. E.; Weel, Hanneke; Heetveld, Martin J.; van der Zande, Ineke; Bijlsma, Taco S.; Bloemers, Frank W.; Goslings, J. Carel

    2013-01-01

    Triage is an important aspect of the management of mass casualty incidents. This study describes the triage after the Turkish Airlines Crash near Amsterdam in 2009. The results of the triage and the injuries of P3 casualties were evaluated. In addition, the role of the trauma mechanism and its

  5. Triage Simulation in a Virtual Environment

    NARCIS (Netherlands)

    Dumay, A.C.M.

    1995-01-01

    Triage is the assessment of physical conditions of casualties with limited support of staff and equipment. The critical factor in handling a mass casualty situation is time. The focus is on the quick and accurate assessment of the physical conditions of casualties and the application of life-saving

  6. Risk Analysis for Environmental Health Triage

    International Nuclear Information System (INIS)

    Bogen, K T

    2005-01-01

    The Homeland Security Act mandates development of a national, risk-based system to support planning for, response to and recovery from emergency situations involving large-scale toxic exposures. To prepare for and manage consequences effectively, planners and responders need not only to identify zones of potentially elevated individual risk, but also to predict expected casualties. Emergency response support systems now define ''consequences'' by mapping areas in which toxic chemical concentrations do or may exceed Acute Exposure Guideline Levels (AEGLs) or similar guidelines. However, because AEGLs do not estimate expected risks, current unqualified claims that such maps support consequence management are misleading. Intentionally protective, AEGLs incorporate various safety/uncertainty factors depending on scope and quality of chemical-specific toxicity data. Some of these factors are irrelevant, and others need to be modified, whenever resource constraints or exposure-scenario complexities require responders to make critical trade-off (triage) decisions in order to minimize expected casualties. AEGL-exceedance zones cannot consistently be aggregated, compared, or used to calculate expected casualties, and so may seriously misguide emergency response triage decisions. Methods and tools well established and readily available to support environmental health protection are not yet developed for chemically related environmental health triage. Effective triage decisions involving chemical risks require a new assessment approach that focuses on best estimates of likely casualties, rather than on upper plausible bounds of individual risk. If risk-based consequence management is to become a reality, federal agencies tasked with supporting emergency response must actively coordinate to foster new methods that can support effective environmental health triage

  7. Triage level assignment and nurse characteristics and experience.

    Science.gov (United States)

    Gómez-Angelats, Elisenda; Miró, Òscar; Bragulat Baur, Ernesto; Antolín Santaliestra, Alberto; Sánchez Sánchez, Miquel

    2018-06-01

    To study the relation between nursing staff demographics and experience and their assignment of triage level in the emergency department. One-year retrospective observational study in the triage area of a tertiary care urban university hospital that applies the Andorran-Spanish triage model. Variables studied were age, gender, nursing experience, triage experience, shift, usual level of emergency work the nurse undertakes, number of triage decisions made, and percentage of patients assigned to each level. Fifty nurses (5 men, 45 women) with a mean (SD) age of 45 (9) years triaged 67 803 patients during the year. Nurses classified more patients in level 5 on the morning shift (7.9%) than on the afternoon shift (5.5%) (P=.003). The difference in the rate of level-5 triage classification became significant when nurses were older (β = 0.092, P=.037) and experience was greater (β = 0.103, P=.017). The number of triages recorded by a nurse was significantly and directly related to the percentage of patients assigned to level 3 (β = 0.003, P=.006) and inversely related to the percentages assigned to level 4 (β = -0.002, P=.008) and level 5 (β = -0.001, P=.017). We found that triage level assignments were related to age, experience, shift, and total number of patients triaged by a nurse.

  8. El triage en enfermería

    OpenAIRE

    Macías de Plasencia, Guillermo

    2013-01-01

    El objetivo del trabajo es dar a conocer y desarrollar todo lo relacionado con el triage, técnica que se pone en práctica en los servicios de emergencias médicas con la finalidad de mejorar la atención de los pacientes reducir la espera a los más graves y mandarles al especialista adecuado

  9. Identifying the core competencies of mental health telephone triage.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Gerdtz, Marie; Henderson, Kathryn; Keppich-Arnold, Sandra; Droste, Nicolas; Prematunga, Roshani K; Wereta, Zewdu W

    2013-11-01

    The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. An observational design was employed to address the research aims. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to

  10. Analysis of the development and performance of hard disks

    OpenAIRE

    Novak, Davorin

    2010-01-01

    With the emergence of new technologies in the field of hard drives we can witness a significant increase of surface density and transfer rate of interfaces which, as a result, enables greater performance and reliability of hard disks. The reason for this are increasing needs for higher capacities and data transfer rate to or from the hard disk. This thesis presents the structure of hard drives, features, performance and reliability of hard drives and alternative data storage technologies. Par...

  11. Triage Decision Trees and Triage Protocols: Changing Strategies for Medical Rescue in Civilian Mass Casualty Situations.

    Science.gov (United States)

    1984-02-06

    capacity loads. o Passenger instruction in the use of and the design of escape and floatation gear are grossly inadequate. o Hazards change with weather...triage, Canad Anesth Soc J., 27(3) May 80, p. 201 * 52. Cope 0. and Moore F.D., The redistribution of body water in the fluid therapy of the burned

  12. 'Smart card' speeds triage, boosts safety.

    Science.gov (United States)

    2008-10-01

    An internally developed 'smart card' and a kiosk equipped with an electronic reader have helped Wellington (FL) Regional Medical Center speed up its triage process considerably. The new technology is extremely popular with the staff, as well as with the patients. Here are some of its benefits: Patients who have the card don't need to provide a detailed history every time they visit the ED. Nurses don't have to type in the patient's medical information. It automatically "populates" their computer screen. Security is maintained, because the information is stored in a database, and not on the card.

  13. Redeye: A Digital Library for Forensic Document Triage

    Energy Technology Data Exchange (ETDEWEB)

    Bogen, Paul Logasa [ORNL; McKenzie, Amber T [ORNL; Gillen, Rob [ORNL

    2013-01-01

    Forensic document analysis has become an important aspect of investigation of many different kinds of crimes from money laundering to fraud and from cybercrime to smuggling. The current workflow for analysts includes powerful tools, such as Palantir and Analyst s Notebook, for moving from evidence to actionable intelligence and tools for finding documents among the millions of files on a hard disk, such as FTK. However, the analysts often leave the process of sorting through collections of seized documents to filter out the noise from the actual evidence to a highly labor-intensive manual effort. This paper presents the Redeye Analysis Workbench, a tool to help analysts move from manual sorting of a collection of documents to performing intelligent document triage over a digital library. We will discuss the tools and techniques we build upon in addition to an in-depth discussion of our tool and how it addresses two major use cases we observed analysts performing. Finally, we also include a new layout algorithm for radial graphs that is used to visualize clusters of documents in our system.

  14. An adapted triage tool (ETAT) at Red Cross War Memorial ...

    African Journals Online (AJOL)

    Objective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children's hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July ...

  15. Triage and mortality in 2875 consecutive trauma patients

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, A B; Abildstrøm, H

    2010-01-01

    Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....

  16. Reliability and validity of emergency department triage systems

    NARCIS (Netherlands)

    van der Wulp, I.

    2010-01-01

    Reliability and validity of triage systems is important because this can affect patient safety. In this thesis, these aspects of two emergency department (ED) triage systems were studied as well as methodological aspects in these types of studies. The consistency, reproducibility, and criterion

  17. No Child Overlooked: Mental Health Triage in the Schools

    Science.gov (United States)

    Wilson, F. Robert; Tang, Mei; Schiller, Kelly; Sebera, Kerry

    2009-01-01

    Mental health problems among children in schools are on the increase. To exercise due diligence in their responsibility to monitor and promote mental health among our nation's children, school counselors may learn from triage systems employed in hospitals, clinics, and mental health centers. The School Counselor's Triage Model provides school…

  18. Improvements of Paediatric Triage at the Emergency Department

    NARCIS (Netherlands)

    N. Seiger (Nienke)

    2014-01-01

    markdownabstract__Abstract__ The practice of triage, originated from the French word “trier” which means to sort, was conceived around 1792 by Baron Dominique-Jean Larrey, Surgeon in Chief to Napoleon’s Imperial Gard. In these days, triage was used to identify soldiers whose injuries were

  19. An exploration of clinical decision making in mental health triage.

    Science.gov (United States)

    Sands, Natisha

    2009-08-01

    Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

  20. Do poison center triage guidelines affect healthcare facility referrals?

    Science.gov (United States)

    Benson, B E; Smith, C A; McKinney, P E; Litovitz, T L; Tandberg, W D

    2001-01-01

    The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

  1. The accuracy of nurse performance of the triage process in a tertiary ...

    African Journals Online (AJOL)

    The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous ... used as a nurse-led, in-hospital triage tool. ... management in the ED. ..... Physician-led team triage based on lean principles may be.

  2. Computer Forensics Field Triage Process Model

    Directory of Open Access Journals (Sweden)

    Marcus K. Rogers

    2006-06-01

    Full Text Available With the proliferation of digital based evidence, the need for the timely identification, analysis and interpretation of digital evidence is becoming more crucial. In many investigations critical information is required while at the scene or within a short period of time - measured in hours as opposed to days. The traditional cyber forensics approach of seizing a system(s/media, transporting it to the lab, making a forensic image(s, and then searching the entire system for potential evidence, is no longer appropriate in some circumstances. In cases such as child abductions, pedophiles, missing or exploited persons, time is of the essence. In these types of cases, investigators dealing with the suspect or crime scene need investigative leads quickly; in some cases it is the difference between life and death for the victim(s. The Cyber Forensic Field Triage Process Model (CFFTPM proposes an onsite or field approach for providing the identification, analysis and interpretation of digital evidence in a short time frame, without the requirement of having to take the system(s/media back to the lab for an in-depth examination or acquiring a complete forensic image(s. The proposed model adheres to commonly held forensic principles, and does not negate the ability that once the initial field triage is concluded, the system(s/storage media be transported back to a lab environment for a more thorough examination and analysis. The CFFTPM has been successfully used in various real world cases, and its investigative importance and pragmatic approach has been amply demonstrated. Furthermore, the derived evidence from these cases has not been challenged in the court proceedings where it has been introduced. The current article describes the CFFTPM in detail, discusses the model’s forensic soundness, investigative support capabilities and practical considerations.

  3. How Triage Nurses Use Discretion: a Literature Review

    Directory of Open Access Journals (Sweden)

    Lars Emil Fagernes Johannessen

    2016-02-01

    Full Text Available Discretion is quintessential for professional work. This review aims to understand how nurses use discretion when they perform urgency assessments in emergency departments with formalised triage systems—systems that are intended to reduce nurses’ use of discretion. Because little research has dealt explicitly with this topic, this review addresses the discretionary aspects of triage by reinterpreting qualitative studies of how triage nurses perform urgency assessments. The review shows (a how inexhaustive guidelines and a hectic work environment are factors that necessitate nurses’ use of discretion and (b how nurses reason within this discretionary space by relying on their experience and intuition, judging patients according to criteria such as appropriateness and believability, and creating urgency ratings together with their patients. The review also offers a synthesis of the findings’ discretionary aspects and suggests a new interactionist dimension of discretion.Keywords: Triage, discretion, emergency department, meta-ethnography, review, decision-making

  4. Dental triage Hydebank Wood Prison and young offenders centre, Belfast.

    Science.gov (United States)

    Gray, R; Fawcett, T

    2014-05-01

    The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services. The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination. Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services. This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation.

  5. Working with Manchester triage -- job satisfaction in nursing.

    Science.gov (United States)

    Forsgren, Susanne; Forsman, Berit; Carlström, Eric D

    2009-10-01

    This article covers nurses' job satisfaction during triage at emergency departments in Western Sweden. Data was collected from 74 triage nurses using a questionnaire containing 37 short form open questions. The answers were analyzed descriptively and by measuring the covariance. The open questions were analyzed by content analysis. The results showed a high degree of job satisfaction (88%). Triage as a method, the interesting nature of the work, and a certain freedom in connection with the triage tasks contributed to job satisfaction (R(2) = 0.40). The nurses found their work interesting and stimulating, although some reported job dissatisfaction due to a heavy workload and lack of competence. Most of the nurses thought that Manchester triage (MTS) was a clear and straightforward method but in need of development. The rational modelling structure by which the triage method is constructed is unable to distinguish all the parameters that an experienced nurse takes into account. When the model is allowed to take precedence over experience, it can be of hindrance and contribute to certain estimates not corresponding with the patient's needs. The participants requested regular exercises solving and discussing patient scenarios. They also wanted to participate on a regular basis in the development of the instrument.

  6. Multibiodose radiation emergency triage categorization software.

    Science.gov (United States)

    Ainsbury, Elizabeth A; Barnard, Stephen; Barrios, Lleonard; Fattibene, Paola; de Gelder, Virginie; Gregoire, Eric; Lindholm, Carita; Lloyd, David; Nergaard, Inger; Rothkamm, Kai; Romm, Horst; Scherthan, Harry; Thierens, Hubert; Vandevoorde, Charlot; Woda, Clemens; Wojcik, Andrzej

    2014-07-01

    In this note, the authors describe the MULTIBIODOSE software, which has been created as part of the MULTIBIODOSE project. The software enables doses estimated by networks of laboratories, using up to five retrospective (biological and physical) assays, to be combined to give a single estimate of triage category for each individual potentially exposed to ionizing radiation in a large scale radiation accident or incident. The MULTIBIODOSE software has been created in Java. The usage of the software is based on the MULTIBIODOSE Guidance: the program creates a link to a single SQLite database for each incident, and the database is administered by the lead laboratory. The software has been tested with Java runtime environment 6 and 7 on a number of different Windows, Mac, and Linux systems, using data from a recent intercomparison exercise. The Java program MULTIBIODOSE_1.0.jar is freely available to download from http://www.multibiodose.eu/software or by contacting the software administrator: MULTIBIODOSE-software@gmx.com.

  7. 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

  8. Educational Triage in Open Distance Learning: Walking a Moral Tightrope

    Directory of Open Access Journals (Sweden)

    Paul Prinsloo

    2014-09-01

    Full Text Available Higher education, and more specifically, distance education, is in the midst of a rapidly changing environment. Higher education institutions increasingly rely on the harvesting and analyses of student data to inform key strategic decisions across a wide range of issues, including marketing, enrolment, curriculum development, the appointment of staff, and student assessment. In the light of persistent concerns regarding student success and retention in distance education contexts, the harvesting and analysis of student data in particular in the emerging field of learning analytics holds much promise. As such the notion of educational triage needs to be interrogated. Educational triage is defined as balancing between the futility or impact of the intervention juxtaposed with the number of students requiring care, the scope of care required, and the resources available for care/interventions. The central question posed by this article is “how do we make moral decisions when resources are (increasingly limited?” An attempt is made to address this by discussing the use of data to support decisions regarding student support and examining the concept of educational triage. Despite the increase in examples of institutions implementing a triage based approach to student support, there is a serious lack of supporting conceptual and theoretical development, and, more importantly, to consideration of the moral cost of triage in educational settings. This article provides a conceptual framework to realise the potential of educational triage to responsibly and ethically respond to legitimate concerns about the “revolving door” in distance and online learning and the sustainability of higher education, without compromising ‘openness.’ The conceptual framework does not attempt to provide a detailed map, but rather a compass consisting of principles to consider in using learning analytics to classify students according to their perceived risk of

  9. The Impact of Telemedicine on Pediatric Critical Care Triage.

    Science.gov (United States)

    Harvey, Jillian B; Yeager, Brooke E; Cramer, Christina; Wheeler, David; McSwain, S David

    2017-11-01

    To examine the relationship between pediatric critical care telemedicine consultation to rural emergency departments and triage decisions. We compare the triage location and provider rating of the accuracy of remote assessment for a cohort of patients who receive critical care telemedicine consultations and a similar group of patients receiving telephone consultations. Retrospective evaluation of consultations occurring between April 2012 and March 2016. Pediatric critical care telemedicine and telephone consultations in 52 rural healthcare settings in South Carolina. Pediatric patients receiving critical care telemedicine or telephone consultations. Telemedicine consultations. Data were collected from the consulting provider for 484 total consultations by telephone or telemedicine. We examined the providers' self-reported assessments about the consultation, decision-making, and triage outcomes. We estimate a logit model to predict triage location as a function of telemedicine consult age and sex. For telemedicine patients, the odds of triage to a non-ICU level of care are 2.55 times larger than the odds for patients receiving telephone consultations (p = 0.0005). Providers rated the accuracy of their assessments higher when consultations were provided via telemedicine. When patients were transferred to a non-ICU location following a telemedicine consultation, providers indicated that the use of telemedicine influenced the triage decision in 95.7% of cases (p telemedicine consultation to community hospitals is feasible and results in a reduction in PICU admissions. This study demonstrates an improvement in provider-reported accuracy of patient assessment via telemedicine compared with telephone, which may produce a higher comfort level with transporting patients to a lower level of care. Pediatric critical care telemedicine consultations represent a promising means of improving care and reducing costs for critically ill children in rural areas.

  10. SARP: a value-based approach to hospice admissions triage.

    Science.gov (United States)

    MacDonald, D

    1995-01-01

    As hospices become established and case referrals increase, many programs are faced with the necessity of instituting waiting lists. Prioritizing cases for order of admission requires a triage method that is rational, fair, and consistent. This article describes the SARP method of hospice admissions triage, which evaluates prospective cases according to seniority, acuity, risk, and political significance. SARP's essential features, operative assumptions, advantages, and limitations are discussed, as well as the core hospice values which underlie its use. The article concludes with a call for trial and evaluation of SARP in other hospice settings.

  11. A New Triage Support Tool in Case of Explosion.

    Science.gov (United States)

    Yavari-Sartakhti, Olivier; Briche, Frédérique; Jost, Daniel; Michaud, Nicolas; Bignand, Michel; Tourtier, Jean-Pierre

    2018-04-01

    Deafness frequently observed in explosion victims, currently following terrorist attack, is a barrier to communication between victims and first responders. This may result in a delay in the initial triage and evacuation. In such situations, Paris Fire Brigade (Paris, France) proposes the use of assistance cards to help conscious, but deafened patients at the site of an attack where there may be numerous victims. Yavari-Sartakhti O , Briche F , Jost D , Michaud N , Bignand M , Tourtier JP . A new triage support tool in case of explosion. Prehosp Disaster Med. 2018;33(2):213-214.

  12. Low compliance with a validated system for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke

    2011-01-01

    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  13. 2 Major incident triage and the implementation of a new triage tool, the MPTT-24.

    Science.gov (United States)

    Vassallo, James; Smith, Jason

    2017-12-01

    Over the last decade, a number of European cities including London, have witnessed high profile terrorist attacks resulting in major incidents with large numbers of casualties. Triage, the process of categorising casualties on the basis of their clinical acuity, is a key principle in the effective management of major incidents.The Modified Physiological Triage Tool (MPTT) is a recently developed primary triage tool which in comparison to existing triage tools, including the 2013 UK NARU Sieve, demonstrates the greatest sensitivity at predicting need for life-saving intervention (LSI) within both military and civilian populations.To improve the applicability and usability of the MPTT we increased the upper respiratory rate threshold to 24 breaths per minute (MPTT-24), to make it divisible by four, and included an assessment of external catastrophic haemorrhage. The aim of this study was to conduct a feasibility analysis of the proposed MPTT-24 (figure 1).emermed;34/12/A860-b/F1F1F1Figure 1MPTT-24 METHODS: A retrospective review of the Joint Theatre Trauma Registry (JTTR) and Trauma Audit Research Network (TARN) databases was performed for all adult ( > 18 years) patients presenting between 2006-2013 (JTTR) and 2014 (TARN). Patients were defined as priority one (P1) if they had received one or more life-saving interventions.Using first recorded hospital physiology, patients were categorised as P1 or not-P1 by existing triage tools and both MPTT and MPTT-24. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage with a McNemar test to determine statistical significance. Basic study characteristics are shown in Table 1. Both the MPTT and MPTT-24 outperformed all existing triage methods with a statistically significant (p<0.001) absolute reduction of between 25.5%-29.5% in under-triage when compared to existing UK civilian methods (NARU Sieve). In both populations the MPTT-24 demonstrated an absolute reduction in sensitivity

  14. Employees' views on home-based, after-hours telephone triage by Dutch GP cooperatives.

    Science.gov (United States)

    Backhaus, Ramona; van Exel, Job; de Bont, Antoinette

    2013-11-04

    Dutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care. The study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort. We identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home. Home-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage.

  15. Triage en urgencias y emergencias hospitalarias: revisión de los principales sistemas de triage internacionales.

    OpenAIRE

    Estebaranz Santamaría, Cristina

    2014-01-01

    Trabajo fin de grado en Enfermería Introducción. El “triage” es un proceso de valoración que permite priorizar el nivel de urgencia de los pacientes. Para su aplicación, se utilizan los sistemas de triage estructurado, existiendo en la actualidad cinco modelos a nivel internacional. Objetivo. Analizar los sistemas de triage en el servicio de urgencias y emergencias hospitalarias, determinando las diferencias de sus últimas actualizaciones. Material y método. Revisión narrati...

  16. Evidence-based Effective Triage Operation During Disaster: Application of Human-trajectory Data to Triage Drill Sessions.

    Science.gov (United States)

    Ohta, Shoichi; Yoda, Ikushi; Takeda, Munekazu; Kuroshima, Satomi; Uchida, Kotaro; Kawai, Kentaro; Yukioka, Tetsuo

    2015-02-01

    Though many governmental and nongovernmental efforts for disaster prevention have been sought throughout Japan since the Great East Japan Earthquake on March 11, 2011, most of the preparation efforts for disasters have been based more on structural and conventionalized regulations than on scientific and objective grounds. Problem There has been a lack of scientific knowledge for space utilization for triage posts in disaster drill sessions. This report addresses how participants occupy and make use of the space within a triage post in terms of areas of use and occupied time. The trajectories of human movement by using Ubiquitous Stereo Vision (USV) cameras during two emergency drill sessions held in 2012 in a large commercial building have been measured. The USV cameras collect each participant's travel distance and the wait time before, during, and after undergoing triage. The correlation between the wait time and the space utilization of patients at a triage post has been analyzed. In the first session, there were some spaces not entirely used. This was caused largely by a patient who arrived earlier than others and lingered in the middle area, which caused the later arrivals to crowd the entrance area. On the other hand, in the second session, the area was used in a more evenly-distributed manner. This is mainly because the earlier arrivals were guided to the back space of the triage post (ie, the opposite side of the entrance), and the late arrivals were also guided to the front half, which was not occupied by anyone. As a result, the entire space was effectively utilized without crowding the entrance. This study has shown that this system could measure people's arrival times and the speed of their movements at the triage post, as well as where they are placed until they receive triage. Space utilization can be improved by efficiently planning and controlling the positioning of arriving patients. Based on the results, it has been suggested that for triage

  17. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses.

    Science.gov (United States)

    Chang, Wen; Liu, Hsueh-Erh; Goopy, Suzanne; Chen, Li-Chin; Chen, Hsiao-Jung; Han, Chin-Yen

    2017-10-01

    Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.

  18. Assessment of hospital-based adult triage at emergency receiving ...

    African Journals Online (AJOL)

    The study was conducted in 6 of the 7 hospitals in the region. ... gency department, the rest receive emergency patients/perform triage from .... gional Referral Hospital (government facility) with emer- ... sionals who were involved in daily initial management of ..... for receiving emergency cases can be complex especially.

  19. Therapeutic Assessment in Psychological Triage Using the PAI.

    Science.gov (United States)

    Brown, Joshua D; Morey, Leslie C

    2016-01-01

    This case illustrates the utility of incorporating therapeutic assessment in a triage context that typically involves a focus on gathering information. A man referred to our clinic by a local mental health center was seen by our assessment team for a triage that includes the administration of a single psychological test, the Personality Assessment Inventory (PAI). Although this triage must rapidly gather information to determine client suitability and treatment assignment, we still attempt to work with clients to collaboratively develop goals for this assessment that include addressing questions that are central concerns for the clients. In this case, the test results suggested a severe disorder that accounted for many phenomena that he had been experiencing but had apparently been reluctant to share. The information gathered led to a referral to a different treatment program that could provide pharmacological and more intensive forms of treatment. However, the collaborative bond formed between the assessor and the client during this triage was sufficiently strong that it was our assessor to whom the client turned in a subsequent crisis precipitated by a symptomatic exacerbation. This case illustrates complementary information gathering and therapeutic goals of assessment even in the context of a brief assessment.

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

    Science.gov (United States)

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

    2014-04-01

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

  1. Reliability and accuracy of the South African Triage Scale when ...

    African Journals Online (AJOL)

    Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan. MK Dalwai, M Twomey, J Maikere, M Wakeel, J-P Jemmy, P Valles, K Tayler-Smith, L Wallis, R Zachariah ...

  2. The effects of technology on triage in A & E.

    Science.gov (United States)

    Roberts, J

    1998-04-01

    Within the specialty of Accident and Emergency (A & E) nursing, triage is a term meaning to classify or sort patients according to their need for care (Blythin 1988). Burgess (1992) views this process as a means of prioritizing patients in order, so that the more seriously ill or injured are seen first (Table 1). Triage performance is measured in the author's department by computer. This technological source is used to record the patient's arrival time and the time at which the patient is triaged. Technology is defined by the Oxford Dictionary (1996) as 'the study of mechanical arts and science, their application in industry'. This paper explores the impact of this technology and the related issues on the A & E triage nurse, and will focus on issues related to the Patients' Charter (1991), resource implications, safety and staff training. In conclusion, the quality of a patient's total care, in which the author participated, is discussed with reference to the related issues and implications for future practice.

  3. When the news crew descends: a media triage plan.

    Science.gov (United States)

    Larson, Laurie

    2002-01-01

    Two high-profile media cases near Akron, Ohio, showed local hospital public relations staff that when dealing with a crisis, help from their colleagues could be a life saver. The result: a "media triage" plan steered by the Akron Regional Hospital Association.

  4. Standard hardness conversion tables for metals relationship among brinell hardness, vickers hardness, rockwell hardness, superficial hardness, knoop hardness, and scleroscope hardness

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 Conversion Table 1 presents data in the Rockwell C hardness range on the relationship among Brinell hardness, Vickers hardness, Rockwell hardness, Rockwell superficial hardness, Knoop hardness, and Scleroscope hardness of non-austenitic steels including carbon, alloy, and tool steels in the as-forged, annealed, normalized, and quenched and tempered conditions provided that they are homogeneous. 1.2 Conversion Table 2 presents data in the Rockwell B hardness range on the relationship among Brinell hardness, Vickers hardness, Rockwell hardness, Rockwell superficial hardness, Knoop hardness, and Scleroscope hardness of non-austenitic steels including carbon, alloy, and tool steels in the as-forged, annealed, normalized, and quenched and tempered conditions provided that they are homogeneous. 1.3 Conversion Table 3 presents data on the relationship among Brinell hardness, Vickers hardness, Rockwell hardness, Rockwell superficial hardness, and Knoop hardness of nickel and high-nickel alloys (nickel content o...

  5. Hard coatings

    International Nuclear Information System (INIS)

    Dan, J.P.; Boving, H.J.; Hintermann, H.E.

    1993-01-01

    Hard, wear resistant and low friction coatings are presently produced on a world-wide basis, by different processes such as electrochemical or electroless methods, spray technologies, thermochemical, CVD and PVD. Some of the most advanced processes, especially those dedicated to thin film depositions, basically belong to CVD or PVD technologies, and will be looked at in more detail. The hard coatings mainly consist of oxides, nitrides, carbides, borides or carbon. Over the years, many processes have been developed which are variations and/or combinations of the basic CVD and PVD methods. The main difference between these two families of deposition techniques is that the CVD is an elevated temperature process (≥ 700 C), while the PVD on the contrary, is rather a low temperature process (≤ 500 C); this of course influences the choice of substrates and properties of the coating/substrate systems. Fundamental aspects of the vapor phase deposition techniques and some of their influences on coating properties will be discussed, as well as the very important interactions between deposit and substrate: diffusions, internal stress, etc. Advantages and limitations of CVD and PVD respectively will briefly be reviewed and examples of applications of the layers will be given. Parallel to the development and permanent updating of surface modification technologies, an effort was made to create novel characterisation methods. A close look will be given to the coating adherence control by means of the scratch test, at the coating hardness measurement by means of nanoindentation, at the coating wear resistance by means of a pin-on-disc tribometer, and at the surface quality evaluation by Atomic Force Microscopy (AFM). Finally, main important trends will be highlighted. (orig.)

  6. Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial.

    Science.gov (United States)

    Murdoch, Jamie; Varley, Anna; Fletcher, Emily; Britten, Nicky; Price, Linnie; Calitri, Raff; Green, Colin; Lattimer, Valerie; Richards, Suzanne H; Richards, David A; Salisbury, Chris; Taylor, Rod S; Campbell, John L

    2015-04-10

    Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone

  7. Use of biomarkers in triage of patients with suspected stroke.

    Science.gov (United States)

    Vanni, Simone; Polidori, Gianluca; Pepe, Giuseppe; Chiarlone, Melisenda; Albani, Alberto; Pagnanelli, Adolfo; Grifoni, Stefano

    2011-05-01

    The absence of a rapidly available and sensitive diagnostic test represents an important limitation in the triage of patients with suspected stroke. The aim of the present study was to investigate the triage accuracy of a novel test that measures blood-borne biomarkers (triage stroke panel, TSP) and to compare its accuracy with that of the Cincinnati Prehospital Stroke Scale (CPSS). Consecutive patients with suspected stroke presenting to the Emergency Departments of three Italian hospitals underwent triage by a trained nurse according to the CPSS and had blood drawn for TSP testing. The TSP simultaneously measures four markers (B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100β) presenting a single composite result, the Multimarker Index (MMX). Stroke diagnosis was established by an expert committee blinded to MMX and CPSS results. There were 155 patients enrolled, 87 (56%) of whom had a final diagnosis of stroke. The area under the receiver operating characteristic (ROC) curve for CPSS was 0.77 (95% confidence interval [CI] 0.70-0.84) and that of MMX was 0.74 (95% CI 0.66-0.82) (p = 0.285). Thus, both tests, when used alone, failed to recognize approximately 25% of strokes. The area under the ROC curve of the combination of the two tests (0.86, 95% CI 0.79-0.91) was significantly greater than that of either single test (p = 0.01 vs. CPSS and p vs. TSP). In an emergency care setting, a panel test using multiple biochemical markers showed triage accuracy similar to that of CPSS. Further studies are needed before biomarkers can be introduced in the clinical work-up of patients with suspected stroke. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Mixed Methods Approach for Measuring the Impact of Video Telehealth on Outpatient Clinic Triage Nurse Workflow

    Science.gov (United States)

    Cady, Rhonda G.; Finkelstein, Stanley M.

    2015-01-01

    Nurse-delivered telephone triage is a common component of outpatient clinic settings. Adding new communication technology to clinic triage has the potential to not only transform the triage process, but also alter triage workflow. Evaluating the impact of new technology on an existing workflow is paramount to maximizing efficiency of the delivery system. This study investigated triage nurse workflow before and after the implementation of video telehealth using a sequential mixed methods protocol that combined ethnography and time-motion study to provide a robust analysis of the implementation environment. Outpatient clinic triage using video telehealth required significantly more time than telephone triage, indicating a reduction in nurse efficiency. Despite the increased time needed to conduct video telehealth, nurses consistently rated it useful in providing triage. Interpretive analysis of the qualitative and quantitative data suggests the increased depth and breadth of data available during video triage alters the assessment triage nurses provide physicians. This in turn could impact the time physicians spend formulating a diagnosis and treatment plan. While the immediate impact of video telehealth is a reduction in triage nurse efficiency, what is unknown is the impact of video telehealth on physician and overall clinic efficiency. Future studies should address this area. PMID:24080753

  9. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2015-02-01

    Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

  10. Drive Stands

    Data.gov (United States)

    Federal Laboratory Consortium — The Electrical Systems Laboratory (ESL)houses numerous electrically driven drive stands. A drive stand consists of an electric motor driving a gearbox and a mounting...

  11. Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Lippert, Freddy K; Egerod, Ingrid

    2017-01-01

    BACKGROUND: Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone...... triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region...... (19%), respiratory (15%) and all others (42%). Thematic analysis of the voice logs suggested that inadequate communication and non-normative symptom description contributed to under-triage. DISCUSSION: The incidence of potentially under-triage is low (0.04%). However, the over...

  12. Hard Copy Market Overview

    Science.gov (United States)

    Testan, Peter R.

    1987-04-01

    A number of Color Hard Copy (CHC) market drivers are currently indicating strong growth in the use of CHC technologies for the business graphics marketplace. These market drivers relate to product, software, color monitors and color copiers. The use of color in business graphics allows more information to be relayed than is normally the case in a monochrome format. The communicative powers of full-color computer generated output in the business graphics application area will continue to induce end users to desire and require color in their future applications. A number of color hard copy technologies will be utilized in the presentation graphics arena. Thermal transfer, ink jet, photographic and electrophotographic technologies are all expected to be utilized in the business graphics presentation application area in the future. Since the end of 1984, the availability of color application software packages has grown significantly. Sales revenue generated by business graphics software is expected to grow at a compound annual growth rate of just over 40 percent to 1990. Increased availability of packages to allow the integration of text and graphics is expected. Currently, the latest versions of page description languages such as Postscript, Interpress and DDL all support color output. The use of color monitors will also drive the demand for color hard copy in the business graphics market place. The availability of higher resolution screens is allowing color monitors to be easily used for both text and graphics applications in the office environment. During 1987, the sales of color monitors are expected to surpass the sales of monochrome monitors. Another major color hard copy market driver will be the color copier. In order to take advantage of the communications power of computer generated color output, multiple copies are required for distribution. Product introductions of a new generation of color copiers is now underway with additional introductions expected

  13. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  14. Dementia & Driving

    Science.gov (United States)

    ... have to give up driving. Many people associate driving with self-reliance and freedom; the loss of driving privileges ... familiar roads and avoid long distances. Avoid heavy traffic and heavily traveled roads. Avoid driving at night and in bad weather. Reduce the ...

  15. Momentary fitting in a fluid environment: A grounded theory of triage nurse decision making.

    Science.gov (United States)

    Reay, Gudrun; Rankin, James A; Then, Karen L

    2016-05-01

    Triage nurses control access to the Emergency Department (ED) and make decisions about patient acuity, patient priority, and placement of the patient in the ED. Understanding the processes and strategies that triage nurses use to make decisions is therefore vital for patient safety and the operation of the ED. The aim of the current study was to generate a substantive grounded theory (GT) of decision making by emergency triage Registered Nurses (RNs). Data collection consisted of seven observations of the triage environment at three tertiary care hospitals where RNs conducted triage and twelve interviews with triage RNs. The data were analyzed by constant comparison in accordance with the classical GT method. In the resultant theory, Momentary Fitting in a Fluid Environment, triage is conceptualized as a process consisting of four categories, determining acuity, anticipating needs, managing space, and creating space. The findings indicate that triage RNs continually strive to achieve fit, while simultaneously considering the individual patient and the ED as a whole entity. Triage RNs require appropriately designed triage environments and computer technology that enable them to secure real time knowledge of the ED to maintain situation awareness. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Assessing the reliability and accuracy of nurse triage ratings when using the South African Triage Scale in the Emergency Department of District Headquarter Hospital of Timergara, Pakistan

    Directory of Open Access Journals (Sweden)

    M. Dalwai*

    2013-12-01

    Conclusion: The SATS has been shown to be a reliable triage scale for a developing country such as Pakistan. With accuracy being acceptable in the context of Timergara, we would suggest further validation studies looking at simple ways of validating the triage scale bearing in mind the challenges facing a developing country ED.

  17. Self-rated worry in acute care telephone triage

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Huibers, Linda; Pedersen, Kristoffer

    2018-01-01

    the caller's ability to quantify their degree of worry, the association between degree of worry and variables related to the caller, the effect of degree of worry on triage outcome, and the thematic content of the caller's worry. DESIGN AND SETTING: A mixed-methods study with simultaneous convergent design...... combining descriptive statistics and thematic analysis of 180 calls to a Danish out-of-hours service. METHOD: The following quantitative data were measured: age of caller, sex, reason for encounter, symptom duration, triage outcome, and degree of worry (rated from 1 = minimally worried to 5 = extremely...... worried). Qualitative data consisted of audio-recorded telephone calls. RESULTS: Most callers (170 out of 180) were able to scale their worry when contacting the out-of-hours service (median = 3, interquartile range = 2-4, mean = 2.76). Degree of worry was associated with female sex (odds ratio [OR] 1...

  18. Cost analysis and provider satisfaction with pediatrician in triage.

    Science.gov (United States)

    Kezirian, Janice; Muhammad, Warees T; Wan, Jim Y; Godambe, Sandip A; Pershad, Jay

    2012-10-01

    The goals of this study were to (1) conduct a cost-benefit analysis, from a hospital's perspective, of using a pediatrician in triage (PIT) in the emergency department (ED) and (2) assess the impact of a physician in triage on provider satisfaction. This was a prospective, controlled trial of PIT (intervention) versus conventional registered nurse-driven triage (control), at an urban, academic, tertiary level pediatric ED, which led to a cost-benefit analysis by looking at the effect that PIT has on length of stay (LOS) and thus on ED revenue. Provider satisfaction was assessed through surveys. During the 8-week study period, a total of 6579 patients were triaged: 3242 in the PIT group and 3337 in the control group. The 2 groups were similar in age, sex, admission rate, left-without-being-seen rate, and level of acuity. The mean LOS in the PIT group was 24.3 minutes shorter than in the control group. The costs of PIT seem to be increased and are not offset by savings; the net margin (total revenue minus costs) was $42,883 per year lower in the PIT than in the control group. Sensitivity analysis showed that if the LOS were reduced by more than 98.4 minutes, the cost savings would favor PIT. Most of the physicians and nurses (67%) reported that PIT facilitated their job. Placement of a PIT during periods of peak census resulted in shorter stay and notable provider satisfaction but at an incremental cost of $42,883 per year.

  19. Development of rapid high throughput biodosimetry tools for radiological triage

    International Nuclear Information System (INIS)

    Balajee, Adayabalam S.; Escalona, Maria; Smith, Tammy; Ryan, Terri; Dainiak, Nicholas

    2018-01-01

    Accidental or intentional radiological or nuclear (R/N) disasters constitute a major threat around the globe that can affect several tens, hundreds and thousands of humans. Currently available cytogenetic biodosimeters are time consuming and laborious to perform making them impractical for triage scenarios. Therefore, it is imperative to develop high throughput techniques which will enable timely assessment of personalized dose for making an appropriate 'life-saving' clinical decision

  20. Orthopaedic podiatry triage: process outcomes of a skill mix initiative.

    Science.gov (United States)

    Homeming, Lyndon J; Kuipers, Pim; Nihal, Aneel

    2012-11-01

    The Orthopaedic Podiatry Triage Clinic (OPodTC) is a 'skill mix' model of care developed in Queensland Health to address the problem of lengthy waiting times for orthopaedic surgery on foot and ankle pathologies. It is based on the recognition that many orthopaedic surgery referrals can be identified early and treated conservatively with podiatry, averting the need for more costly and invasive surgical interventions. The model is collaborative and relies on screening and triage by the podiatrist, rather than delegation by the orthopaedic surgeon. Screening and triage through OPodTC was trialled at three Queensland Health hospital facilities during 2009 and 2010 to improve service timeliness. Patients identified by the OPodTC podiatrist as suitable for conservative management were provided with non-surgical podiatry interventions and discharged if appropriate. Those identified as still requiring surgical intervention after the benefit of interim conservative treatment provided by the podiatrist (or who chose to remain on the list) were returned to their previous place on the orthopaedic waiting list. This paper presents a summary and description of waiting list changes in association with this trial. The OPodTC intervention resulted in a reduction in the non-urgent category of the waiting list across the three hospitals of between 23.3% and 49.7%. Indications from wait-list service data demonstrated increased timeliness and improved patient flow, which are core goals of these skill mix initiatives. This study highlights the potential of screening and triage functions in the skill mix debate. In this example, conservative treatment options were considered first, suitable patients did not have to wait long periods to receive timely and appropriate interventions, and those for whom surgery was indicated, were provided with a more targeted service.

  1. Development of a Mass Casualty Triage Performance Assessment Tool

    Science.gov (United States)

    2015-02-01

    CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON Cindy Underwood a. REPORT Unlimited b. ABSTRACT...describing the victim’s physical state; a list of tasks that must be carried out in order to treat the victim and correctly determine the victim’s triage...have nonmedical personnel practice proper techniques for transporting patients, including the loading, carrying , and unloading of litters

  2. Pushing hard on the accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1987-09-15

    The quest for new techniques to drive future generations of particle accelerators has been pushed hard in recent years, efforts having been highlighted by workshops in Europe, organized by the European Committee for Future Accelerators, and in the US. The latest ECFA Workshop on New Developments in Particle Acceleration Techniques, held at Orsay from 29 June to 4 July, showed how the initial frantic search for innovation is now maturing.

  3. Nurses’ Evaluation of a New Formalized Triage System in the Emergency Department

    DEFF Research Database (Denmark)

    Brehm Johansen, Mette; Forberg, Jakob Lundager

    2011-01-01

    Introduction: Formalized triage in the emergency department (ED) is not widely used in Denmark; this study explores the effects of introducing a five-level process triage system in a Danish ED. Material and methods: Semi-structured qualitative interviews were conducted with 15 emergency nurses....... The interviews were preceded by observations of the work of the ED nurses in which focus was on the triage process. Results: Formalized triage was experienced to improve the overview of patients and resources at the ED, and the nurses described that they felt more assured when prioritizing between patients....... Communication and coordination were also improved by the triage system. But more time spent on documentation and re-evaluation may cause the nurses to feel professionally inadequate if adequate resources are not provided. Furthermore, the triage system has reduced the focus on the humanistic and psychosocial...

  4. Conservation Triage Falls Short Because Conservation Is Not Like Emergency Medicine

    Directory of Open Access Journals (Sweden)

    John A. Vucetich

    2017-05-01

    Full Text Available Conservation triage, as a concept, seems to have been born from analogizing circumstances that characterize conservation with triage, as the concept applies to emergency medicine. Careful consideration—facilitated through the aid of formal argumentation—demonstrates the critical limitations of the analogy. Those limitations reveal how the concept of conservation triage falls short. For example, medical triage presupposes that resources available for an emergency are limited and fixed. By contrast, the resources available for conservation are not fixed. Moreover, the ethics of prioritization in medical triage is characterized by there being universal agreement on the moral value of the patients. However, in conservation there is not universal agreement on the value of various objects of conservation concern. The looming importance of those features of conservation—disputed values and unfixed resources—make conservation triage a largely un-useful concept.

  5. Cost Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

    Science.gov (United States)

    Newgard, Craig D; Yang, Zhuo; Nishijima, Daniel; McConnell, K John; Trent, Stacy; Holmes, James F; Daya, Mohamud; Mann, N Clay; Hsia, Renee Y; Rea, Tom; Wang, N Ewen; Staudenmayer, Kristan; Delgado, M Kit

    2016-01-01

    Background The American College of Surgeons Committee on Trauma sets national targets for the accuracy of field trauma triage at ≥ 95% sensitivity and ≥ 65% specificity, yet the cost-effectiveness of realizing these goals is unknown. We evaluated the cost-effectiveness of current field trauma triage practices compared to triage strategies consistent with the national targets. Study Design This was a cost-effectiveness analysis using data from 79,937 injured adults transported by 48 emergency medical services (EMS) agencies to 105 trauma and non-trauma hospitals in 6 regions of the Western U.S. from 2006 through 2008. Incremental differences in survival, quality adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER; costs per QALY gained) were estimated for each triage strategy over a 1-year and lifetime horizon using a decision analytic Markov model. We considered an ICER threshold of less than $100,000 to be cost-effective. Results For these 6 regions, a high sensitivity triage strategy consistent with national trauma policy (sensitivity 98.6%, specificity 17.1%) would cost $1,317,333 per QALY gained, while current triage practices (sensitivity 87.2%, specificity 64.0%) cost $88,000 per QALY gained compared to a moderate sensitivity strategy (sensitivity 71.2%, specificity 66.5%). Refining EMS transport patterns by triage status improved cost-effectiveness. At the trauma system level, a high-sensitivity triage strategy would save 3.7 additional lives per year at a 1-year cost of $8.78 million, while a moderate sensitivity approach would cost 5.2 additional lives and save $781,616 each year. Conclusions A high-sensitivity approach to field triage consistent with national trauma policy is not cost effective. The most cost effective approach to field triage appears closely tied to triage specificity and adherence to triage-based EMS transport practices. PMID:27178369

  6. The introduction of the Manchester triage scale to an emergency department in the Republic of Ireland.

    LENUS (Irish Health Repository)

    Cronin, J G

    2012-02-03

    Triage is an integral part of the modern emergency department. The use of a recognised triage system has many advantages for the emergency department including reference to a recognised decision-making structure and support in the form of a professionally accepted and validated system. As part of a programme of internal change the Manchester triage system (MTS) was introduced to an emergency department in the Republic of Ireland. This article outlines the introduction of this method of triage and cites the domestic and international drivers of the change.

  7. Implementing The Automated Phases Of The Partially-Automated Digital Triage Process Model

    Directory of Open Access Journals (Sweden)

    Gary D Cantrell

    2012-12-01

    Full Text Available Digital triage is a pre-digital-forensic phase that sometimes takes place as a way of gathering quick intelligence. Although effort has been undertaken to model the digital forensics process, little has been done to date to model digital triage. This work discuses the further development of a model that does attempt to address digital triage the Partially-automated Crime Specific Digital Triage Process model. The model itself will be presented along with a description of how its automated functionality was implemented to facilitate model testing.

  8. Distracted driving

    Science.gov (United States)

    ... including maps) The Dangers of Talking on the Phone While Driving You are four times more likely to get ... of reach. If you are caught using a phone while driving, you may risk a ticket or fine. Most ...

  9. Distracted Driving

    Science.gov (United States)

    ... and increased awareness of distracted driving using radio advertisements, news stories, and similar media. After the projects ... available at www.trafficsafetymarketing.gov . Distracted Driving Enforcement – TV Ads (Paid). For re-tagging, go to: www. ...

  10. Testing the START Triage Protocol: Can It Improve the Ability of Nonmedical Personnel to Better Triage Patients During Disasters and Mass Casualties Incidents ?

    Science.gov (United States)

    Badiali, Stefano; Giugni, Aimone; Marcis, Lucia

    2017-06-01

    START (Simple Triage and Rapid Treatment) triage is a tool that is available even to nonmedical rescue personnel in case of a disaster or mass casualty incident (MCI). In Italy, no data are available on whether application of the START protocol could improve patient outcomes during a disaster or MCI. We aimed to address whether "last-minute" START training of nonmedical personnel during a disaster or MCI would result in more effective triage of patients. In this case-control study, 400 nonmedical ambulance crew members were randomly assigned to a non-START or a START group (200 per group). The START group received last-minute START training. Each group examined 6000 patients, obtained from the Emergo Train System (ETS Italy, Bologna, Italy) victims database, and assigned patients a triage code (black-red-yellow-green) along with a reason for the assignment. Each rescuer triaged 30 patients within a 30-minute time frame. Results were analyzed according to Fisher's exact test for a P valueSTART group completed the evaluations in 15 minutes, whereas the non-START group took 30 minutes. The START group correctly triaged 94.2% of their patients, as opposed to 59.83% of the non-START group (PSTART group versus 13.67% and 26.5% for the non-START group. The non-START group had 458 "preventable deaths" on 6000 cases because of incorrect triage, whereas the START group had 91. Even a "last-minute" training on the START triage protocol allows nonmedical personnel to better identify and triage the victims of a disaster or MCI, resulting in more effective and efficient medical intervention. (Disaster Med Public Health Preparedness. 2017;11:305-309).

  11. Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

    Science.gov (United States)

    North, Frederick; Richards, Debra D; Bremseth, Kimberly A; Lee, Mary R; Cox, Debra L; Varkey, Prathibha; Stroebel, Robert J

    2014-03-20

    Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed

  12. Electric drives

    CERN Document Server

    Boldea, Ion

    2005-01-01

    ENERGY CONVERSION IN ELECTRIC DRIVESElectric Drives: A DefinitionApplication Range of Electric DrivesEnergy Savings Pay Off RapidlyGlobal Energy Savings Through PEC DrivesMotor/Mechanical Load MatchMotion/Time Profile MatchLoad Dynamics and StabilityMultiquadrant OperationPerformance IndexesProblemsELECTRIC MOTORS FOR DRIVESElectric Drives: A Typical ConfigurationElectric Motors for DrivesDC Brush MotorsConventional AC MotorsPower Electronic Converter Dependent MotorsEnergy Conversion in Electric Motors/GeneratorsPOWER ELECTRONIC CONVERTERS (PECs) FOR DRIVESPower Electronic Switches (PESs)The

  13. Development of statewide geriatric patients trauma triage criteria.

    Science.gov (United States)

    Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

    2011-06-01

    The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

  14. Serological biomarkers in triage of FIT-positive subjects?

    DEFF Research Database (Denmark)

    Nielsen, Hans J; Christensen, Ib Jarle; Andersen, Berit

    2017-01-01

    with neoplastic lesions missed by increased cut-off levels appears to be much higher than expected. Therefore, tests that identify those patients missed by increased FIT cut-off levels must be developed. Preliminary results of determination of one of several biomarker entities currently under investigation show...... that nucleosome blood tests may be one option for identifying some of these patients. Implementation of a triage test consisting of FIT, blood-based biomarkers and plus/minus colonoscopy is suggested to identify subjects with FIT levels between the initial and the increased cut-off level that must be offered...

  15. [Triage evaluation making in a pediatric emergency department of a tertiary hospital].

    Science.gov (United States)

    Pascual-Fernández, Ma Cristina; Ignacio-Cerro, Ma Carmen; Jiménez-Carrascosa, Ma Amalia

    2014-03-01

    Evaluation triage level assignments depending level of the professionals' education and experience in the unit. This was a retrospective and observational study to triages making from January to March 2012 in Pediatric Emergency Department of tertiary hospital in Madrid. The collection data included variables from Pediatric Canadian Triage with five levels, triage tool using in the unit. 6443 triages were evaluated. The most common mistakes was: not to register pain level, 1445 (22.4%); not to register hydration level, 377 (5.9%); principal symptoms inappropriate, 232 (3.6%). Didn't indicate pain level 140 (5.6%) nurses with 12 hour formal training on triage; 492 (14.5%) with training in the unit, and 92 (16.3%) without training in the last year (p hydration level 296 (7.7%). The triage education favors better adaptation in the triage assignment. The most common errors are: not to register level pain and hydration when it's needed for the principal symptoms.

  16. The accuracy of nurse performance of the triage process in a tertiary ...

    African Journals Online (AJOL)

    The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa. ... discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  17. Triage of febrile children at a GP cooperative : determinants of a consultation

    NARCIS (Netherlands)

    Monteny, Miriam; Berger, Marjolein Y.; van der Wouden, Johannes C.; Broekman, Berth J.; Koes, Bart W.

    Background Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. Aim To investigate the determinants related to the outcome of triage in febrile children. Design of study

  18. Triage medfører hurtigere behandling af de mest syge

    DEFF Research Database (Denmark)

    Skriver, Claus; Lauritzen, Marlene Mauson Pankoke; Forberg, Jakob Lundager

    2011-01-01

    Systematic process triage is a relatively unknown concept in Denmark. Currently there are no national recommendations regarding triage models for use in the emergency department (ED). Four medium-sized EDs from different regions across the country cooperated in a joint venture to develop a new...

  19. An evaluation of the use of the South African Triage Scale in an ...

    African Journals Online (AJOL)

    S Soogun

    Conclusion: Nurse-led triage has been successfully implemented at the emergency centre of this hospital using SATS ... points for hospital care for patients referred by local clinics, ..... made decisions on the final triage score in 7.5% of cases.

  20. Emergency nurses' knowledge and experience with the triage process in Hunan Province, China.

    Science.gov (United States)

    Hammad, Karen; Peng, Lingli; Anikeeva, Olga; Arbon, Paul; Du, Huiyun; Li, Yinglan

    2017-11-01

    Triage is implemented to facilitate timely and appropriate treatment of patients, and is typically conducted by senior nurses. Triage accuracy and consistency across emergency departments remain a problem in mainland China. This study aimed to investigate the current status of triage practice and knowledge among emergency nurses in Changsha, Hunan Province, China. A sample of 300 emergency nurses was selected from 13 tertiary hospitals in Changsha and a total of 193 completed surveys were returned (response rate=64.3%). Surveys were circulated to head nurses, who then distributed them to nurses who met the selection criteria. Nurses were asked to complete the surveys and return them via dedicated survey return boxes that were placed in discreet locations to ensure anonymity. Just over half (50.8%) of participants reported receiving dedicated triage training, which was provided by their employer (38.6%), an education organisation (30.7%) or at a conference (26.1%). Approximately half (53.2%) reported using formal triage scales, which were predominantly 4-tier (43%) or 5-tier (34%). The findings highlight variability in triage practices and training of emergency nurses in Changsha. This has implications for the comparability of triage data and transferability of triage skills across hospitals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Reliability of the primary triage process after the volendam fire disaster

    NARCIS (Netherlands)

    Welling, Lieke; van Harten, Sabine M.; Henny, C. Pieter; Mackie, Dave P.; Ubbink, Dirk T.; Kreis, Robert W.; Trouwborst, Ad

    2008-01-01

    In a major incident, correct triage is crucial to emergency treatment and transportation priority. The aim of this study was to evaluate the triage process pursued at the site of the fire disaster in Volendam, the Netherlands on January 1, 2001. On-site (OS) and Emergency Department (ED) data

  2. Using robotic telecommunications to triage pediatric disaster victims.

    Science.gov (United States)

    Burke, Rita V; Berg, Bridget M; Vee, Paul; Morton, Inge; Nager, Alan; Neches, Robert; Wetzel, Randall; Upperman, Jeffrey S

    2012-01-01

    During a disaster, hospitals may be overwhelmed and have an insufficient number of pediatric specialists available to care for injured children. The aim of this study was to determine the feasibility of remotely providing pediatric expertise via a robot to treat pediatric victims. In 2008, Los Angeles County held 2 drills involving telemedicine. The first was the Tri-Hospital drill in which 3 Los Angeles County hospitals, one being a pediatric hospital, participated. The disaster scenario involved a Metrolink train crash, resulting in a large surge of traumatic injuries. The second drill involved multiple agencies and was called the Great California Shakeout, a simulated earthquake exercise. The telemedicine equipment installed is an InTouch Health, Inc, Santa Barbara, CA robotic telecommunications system. We used mixed-methods to evaluate the use of telemedicine during these drills. Pediatric specialists successfully provided remote triage and treatment consults of victims via the robot. The robot proved to be a useful means to extend resources and provide expert consult if pediatric specialists were unable to physically be at the site. Telemedicine can be used in the delayed treatment areas as well as for training first receivers to collaborate with specialists in remote locations to triage and treat seriously injured pediatric victims. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Pile Driving

    Science.gov (United States)

    1987-01-01

    Machine-oriented structural engineering firm TERA, Inc. is engaged in a project to evaluate the reliability of offshore pile driving prediction methods to eventually predict the best pile driving technique for each new offshore oil platform. Phase I Pile driving records of 48 offshore platforms including such information as blow counts, soil composition and pertinent construction details were digitized. In Phase II, pile driving records were statistically compared with current methods of prediction. Result was development of modular software, the CRIPS80 Software Design Analyzer System, that companies can use to evaluate other prediction procedures or other data bases.

  4. Accuracy of prehospital triage protocols in selecting severely injured patients: A systematic review.

    Science.gov (United States)

    van Rein, Eveline A J; Houwert, R Marijn; Gunning, Amy C; Lichtveld, Rob A; Leenen, Luke P H; van Heijl, Mark

    2017-08-01

    Prehospital trauma triage ensures proper transport of patients at risk of severe injury to hospitals with an appropriate corresponding level of trauma care. Incorrect triage results in undertriage and overtriage. The American College of Surgeons Committee on Trauma recommends an undertriage rate below 5% and an overtriage rate below 50% for prehospital trauma triage protocols. To find the most accurate prehospital trauma triage protocol, a clear overview of all currently available protocols and corresponding outcomes is necessary. The aim of this systematic review was to evaluate the current literature on all available prehospital trauma triage protocols and determine accuracy of protocol-based triage quality in terms of sensitivity and specificity. A search of Pubmed, Embase, and Cochrane Library databases was performed to identify all studies describing prehospital trauma triage protocols before November 2016. The search terms included "trauma," "trauma center," or "trauma system" combined with "triage," "undertriage," or "overtriage." All studies describing protocol-based triage quality were reviewed. To assess the quality of these type of studies, a new critical appraisal tool was developed. In this review, 21 articles were included with numbers of patients ranging from 130 to over 1 million. Significant predictors for severe injury were: vital signs, suspicion of certain anatomic injuries, mechanism of injury, and age. Sensitivity ranged from 10% to 100%; specificity from 9% to 100%. Nearly all protocols had a low sensitivity, thereby failing to identify severely injured patients. Additionally, the critical appraisal showed poor quality of the majority of included studies. This systematic review shows that nearly all protocols are incapable of identifying severely injured patients. Future studies of high methodological quality should be performed to improve prehospital trauma triage protocols. Systematic review, level III.

  5. A better START for low-acuity victims: data-driven refinement of mass casualty triage.

    Science.gov (United States)

    Cross, Keith P; Petry, Michael J; Cicero, Mark X

    2015-01-01

    Methods currently used to triage patients from mass casualty events have a sparse evidence basis. The objective of this project was to assess gaps of the widely used Simple Triage and Rapid Transport (START) algorithm using a large database when it is used to triage low-acuity patients. Subsequently, we developed and tested evidenced-based improvements to START. Using the National Trauma Database (NTDB), a large set of trauma victims were assigned START triage levels, which were then compared to recorded patient mortality outcomes using area under the receiver-operator curve (AUC). Subjects assigned to the "Minor/Green" level who nevertheless died prior to hospital discharge were considered mistriaged. Recursive partitioning identified factors associated with of these mistriaged patients. These factors were then used to develop candidate START models of improved triage, whose overall performance was then re-evaluated using data from the NTDB. This process of evaluating performance, identifying errors, and further adjusting candidate models was repeated iteratively. The study included 322,162 subjects assigned to "Minor/Green" of which 2,046 died before hospital discharge. Age was the primary predictor of under-triage by START. Candidate models which re-assigned patients from the "Minor/Green" triage level to the "Delayed/Yellow" triage level based on age (either for patients >60 or >75), reduced mortality in the "Minor/Green" group from 0.6% to 0.1% and 0.3%, respectively. These candidate START models also showed net improvement in the AUC for predicting mortality overall and in select subgroups. In this research model using trauma registry data, most START under-triage errors occurred in elderly patients. Overall START accuracy was improved by placing elderly but otherwise minimally injured-mass casualty victims into a higher risk triage level. Alternatively, such patients would be candidates for closer monitoring at the scene or expedited transport ahead of other

  6. [Clinical evaluation of triage as drug-of-abuse test kit].

    Science.gov (United States)

    Yoshioka, Toshiharu; Kohriyama, Kazuaki; Kondo, Rumiko; Goto, Kyoko; Yashiki, Mikio

    2003-01-01

    There are about 60,000 chemical substances which may cause poisoning. Identifying the cause substances is, therefore, very important for patient at emergency department. Triage is an immunoassay kit for the qualitative test for the metabolites of 8 major abuse drugs in urine. We assessed the usefullness of Triage on two patient groups. The first Group consists of the patients considered having not taken substances at initial diagnosis; the second Group consists of the patients considered having taken substances. The result are as follows. 1) The rate of Triage positive patients in the first Group were: attempt-suicide 23%, coma 24%, shock 10%, trauma 7%, respectively. Except for the habitually used medicine, narcotic and stimulant drugs were detected. In the first Group, negative result of Triage was effective in diagnosing the patients as not poisoned, excluding the possitivity of 8 major drugs usage. 2) The rate of Triage positive patients in the second Group were very high: attempt-suicide 77%, coma 51%, shock 57%, trauma 30%, respectively, showing mostly any of 8 major drugs were the cause of poisoning. In the second Group, positive result of Triage was effective in diagnosing the patient as poisoning or as coexisting poisoning with other diseases. 3) The specificity of Triage diagnosis in the first Group was 80% (113/142). The specificity and the sensitivity in the second Group were 64% (50/78) and 97% (74/76), respectively. These results means that Triage is very useful for diagnosis on 8 major drugs poisoning. 4) Triage is efficient for identifying the cause substances in drug poisoning and, therefore, can save medical expense. Triage is a very useful test kit at emergency department.

  7. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Adeloye A. Adeniji

    2016-06-01

    Full Text Available Background: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting: Gugulethu Community Health Centre, Cape Town. Methods: A purposive sample consisted of five women (one coded green, three orange, one yellow and four men (one coded green and three yellow. A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results: All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion: Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. Keywords: emergency care; primary care; triage; patient satisfaction

  8. Multiple performance measures are needed to evaluate triage systems in the emergency department.

    Science.gov (United States)

    Zachariasse, Joany M; Nieboer, Daan; Oostenbrink, Rianne; Moll, Henriëtte A; Steyerberg, Ewout W

    2018-02-01

    Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aimed to propose a set of performance measures that should be used in future studies. We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits. Strengths and weaknesses of the performance measures were systematically appraised. Commonly reported performance measures are measures of statistical association (34/60 studies) and diagnostic accuracy (17/60 studies). The case study illustrates that none of the performance measures fulfills all criteria for triage evaluation. Decision curves are the performance measures with the most attractive features but require dichotomization. In addition, paired diagnostic accuracy measures can be recommended for dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 for ordinal analyses. Other performance measures provide limited additional information. When comparing modifications of triage systems, decision curves and diagnostic accuracy measures should be used in a dichotomized analysis, and the triage-weighted kappa and Nagelkerke's R 2 in an ordinal approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Recent advances in medical device triage technologies for chemical, biological, radiological, and nuclear events.

    Science.gov (United States)

    Lansdowne, Krystal; Scully, Christopher G; Galeotti, Loriano; Schwartz, Suzanne; Marcozzi, David; Strauss, David G

    2015-06-01

    In 2010, the US Food and Drug Administration (Silver Spring, Maryland USA) created the Medical Countermeasures Initiative with the mission of development and promoting medical countermeasures that would be needed to protect the nation from identified, high-priority chemical, biological, radiological, or nuclear (CBRN) threats and emerging infectious diseases. The aim of this review was to promote regulatory science research of medical devices and to analyze how the devices can be employed in different CBRN scenarios. Triage in CBRN scenarios presents unique challenges for first responders because the effects of CBRN agents and the clinical presentations of casualties at each triage stage can vary. The uniqueness of a CBRN event can render standard patient monitoring medical device and conventional triage algorithms ineffective. Despite the challenges, there have been recent advances in CBRN triage technology that include: novel technologies; mobile medical applications ("medical apps") for CBRN disasters; electronic triage tags, such as eTriage; diagnostic field devices, such as the Joint Biological Agent Identification System; and decision support systems, such as the Chemical Hazards Emergency Medical Management Intelligent Syndromes Tool (CHEMM-IST). Further research and medical device validation can help to advance prehospital triage technology for CBRN events.

  10. Sepsis Alert - a triage model that reduces time to antibiotics and length of hospital stay.

    Science.gov (United States)

    Rosenqvist, Mari; Fagerstrand, Emma; Lanbeck, Peter; Melander, Olle; Åkesson, Per

    2017-07-01

    To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection. A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist. Also, all ED staff participated in a designated sepsis education before Sepsis Alert was introduced. Medical records were evaluated for patients during a 3-month period after the triage system was started in 2012, and also during the corresponding months in 2010 and 2014. A total of 1837 patients presented with abnormal vital signs. Of these, 221 patients presented with fever and thus at risk of having severe sepsis. Among patients triaged according to the new model, median time to antibiotics was 58.5 at startup and 24.5 minutes at follow-up two years later. This was significantly less than for patients treated before the new model, 190 minutes. Also, median LOS was significantly decreased after introduction of the new triage model, from nine to seven days. A triage model at the ED with special attention to severe sepsis patients, led to sustained improvements of time to antibiotic treatment and LOS.

  11. Telephone triage by GPs in out-of-hours primary care in Denmark: a prospective observational study of efficiency and relevance

    NARCIS (Netherlands)

    Huibers, L.; Moth, G.; Carlsen, A.H.; Christensen, M.B.; Vedsted, P.

    2016-01-01

    BACKGROUND: In the UK, telephone triage in out-of-hours primary care is mostly managed by nurses, whereas GPs perform triage in Denmark. AIM: To describe telephone contacts triaged to face-to-face contacts, GP-assessed relevance, and factors associated with triage to face-to-face contact. DESIGN AND

  12. Adoption of the 2006 Field Triage Decision Scheme for Injured Patients

    Directory of Open Access Journals (Sweden)

    Sasser, Scott

    2011-07-01

    Full Text Available Background: When emergency medical services (EMS providers respond to the scene of an injury, they must decide where to transport the injured patients for further evaluation and treatment. This is done through a process known as “field triage”, whereby a patient’s injuries are matched to the most appropriate hospital. In 2005-2006 the National Expert Panel on Field Triage, convened by the Centers for Disease Control and Prevention and the National Highway Traffic Safety Administration, revised the 1999 American College of Surgeons Committee on Trauma Field Triage Decision Scheme. This revision, the 2006 Field Triage Decision Scheme, was published in 2006.Methods: State Public Health departments’ and EMS’ external websites were evaluated to ascertain the current status of implementation of the 2006 Field Triage Decision Scheme.Results: Information regarding field triage was located for 41 states. In nine states no information regarding field triage was available on their websites. Of the 41 states where information was located, seven were classified as “full adopters” of the 2006 Field Triage Decision Scheme; nine were considered “partial adopters”; 17 states were found to be using a full version or modification of the 1999 Field Triage Decision Scheme; and eight states were considered to be using a different protocol or scheme for field triage.Conclusion: Many states have adopted the 2006 Decision Scheme (full or partial. Further investigation is needed to determine the reasons why some states do not adopt the guidelines. [West J Emerg Med. 2011;12(3:275-283.

  13. Decision analytic model exploring the cost and cost-offset implications of street triage.

    Science.gov (United States)

    Heslin, Margaret; Callaghan, Lynne; Packwood, Martin; Badu, Vincent; Byford, Sarah

    2016-02-11

    To determine if street triage is effective at reducing the total number of people with mental health needs detained under section 136, and is associated with cost savings compared to usual police response. Routine data from a 6-month period in the year before and after the implementation of a street triage scheme were used to explore detentions under section 136, and to populate a decision analytic model to explore the impact of street triage on the cost to the NHS and the criminal justice sector of supporting people with a mental health need. A predefined area of Sussex, South East England, UK. All people who were detained under section 136 within the predefined area or had contact with the street triage team. The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. The primary outcome was change in the total number of detentions under section 136 between the before and after periods assessed. Secondary analysis focused on whether the additional costs of street triage were offset by cost savings as a result of changes in detentions under section 136. Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ(2) (1df) 18.542, p<0.001). Total NHS and criminal justice costs were estimated to be £1043 in the street triage period compared to £1077 in the usual response period. Investment in street triage was offset by savings as a result of reduced detentions under section 136, particularly detentions in custody. Data available did not include assessment of patient outcomes, so a full economic evaluation was not possible. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Triage in an adult emergency service: patient satisfaction

    Directory of Open Access Journals (Sweden)

    Pollyane Liliane Silva

    2016-06-01

    Full Text Available Abstract OBJECTIVE Assess the degree of patient satisfaction with triage in the adult emergency service of a public hospital. METHOD Exploratory, descriptive, cross-sectional study with a quantitative approach. Three hundred patients were interviewed and the data were analyzed using descriptive statistics based on sociodemographic variables and those related to patient satisfaction. RESULTS There was a predominance of women, with elementary education and a mean age of 41 years. Most of the interviewees reported being satisfied in regard to the following items: timely service, embracement, trust, environment (comfort, cleanliness and signage, humanization (courtesy, respect, and interest, timely referral/scheduling of appointments and care expectations. CONCLUSION There was a high level of patient satisfaction, evidenced by the strong association of user satisfaction with the items investigated.

  15. Triage (2009: la ética en tiempos de guerra

    Directory of Open Access Journals (Sweden)

    María Teresa ICART ISERN

    2016-09-01

    Full Text Available A través de la película Triage (2009 de Danis Tanovic, este trabajo repasa las características del triaje y sus implicaciones éticas en el contexto bélico donde dos fotorreporteros intentan documentar la crueldad de la guerra. Las características del singular triaje que realiza el Dr Talzani plantea la conveniencia de la eutanasia en situaciones extremas. También se analiza el trastorno por estrés post traumático que padecerá uno de los protagonistas como consecuencia del impacto que las experiencias vividas causan en quienes sobreviven al horror de la guerra

  16. Point-of-care test identifies diabetic ketoacidosis at triage.

    Science.gov (United States)

    Naunheim, Rosanne; Jang, Timothy J; Banet, Gerald; Richmond, Alec; McGill, Janet

    2006-06-01

    Diabetic ketoacidosis (DKA) is a common, life-threatening complication of diabetes. The diagnosis of DKA relies on signs and symptoms, plus laboratory findings of blood glucose (BG) of > 250 mg/dL, an anion gap (AG) of > or = 15 mmol/L, and carbon dioxide (CO2) of 250 mg/dL underwent testing for beta-OHB with the Precision Xtra meter (Abbott Laboratories, North Chicago, IL) at triage in a large urban hospital emergency department. The diagnosis of DKA was made by clinicians by using standard clinical criteria without knowledge of the beta-OHB test. A diagnosis of DKA was made in 57 of 160 subjects. The beta-OHB values correlated strongly with AG (r = 0.66, p < 0.001) and with CO2 (r = -0.69, p < 0.001), as well as with glucose (r = 0.31, p < 0.001). Cross-classification of DKA vs. beta-OHB yielded sensitivity of 98% (95% CI = 91% to 100%), specificity of 85% (95% CI = 78% to 91%), with a positive likelihood ratio of 6.7 (95% CI = 4.22 to 10.78), and negative likelihood ratio of 0.021 (95% CI = 0.003 to 0.144) at the manufacturer-suggested beta-OHB level of 1.5. The point-of-care test for beta-OHB was as sensitive as more established indicators of DKA. It is more useful than glucose alone for the diagnosis of DKA and offers immediate diagnosis of patients at triage.

  17. Electronic sorting of radioactive ores; Triage electronique des minerais radioactifs

    Energy Technology Data Exchange (ETDEWEB)

    Sandier, J.

    1958-01-15

    Electronic sorting of radioactive ores consists in passing the rock lumps, after sieving, one by one in front of radioactivity detectors; these detectors command electromechanical systems which class the ores according to their radioactivity level. This note sets on the state of progress of the work going on at the D.R.E.M.: use of scintillometers for γ-ray detection, with circuits carrying magnetic memories to improve their operation; results of laboratory and semi-industrial tests on several deposits; description of the material, data on the first factory project; notes on the financial returns of the process. A description is also given of the electronic sorting material used skip by skip for a first rough classification of the ores according to their content, as they leave the shaft. (author) [French] Le triage electronique des minerais radioactifs consiste a faire passer, apres criblage, les cailloux un par un devant des detecteurs de radioactivite; ces detecteurs commandent des systemes electromecaniques qui classent les minerais selon leur niveau de radioactivite. La note expose l'etat d'avancement des travaux en cours a la D.R.E.M: utilisation des scintillometres pour la detection des rayonnements γ, de circuits comportant des memoires magnetiques pour ameliorer le fonctionnement; resultats d'essais de laboratoire et semi-industriels sur plusieurs gisements; description du materiel, donnees sur le premier projet d'usine; notes sur la rentabilite du procede. Est egalement decrit le materiel de triage electronique skip par skip utilise pour une premiere classification grossiere des minerais selon leurs teneurs, des la sortie des puits. (auteur)

  18. Impaired Driving

    Science.gov (United States)

    ... Get the Facts What Works: Strategies to Increase Car Seat and Booster Seat ... narcotics. 3 That’s one percent of the 111 million self-reported episodes of alcohol-impaired driving among U.S. ...

  19. Incorporating solid state drives into distributed storage systems

    OpenAIRE

    Wacha, Rosie

    2012-01-01

    Big data stores are becoming increasingly important in a variety of domains including scientific computing, internet applications, and business applications. For price and performance reasons, such storage is comprised of magnetic hard drives. To achieve the necessary degree of performance and reliability, the drives are configured into storage subsystems based on RAID (Redundant Array of Independent Disks). Because of their mechanical nature, hard drives are relatively power-hungry and slow ...

  20. An evaluation of the Triage Early Warning Score in an urban ...

    African Journals Online (AJOL)

    2013-12-03

    Dec 3, 2013 ... Original Research: An evaluation of the Triage Early Warning Score in an urban accident and emergency department. 69 ... This can potentially improve the gap .... were defined as “discharge within 24 hours of admission,.

  1. Lack of Gender Disparities in Emergency Department Triage of Acute Stroke Patients

    Directory of Open Access Journals (Sweden)

    Madsen, Tracy E.

    2014-12-01

    Full Text Available Introduction: Previous literature has shown gender disparities in the care of acute ischemic stroke. Compared to men, women wait longer for brain imaging and are less likely to receive intravenous (IV tissue plasminogen activator (tPA. Emergency department (ED triage is an important step in the rapid assessment of stroke patients and is a possible contributor to disparities. It is unknown whether gender differences exist in ED triage of acute stroke patients. Our primary objective was to determine whether gender disparities exist in the triage of acute stroke patients as defined by Emergency Severity Index (ESI levels and use of ED critical care beds. Methods: This was a retrospective, observational study of both ischemic and hemorrhagic stroke patients age ≥18 years presenting to a large, urban, academic ED within six hours of symptom onset between January 2010, and December 2012. Primary outcomes were triage to a non-critical ED bed and Emergency Severity Index (ESI level. Primary outcome data were extracted from electronic medical records by a blinded data manager; secondary outcome data and covariates were abstracted by trained research assistants. We performed bivariate and multivariate analyses. Logistic regression was performed using age, race, insurance status, mode of and time to arrival, National Institutes of Health Stroke Scale, and presence of atypical symptoms as covariates. Results: There were 537 patients included in this study. Women were older (75.6 vs. 69.5, p<0.001, and more women had a history of atrial fibrillation (39.8% vs. 25.3%, p<0.001. Compared to 9.5% of men, 10.3% of women were triaged to a non-critical care ED bed (p=0.77; 92.1% of women were triaged as ESI 1 or 2 vs. 93.6% of men (p=0.53. After adjustment, gender was not associated with triage location or ESI level, though atypical symptoms were associated with higher odds of being triaged to a non-critical care bed (aOR 1.98, 95%CI [1.03 – 3.81] and 3

  2. Virtual reality and live simulation: a comparison between two simulation tools for assessing mass casualty triage skills.

    Science.gov (United States)

    Luigi Ingrassia, Pier; Ragazzoni, Luca; Carenzo, Luca; Colombo, Davide; Ripoll Gallardo, Alba; Della Corte, Francesco

    2015-04-01

    This study tested the hypothesis that virtual reality simulation is equivalent to live simulation for testing naive medical students' abilities to perform mass casualty triage using the Simple Triage and Rapid Treatment (START) algorithm in a simulated disaster scenario and to detect the improvement in these skills after a teaching session. Fifty-six students in their last year of medical school were randomized into two groups (A and B). The same scenario, a car accident, was developed identically on the two simulation methodologies: virtual reality and live simulation. On day 1, group A was exposed to the live scenario and group B was exposed to the virtual reality scenario, aiming to triage 10 victims. On day 2, all students attended a 2-h lecture on mass casualty triage, specifically the START triage method. On day 3, groups A and B were crossed over. The groups' abilities to perform mass casualty triage in terms of triage accuracy, intervention correctness, and speed in the scenarios were assessed. Triage and lifesaving treatment scores were assessed equally by virtual reality and live simulation on day 1 and on day 3. Both simulation methodologies detected an improvement in triage accuracy and treatment correctness from day 1 to day 3 (PVirtual reality simulation proved to be a valuable tool, equivalent to live simulation, to test medical students' abilities to perform mass casualty triage and to detect improvement in such skills.

  3. ED Triage Decision-Making With Mental Health Presentations: A "Think Aloud" Study.

    Science.gov (United States)

    Clarke, Diana E; Boyce-Gaudreau, Krystal; Sanderson, Ana; Baker, John A

    2015-11-01

    Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do "decision aids" (i.e., structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses' decision making? Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department. Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario. Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  4. Triage: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

    Science.gov (United States)

    Christian, Michael D; Sprung, Charles L; King, Mary A; Dichter, Jeffrey R; Kissoon, Niranjan; Devereaux, Asha V; Gomersall, Charles D

    2014-10-01

    Pandemics and disasters can result in large numbers of critically ill or injured patients who may overwhelm available resources despite implementing surge-response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in this chapter are important for all who are involved in large-scale pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Triage topic panel reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This article provides 11 suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.

  5. Addressing the third delay: implementing a novel obstetric triage system in Ghana.

    Science.gov (United States)

    Goodman, David M; Srofenyoh, Emmanuel K; Ramaswamy, Rohit; Bryce, Fiona; Floyd, Liz; Olufolabi, Adeyemi; Tetteh, Cecilia; Owen, Medge D

    2018-01-01

    Institutional delivery has been proposed as a method for reducing maternal morbidity and mortality, but little is known about how referral hospitals in low-resource settings can best manage the expected influx of patients. In this study, we assess the impact of an obstetric triage improvement programme on reducing hospital-based delay in a referral hospital in Accra, Ghana. An Active Implementation Framework is used to describe a 5-year intervention to introduce and monitor obstetric triage capabilities. Baseline data, collected from September to November 2012, revealed significant delays in patient assessment on arrival. A triage training course and monitoring of quality improvement tools occurred in 2013 and 2014. Implementation barriers led to the construction of a free-standing obstetric triage pavilion, opened January 2015, with dedicated midwives. Data were collected at three time intervals following the triage pavilion opening and compared with baseline including: referral indications, patient and labour characteristics, waiting time from arrival to assessment and the documentation of a care plan. An obstetric triage improvement programme reduced the median (IQR) patient waiting time from facility arrival to first assessment by a midwife from 40 min (15-100) to 5 min (2-6) (p<0.001) over the 5-year intervention. The triage pavilion enhanced performance resulting in the elimination of previous delays associated with the time of admission and disease acuity. Care plan documentation increased from 51% to 96%. Obstetric triage, when properly implemented, reduced delay in a busy, low-resource hospital. The implementation process was sustained under local leadership during transition to a new hospital.

  6. Driving things

    DEFF Research Database (Denmark)

    Nevile, Maurice Richard

    2015-01-01

    I explore how participants organise involvement with objects brought into the car, relative to the demands of driving and social activity. Objects in cars commonly include phones or other technologies, food, body care products, texts, clothing, bags and carry items, toys, and even animals...... 2004, Haddington et al. 2012). I focus here especially on how the practical and interactional work of locating, seeing, placing, handling, hearing, and relinquishing, is ordered and accomplished relative to the emerging and contingent demands of both driving and social participation......, such that involvement with objects is constituted as secondary to driving in a multiactivity setting (e.g. Haddington et al. 2014). We see how events with, for, of, and even by objects can occur as predictable, planned and even designed for (e.g. changing glasses, applying body lotion), or might be unexpected...

  7. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department

    Directory of Open Access Journals (Sweden)

    Yuwares Sittichanbuncha

    2015-01-01

    Full Text Available Background. To differentiate acute coronary syndrome (ACS from other causes in patients presenting with chest pain at the emergency department (ED is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0% were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval were 4.220 (1.445, 12.327, 3.333 (1.040, 10.684, and 12.539 (3.876, 40.567, respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals.

  8. The accuracy and consistency of rural, remote and outpost triage nurse decision making in one Western Australia Country Health Service Region.

    Science.gov (United States)

    Ekins, Kylie; Morphet, Julia

    2015-11-01

    The Australasian Triage Scale aims to ensure that the triage category allocated, reflects the urgency with which the patient needs medical assistance. This is dependent on triage nurse accuracy in decision making. The Australasian Triage Scale also aims to facilitate triage decision consistency between individuals and organisations. Various studies have explored the accuracy and consistency of triage decisions throughout Australia, yet no studies have specifically focussed on triage decision making in rural health services. Further, no standard has been identified by which accuracy or consistency should be measured. Australian emergency departments are measured against a set of standard performance indicators, including time from triage to patient review, and patient length of stay. There are currently no performance indicators for triage consistency. An online questionnaire was developed to collect demographic data and measure triage accuracy and consistency. The questionnaire utilised previously validated triage scenarios.(1) Triage decision accuracy was measured, and consistency was compared by health site type using Fleiss' kappa. Forty-six triage nurses participated in this study. The accuracy of participants' triage decision-making decreased with each less urgent triage category. Post-graduate qualifications had no bearing on triage accuracy. There was no significant difference in the consistency of decision-making between paediatric and adult scenarios. Overall inter-rater agreement using Fleiss' kappa coefficient, was 0.4. This represents a fair-to-good level of inter-rater agreement. A standard definition of accuracy and consistency in triage nurse decision making is required. Inaccurate triage decisions can result in increased morbidity and mortality. It is recommended that emergency department performance indicator thresholds be utilised as a benchmark for national triage consistency. Crown Copyright © 2015. Published by Elsevier Ltd. All rights

  9. Swallowable fluorometric capsule for wireless triage of gastrointestinal bleeding.

    Science.gov (United States)

    Nemiroski, A; Ryou, M; Thompson, C C; Westervelt, R M

    2015-12-07

    Real-time detection of gastrointestinal bleeding remains a major challenge because there does not yet exist a minimally invasive technology that can both i) monitor for blood from an active hemorrhage and ii) uniquely distinguish it from blood left over from an inactive hemorrhage. Such a device would be an important tool for clinical triage. One promising solution, which we have proposed previously, is to inject a fluorescent dye into the blood stream and to use it as a distinctive marker of active bleeding by monitoring leakage into the gastrointestinal tract with a wireless fluorometer. This paper reports, for the first time to our knowledge, the development of a swallowable, wireless capsule with a built-in fluorometer capable of detecting fluorescein in blood, and intended for monitoring gastrointestinal bleeding in the stomach. The embedded, compact fluorometer uses pinholes to define a microliter sensing volume and to eliminate bulky optical components. The proof-of-concept capsule integrates optics, low-noise analog sensing electronics, a microcontroller, battery, and low power Zigbee radio, all into a cylindrical package measuring 11 mm × 27 mm and weighing 10 g. Bench-top experiments demonstrate wireless fluorometry with a limit-of-detection of 20 nM aqueous fluorescein. This device represents a major step towards a technology that would enable simple, rapid detection of active gastrointestinal bleeding, a capability that would save precious time and resources and, ultimately, reduce complications in patients.

  10. Investigating the validity and usability of an interactive computer programme for assessing competence in telephone-based mental health triage.

    Science.gov (United States)

    Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; King, Peter; Bourke-Finn, Karen; Brunning, Debra

    2016-02-01

    Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage. © 2015 Australian College of Mental Health Nurses Inc.

  11. Perceptions and Challenges of Using Emergency Triage Assessment Treatment Guideline in Emergency Department at Muhimbili National Hospital, Tanzania

    OpenAIRE

    Safari, Sixtus Ruyumbu

    2012-01-01

    Triage is the process of determining the priority of patients' treatments based on the severity of their conditions. This helps treating patients efficiently when resources are insufficient for all to be treated immediately. Health care providers use ETAT guideline during triaging patients to improve quality of care and reduce morbidity and mortality rates. But the adherence to the guidelines protocol has been a challenge in triage rooms. This paper assessed perspective of HCWs and challenges...

  12. Hard X-ray studies on the Castor tokamak

    International Nuclear Information System (INIS)

    Mlynar, J.

    1990-04-01

    The electron runaway processes in tokamaks are discussed with regard to hard X radiation measurements. The origin and confinement of runaway electrons, their bremsstrahlung spectra and the influence of lower hybrid current drive on the distribution of high-energy electrons are analyzed for the case of the Castor tokamak. The hard X-ray spectrometer designed for the Castor tokamak is also described and preliminary qualitative results of hard X-ray measurements are presented. The first series of integral measurements made it possible to map the azimuthal dependence of the hard X radiation

  13. Effectiveness of prehospital trauma triage systems in selecting severely injured patients: Is comparative analysis possible?

    Science.gov (United States)

    van Rein, Eveline A J; van der Sluijs, Rogier; Houwert, R Marijn; Gunning, Amy C; Lichtveld, Rob A; Leenen, Luke P H; van Heijl, Mark

    2018-01-27

    In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for trauma patients. A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms. All studies describing ground transport and actual destination hospital of patients with and without severe injuries, using prehospital triage, published before November 2017, were eligible for inclusion. To assess the quality of these studies, a critical appraisal tool was developed. A total of 33 articles were included. The percentage of undertriage ranged from 1% to 68%; overtriage from 5% to 99%. Older age and increased geographical distance were associated with undertriage. Mortality was lower for severely injured patients transferred to a higher-level trauma center. The majority of the included studies were of poor methodological quality. The studies of good quality showed poor performance of the triage protocol, but additional value of EMS provider judgment in the identification of severely injured patients. In most of the evaluated trauma systems, a substantial part of the severely injured patients is not transported to the appropriate level trauma center. Future research should come up with new innovative ways to improve the quality of prehospital triage in trauma patients. Copyright © 2018. Published by Elsevier Inc.

  14. Serious gaming technology in major incident triage training: a pragmatic controlled trial.

    Science.gov (United States)

    Knight, James F; Carley, Simon; Tregunna, Bryan; Jarvis, Steve; Smithies, Richard; de Freitas, Sara; Dunwell, Ian; Mackway-Jones, Kevin

    2010-09-01

    By exploiting video games technology, serious games strive to deliver affordable, accessible and usable interactive virtual worlds, supporting applications in training, education, marketing and design. The aim of the present study was to evaluate the effectiveness of such a serious game in the teaching of major incident triage by comparing it with traditional training methods. Pragmatic controlled trial. During Major Incident Medical Management and Support Courses, 91 learners were randomly distributed into one of two training groups: 44 participants practiced triage sieve protocol using a card-sort exercise, whilst the remaining 47 participants used a serious game. Following the training sessions, each participant undertook an evaluation exercise, whereby they were required to triage eight casualties in a simulated live exercise. Performance was assessed in terms of tagging accuracy (assigning the correct triage tag to the casualty), step accuracy (following correct procedure) and time taken to triage all casualties. Additionally, the usability of both the card-sort exercise and video game were measured using a questionnaire. Tagging accuracy by participants who underwent the serious game training was significantly higher than those who undertook the card-sort exercise [Chi2=13.126, p=0.02]. Step accuracy was also higher in the serious game group but only for the numbers of participants that followed correct procedure when triaging all eight casualties [Chi2=5.45, p=0.0196]. There was no significant difference in time to triage all casualties (card-sort=435+/-74 s vs video game=456+/-62 s, p=0.155). Serious game technologies offer the potential to enhance learning and improve subsequent performance when compared to traditional educational methods. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  15. Automated Cervical Screening and Triage, Based on HPV Testing and Computer-Interpreted Cytology.

    Science.gov (United States)

    Yu, Kai; Hyun, Noorie; Fetterman, Barbara; Lorey, Thomas; Raine-Bennett, Tina R; Zhang, Han; Stamps, Robin E; Poitras, Nancy E; Wheeler, William; Befano, Brian; Gage, Julia C; Castle, Philip E; Wentzensen, Nicolas; Schiffman, Mark

    2018-04-11

    State-of-the-art cervical cancer prevention includes human papillomavirus (HPV) vaccination among adolescents and screening/treatment of cervical precancer (CIN3/AIS and, less strictly, CIN2) among adults. HPV testing provides sensitive detection of precancer but, to reduce overtreatment, secondary "triage" is needed to predict women at highest risk. Those with the highest-risk HPV types or abnormal cytology are commonly referred to colposcopy; however, expert cytology services are critically lacking in many regions. To permit completely automatable cervical screening/triage, we designed and validated a novel triage method, a cytologic risk score algorithm based on computer-scanned liquid-based slide features (FocalPoint, BD, Burlington, NC). We compared it with abnormal cytology in predicting precancer among 1839 women testing HPV positive (HC2, Qiagen, Germantown, MD) in 2010 at Kaiser Permanente Northern California (KPNC). Precancer outcomes were ascertained by record linkage. As additional validation, we compared the algorithm prospectively with cytology results among 243 807 women screened at KPNC (2016-2017). All statistical tests were two-sided. Among HPV-positive women, the algorithm matched the triage performance of abnormal cytology. Combined with HPV16/18/45 typing (Onclarity, BD, Sparks, MD), the automatable strategy referred 91.7% of HPV-positive CIN3/AIS cases to immediate colposcopy while deferring 38.4% of all HPV-positive women to one-year retesting (compared with 89.1% and 37.4%, respectively, for typing and cytology triage). In the 2016-2017 validation, the predicted risk scores strongly correlated with cytology (P < .001). High-quality cervical screening and triage performance is achievable using this completely automated approach. Automated technology could permit extension of high-quality cervical screening/triage coverage to currently underserved regions.

  16. Community Drive

    DEFF Research Database (Denmark)

    Magnussen, Rikke

    2018-01-01

    Schools and educational institutions are challenged by not adequately educating students for independent knowledge collaboration and solving of complex societal challenges (Bundsgaard & Hansen, 2016; Slot et al., 2017). As an alternative strategy to formal learning has Community-driven research...... opportunity to break boundaries between research institutions and surrounding communities through the involvement of new types of actors, knowledge forms and institutions (OECD, 2011). This paper presents the project Community Drive a three year cross disciplinary community-driven game– and data-based project....... In the paper we present how the project Community Drive initiated in May 2018 is based on results from pilot projects conducted from 2014 – 2017. Overall these studies showed that it is a strong motivational factor for students to be given the task to change their living conditions through redesign...

  17. Comprehensive hard materials

    CERN Document Server

    2014-01-01

    Comprehensive Hard Materials deals with the production, uses and properties of the carbides, nitrides and borides of these metals and those of titanium, as well as tools of ceramics, the superhard boron nitrides and diamond and related compounds. Articles include the technologies of powder production (including their precursor materials), milling, granulation, cold and hot compaction, sintering, hot isostatic pressing, hot-pressing, injection moulding, as well as on the coating technologies for refractory metals, hard metals and hard materials. The characterization, testing, quality assurance and applications are also covered. Comprehensive Hard Materials provides meaningful insights on materials at the leading edge of technology. It aids continued research and development of these materials and as such it is a critical information resource to academics and industry professionals facing the technological challenges of the future. Hard materials operate at the leading edge of technology, and continued res...

  18. Novel Human Radiation Exposure Biomarker Panel Applicable for Population Triage

    Energy Technology Data Exchange (ETDEWEB)

    Bazan, Jose G. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Chang, Polly; Balog, Robert; D' Andrea, Annalisa; Shaler, Thomas; Lin, Hua; Lee, Shirley; Harrison, Travis [SRI International, Menlo Park, California (United States); Shura, Lei; Schoen, Lucy; Knox, Susan J. [Department of Radiation Oncology, Stanford University, Stanford, California (United States); Cooper, David E., E-mail: david.cooper@sri.com [SRI International, Menlo Park, California (United States)

    2014-11-01

    Purpose: To identify a panel of radiation-responsive plasma proteins that could be used in a point-of-care biologic dosimeter to detect clinically significant levels of ionizing radiation exposure. Methods and Materials: Patients undergoing preparation for hematopoietic cell transplantation using radiation therapy (RT) with either total lymphoid irradiation or fractionated total body irradiation were eligible. Plasma was examined from patients with potentially confounding conditions and from normal individuals. Each plasma sample was analyzed for a panel of 17 proteins before RT was begun and at several time points after RT exposure. Paired and unpaired t tests between the dose and control groups were performed. Conditional inference trees were constructed based on panels of proteins to compare the non-RT group with the RT group. Results: A total of 151 patients (62 RT, 41 infection, 48 trauma) were enrolled on the study, and the plasma from an additional 24 healthy control individuals was analyzed. In comparison with to control individuals, tenascin-C was upregulated and clusterin was downregulated in patients receiving RT. Salivary amylase was strongly radiation responsive, with upregulation in total body irradiation patients and slight downregulation in total lymphoid irradiation patients compared with control individuals. A panel consisting of these 3 proteins accurately distinguished between irradiated patients and healthy control individuals within 3 days after exposure: 97% accuracy, 0.5% false negative rate, 2% false positive rate. The accuracy was diminished when patients with trauma, infection, or both were included (accuracy, 74%-84%; false positive rate, 14%-33%, false negative rate: 8%-40%). Conclusions: A panel of 3 proteins accurately distinguishes unirradiated healthy donors from those exposed to RT (0.8-9.6 Gy) within 3 days of exposure. These findings have significant implications in terms of triaging individuals in the case of nuclear or other

  19. A review of factors affecting patient satisfaction with nurse led triage in emergency departments.

    Science.gov (United States)

    Rehman, Salma Abdul; Ali, Parveen Azam

    2016-11-01

    To determine the factors that affect patient satisfaction with nurse-led-triage in EDs using a systematic review. Nurses' involvement in the triage services provided in the Emergency Department has been an integral part of practice for several decades in some countries. Although studies exploring patient satisfaction with nurse-led ED triage exist, no systematic review of this evidence is available. MEDLINE, CINAHL, PsycInfo, EMBASE, the Cochrane Library, Joanna Briggs Library and Google Scholar were searched (January 1980-June 2013). Eighteen studies that met the inclusion criteria were reviewed. Factors that affect patient satisfaction with nurse-led-triage include nurses' abilities to provide patient centred care, communication skills, nurses' caring abilities, concern for the patient and competence in diagnosing and treating the health problem. Other factors include availability and visibility of nurses, provision of appropriate health related information in a jargon-free language, nurses' ability to answer questions, and an ability to provide patients with an opportunity to ask questions. There is continued scope for nurse-led-triage services in the ED. Patients are generally satisfied with the service provided by nurses in EDs and report a willingness to see the same professional again in the future if needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Application of a first impression triage in the Japan railway west disaster.

    Science.gov (United States)

    Hashimoto, Atsunori; Ueda, Takahiro; Kuboyama, Kazutoshi; Yamada, Taihei; Terashima, Mariko; Miyawaki, Atsushi; Nakao, Atsunori; Kotani, Joji

    2013-01-01

    On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients.

  1. Nurses' and doctors' perceptions regarding the implementation of a triage system in an emergency unit in South Africa

    Directory of Open Access Journals (Sweden)

    Jean E. Augustyn

    2009-09-01

    Opsomming Triage assessering van pasiënte met hulle aankoms by ‘n ongeluk/noodeenheid is ‘n noodsaaklike funksie van noodsorgvoorsiening, en is ‘n koste-effektiewe en tydbesparende onderneming. Hierdie studie het die persepsies van dokters en verpleegkundiges ondersoek betreffende die implementering van die Cape Triage Score in een noodeenheid. Die uitdagings wat ervaar is voor die implementering van die Cape Triage Score, die rolle en kernvaardighede van die triage verpleegkundige asook die swak en sterk punte van die Cape Triage Score is aangespreek. In hierdie beskrywende, kwantitatiewe en verkennende studie het 15 verpleegkundiges en dokters vraelyste voltooi. Uitdagings het verminder en die prioritisering van die pasiënte het verbeter na die implementering van die Cape Triage Score. Ander sterk punte van die stelsel het ingesluit dat die triage verpleegkundige die pasiënte geprioritiseer het, nie die ontvangsdame of die administratiewe personeel nie, en verpleegkundiges kon voorlopige ondersoeke doen sonder om op doktersbevele te wag. Die swakhede van die geïmplementeerde Cape Triage Score het ingesluit dat dit nog nie ten volle 100% van die tyd gefunksioneer het nie, en dat dit moeilik was om triage gedurende spitstye te handhaaf as gevolg van ‘n tekort aan verpleegkundiges. Die aanbevelings het ingesluit dat bestuur oortuig moet word van die voordele van die stelsel, verpleegkundiges triage funksies op ‘n rotasiebasis moet uitvoer, meer verpleegkundiges beskikbaar moet wees gedurende spitstye; en dat administratiewe en ontvangspersoneel ook georiënteer moet word ten opsigte van die triage stelsel.

  2. Decision support system for triage management: A hybrid approach using rule-based reasoning and fuzzy logic.

    Science.gov (United States)

    Dehghani Soufi, Mahsa; Samad-Soltani, Taha; Shams Vahdati, Samad; Rezaei-Hachesu, Peyman

    2018-06-01

    Fast and accurate patient triage for the response process is a critical first step in emergency situations. This process is often performed using a paper-based mode, which intensifies workload and difficulty, wastes time, and is at risk of human errors. This study aims to design and evaluate a decision support system (DSS) to determine the triage level. A combination of the Rule-Based Reasoning (RBR) and Fuzzy Logic Classifier (FLC) approaches were used to predict the triage level of patients according to the triage specialist's opinions and Emergency Severity Index (ESI) guidelines. RBR was applied for modeling the first to fourth decision points of the ESI algorithm. The data relating to vital signs were used as input variables and modeled using fuzzy logic. Narrative knowledge was converted to If-Then rules using XML. The extracted rules were then used to create the rule-based engine and predict the triage levels. Fourteen RBR and 27 fuzzy rules were extracted and used in the rule-based engine. The performance of the system was evaluated using three methods with real triage data. The accuracy of the clinical decision support systems (CDSSs; in the test data) was 99.44%. The evaluation of the error rate revealed that, when using the traditional method, 13.4% of the patients were miss-triaged, which is statically significant. The completeness of the documentation also improved from 76.72% to 98.5%. Designed system was effective in determining the triage level of patients and it proved helpful for nurses as they made decisions, generated nursing diagnoses based on triage guidelines. The hybrid approach can reduce triage misdiagnosis in a highly accurate manner and improve the triage outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

  3. The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

    Directory of Open Access Journals (Sweden)

    L N Goldstein

    2017-03-01

    Full Text Available Background. Triage in the emergency department (ED is necessary to prioritise management according to the severity of a patient’s condition.The South African Triage Scale (SATS is a hospital-based triage tool that has been adopted by numerous EDs countrywide.Many factors can influence the outcome of a patient’s triage result, and evaluation of performance is therefore pivotal. Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4% and patients who should have been in orange were most commonly demoted (35.0%. Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%, followed by numerical miscalculations (21.5%. The leading omitted discriminators were ‘abdominal pain’, ‘chest pain’ and ‘shortness of breath’. Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

  4. The introduction of a midwife-led obstetric triage system into a regional referral hospital in Ghana.

    Science.gov (United States)

    Floyd, Liz; Bryce, Fiona; Ramaswamy, Rohit; Olufolabi, Adeyemi; Srofenyoh, Emmanuel; Goodman, David; Pearson, Nancy; Morgan, Kerry; Tetteh, Cecilia; Ahwireng, Victoria; Owen, Medge

    2018-06-01

    to introduce and embed a midwife-led obstetric triage system in a busy labour ward in Accra, Ghana to improve the quality of care and to reduce delay. the study utilized a participatory action research design. Local staff participated in baseline data collection, the triage training course design and delivery, and post-training monitoring and evaluation. a regional referral hospital in Accra, Ghana undertaking 11,032 deliveries in 2012. all midwives and medical staff. measurements included maternal health outcomes, observations of labour ward activity, structured assessments of midwife actions during admission, waiting times, focus group discussions, and learning needs assessments which informed the course content. During training, two quality improvement tools were developed; coloured risk acuity wristbands and a one page triage assessment form. Participants measured compliance and accuracy in the use of these tools following course completion. initially, no formal triage system was in place. The environment was chaotic with poor compliance to existing protocols. Sixty-two midwives received triage training between 2013 and 2014. Two Triage Champions became responsible for triage implementation, monitoring and further training. Following training, the 'in-charge' midwives recorded a cumulative average of 83.4% of women wearing coloured wristbands. A separate audit by the Triage Champions found that 495/535 (93%) of the wristbands were correctly applied based on the diagnosis. Quarterly monitoring of the triage assessment forms by Kybele trainers, showed that 92% recorded the risk acuity colour, 85% a 'working diagnosis' and 82% a 'plan.' Median (interquartile range) waiting times were reduced from 40 (15-100) to 29 (11-60) minutes (p = 007). Twenty of 25 of the staff reported that the wristbands were helpful. an interactive triage training course led to the development of a triage assessment form and the use of coloured patient wristbands which resulted in delay

  5. Evaluating the construct of triage acuity against a set of reference vignettes developed via modified Delphi method.

    Science.gov (United States)

    Twomey, Michèle; Wallis, Lee A; Myers, Jonathan E

    2014-07-01

    To evaluate the construct of triage acuity as measured by the South African Triage Scale (SATS) against a set of reference vignettes. A modified Delphi method was used to develop a set of reference vignettes. Delphi participants completed a 2-round consensus-building process, and independently assigned triage acuity ratings to 100 written vignettes unaware of the ratings given by others. Triage acuity ratings were summarised for all vignettes, and only those that reached 80% consensus during round 2 were included in the reference set. Triage ratings for the reference vignettes given by two independent experts using the SATS were compared with the ratings given by the international Delphi panel. Measures of sensitivity, specificity, associated percentages for over-triage/under-triage were used to evaluate the construct of triage acuity (as measured by the SATS) by examining the association between the ratings by the two experts and the international panel. On completion of the Delphi process, 42 of the 100 vignettes reached 80% consensus on their acuity rating and made up the reference set. On average, over all acuity levels, sensitivity was 74% (CI 64% to 82%), specificity 92% (CI 87% to 94%), under-triage occurred 14% (CI 8% to 23%) and over-triage 12% (CI 8% to 23%) of the time. The results of this study provide an alternative to evaluating triage scales against the construct of acuity as measured with the SATS. This method of using 80% consensus vignettes may, however, systematically bias the validity estimate towards better performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Electric drives

    Energy Technology Data Exchange (ETDEWEB)

    1986-10-01

    Several electric vehicles have been tested in long-term tests, i.e. an electric passenger car (maximum speed 115 km/h) and several busses for use in pedestrians' zones, spas, airports, natural reserves, and urban transportation (DUO busses). The ICE high-speed train is discussed in some detail, i.e. its aeroacoustic and aerodynamic design, running gear, computer-controlled drives and brakes, diagnostic systems, and electrical equipment. The Berlin Maglev system is mentioned as well as current inverters in rail vehicles. (HWJ).

  7. A machine learning approach to triaging patients with chronic obstructive pulmonary disease.

    Directory of Open Access Journals (Sweden)

    Sumanth Swaminathan

    Full Text Available COPD patients are burdened with a daily risk of acute exacerbation and loss of control, which could be mitigated by effective, on-demand decision support tools. In this study, we present a machine learning-based strategy for early detection of exacerbations and subsequent triage. Our application uses physician opinion in a statistically and clinically comprehensive set of patient cases to train a supervised prediction algorithm. The accuracy of the model is assessed against a panel of physicians each triaging identical cases in a representative patient validation set. Our results show that algorithm accuracy and safety indicators surpass all individual pulmonologists in both identifying exacerbations and predicting the consensus triage in a 101 case validation set. The algorithm is also the top performer in sensitivity, specificity, and ppv when predicting a patient's need for emergency care.

  8. Routine blood tests are associated with short term mortality and can improve emergency department triage

    DEFF Research Database (Denmark)

    Kristensen, Michael; Iversen, Anne Kristine Servais; Gerds, Thomas Alexander

    2017-01-01

    BACKGROUND: Prioritization of acutely ill patients in the Emergency Department remains a challenge. We aimed to evaluate whether routine blood tests can predict mortality in unselected patients in an emergency department and to compare risk prediction with a formalized triage algorithm. METHODS...... registration. Multiple logistic regressions were used to predict 30-day mortality. Validation was performed by applying the regression models on the 2013 validation cohort. RESULTS: Thirty-day mortality was 5.3%. The routine blood tests had a significantly stronger discriminative value on 30-day mortality...... compared to the formalized triage (AUC 88.1 [85.7;90.5] vs. 63.4 [59.1;67.5], p blood tests was able to identify a larger number of low risk patients (n = 2100, 30-day mortality 0.1% [95% CI 0.0;0.3%]) compared to formalized triage (n = 1591, 2.8% [95% CI 2...

  9. A machine learning approach to triaging patients with chronic obstructive pulmonary disease

    Science.gov (United States)

    Qirko, Klajdi; Smith, Ted; Corcoran, Ethan; Wysham, Nicholas G.; Bazaz, Gaurav; Kappel, George; Gerber, Anthony N.

    2017-01-01

    COPD patients are burdened with a daily risk of acute exacerbation and loss of control, which could be mitigated by effective, on-demand decision support tools. In this study, we present a machine learning-based strategy for early detection of exacerbations and subsequent triage. Our application uses physician opinion in a statistically and clinically comprehensive set of patient cases to train a supervised prediction algorithm. The accuracy of the model is assessed against a panel of physicians each triaging identical cases in a representative patient validation set. Our results show that algorithm accuracy and safety indicators surpass all individual pulmonologists in both identifying exacerbations and predicting the consensus triage in a 101 case validation set. The algorithm is also the top performer in sensitivity, specificity, and ppv when predicting a patient’s need for emergency care. PMID:29166411

  10. [Validation of a triage scale: first step in patient admission and in emergency service models].

    Science.gov (United States)

    Legrand, A; Thys, F; Vermeiren, E; Touwaide, M; D'Hoore, W; Hubin, V; Reynaert, M S

    2003-03-01

    At present, most emergency services handle the multitude of various demands in the same unity of place and by the same team of nurses aides, with direct consequences on the waiting time and in the handling of problems of varying degrees of importance. Our service examines other administrative models based on a triage of time and of orientation. In a prospective study on 679 patients, we have validated a triage tool inspired from the ICEM model (International Cooperation of Emergency Medicine) allowing patients to receive, while they wait, information and training, based on the resources provided, in order to deal with their particular medical problem. The validation of this tool was carried out in terms of its utilization as well as its reliability. It appears that, with the type of triage offered, there is a theoretical reserve of waiting time for the patients in which the urgency is relative, and which could be better used in the handling of more vital cases.

  11. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

    2014-01-01

    diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

  12. Induced spherococcoid hard wheat

    International Nuclear Information System (INIS)

    Yanev, Sh.

    1981-01-01

    A mutant has been obtained - a spheroccocoid line -through irradiation of hard wheat seed with fast neutrons. It is distinguished by semispherical glumes and smaller grain; the plants have low stem with erect leaves but with shorter spikes and with lesser number of spikelets than those of the initial cultivar. Good productive tillering and resistance to lodging contributed to 23.5% higher yield. The line was superior to the standard and the initial cultivars by 14.2% as regards protein content, and by up to 22.8% - as to flour gluten. It has been successfully used in hybridization producing high-yielding hard wheat lines resistant to lodging, with good technological and other indicators. The possibility stated is of obtaining a spherococcoid mutant in tetraploid (hard) wheat out of the D-genome as well as its being suited to hard wheat breeding to enhance protein content, resistance to lodging, etc. (author)

  13. Hard probes 2006 Asilomar

    CERN Multimedia

    2006-01-01

    "The second international conference on hard and electromagnetic probes of high-energy nuclear collisions was held June 9 to 16, 2006 at the Asilomar Conference grounds in Pacific Grove, California" (photo and 1/2 page)

  14. Open access phone triage for veterans with suspected malignant pleural mesothelioma.

    Science.gov (United States)

    Siegert, Charles Jeff; Fisichella, Piero Marco; Moseley, Jennifer M; Shoni, Melina; Lebenthal, Abraham

    2017-01-01

    Phone triaging patients with suspected malignant pleural mesothelioma (MPM) within the Veterans Healthcare Administration (VHA) system offers a model for rapid, expert guided evaluation for patients with rare and treatable diseases within a national integrated healthcare system. To assess feasibility of national open access telephone triage using evidence-based treatment recommendations for patients with MPM, measure timelines of the triage and referral process and record the impact on "intent to treat" for patients using our service. A retrospective study. The main outcome measures were: (1) ability to perform long distance phone triage, (2) to assess the speed of access to a mesothelioma surgical specialist for patients throughout the entire VHA, and (3) to determine if access to a specialist would alter the plan of care. Sixty veterans were screened by our phone triage program, 38 traveled an average of 997 miles to VA Boston Healthcare system. On average, 14 d elapsed from initial phone contact until the patient was physically evaluated in our general thoracic clinic in Boston. The treatment plan was altered for 71% of patients evaluated at VA Boston Healthcare system based on 2012 International Mesothelioma Interest Group guidelines. Our initial experience demonstrates that in-network centralized care for Veterans with MPM is feasible within the VHA. National open access phone triage improves access to expert surgical advice and can be delivered in a timely manner for Veterans using our service. Guideline-based treatment recommendations ("intent to treat") changed the therapeutic course for the majority of patients who used our service. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Use of the Triage Stroke Panel in a neurologic emergency service.

    Science.gov (United States)

    Sibon, Igor; Rouanet, François; Meissner, Wassilios; Orgogozo, Jean Marc

    2009-06-01

    Acute stroke is associated with serum elevations of numerous markers. We evaluated the additive accuracy of the Triage Stroke Panel (D-dimer, B-natriuretic peptide, matrix metalloproteinase 9, and S-100beta) to the triaging nurse for acute stroke diagnosis. Consecutive patients with suspected stroke were included in this prospective, controlled, single-center study. A well-trained stroke center triage nurse assigned a probability that the patient had experienced a stroke (certain, very probable, probable, not likely, doubtful, or other); then, the Triage Stroke Panel testing was performed. Patients' diagnosis was based on clinical and imaging data by a neurologist blinded to the test results. Two hundred four patients were evaluated. Confirmed strokes and transient ischemic attacks (TIAs) were observed in 131 patients. When considering an experienced stroke nurse's assessment of "other," "doubtful," or "not likely" to be negative for stroke and categorizing TIA with stroke, the stroke panel's Multimarker Index (MMX) value had identical accuracy (approximately 70%) and equivalent sensitivity (approximately 94%) and specificity (approximately 24%) for stroke diagnosis to that of the nurse. Combining nurse assessment with the MMX result significantly improved the specificity of diagnosing "mimic" vs stroke + TIA from 25.4% (nurse assessment only) to 46.0% (nurse assessment + MMX; P Stroke Panel provides objective information that complements a triage nurse in the assessment of a suspected stroke patient. Its performance compares favorably with that of a well-trained stroke center triage nurse, suggesting potential use in nonexpert centers for improving the accuracy of stroke diagnosis.

  16. The Effect of Start Triage Education on Knowledge and Practice of Emergency Medical Technicians in Disasters

    Directory of Open Access Journals (Sweden)

    Mahboub Pouraghaei

    2017-06-01

    Full Text Available Introduction: Pre-hospital triage is one of the most fundamental concepts in emergency management. Limited human resource changes triage to an inevitable solution in the management of disasters. The aim of this study was to evaluate the role of education of simple triage and rapid treatment (START in the knowledge and practice of Emergency Medical Service (EMS employees of Eastern Azerbaijan. Methods: This is a pre-and post-intervention study conducted on two hundred and five (205 of employees of EMS sector, in the disaster and emergency management center of Eastern Azerbaijan Province, 2015. The utilized tool is a questionnaire of the knowledge and practice of individuals regarding START triage. The questionnaire was filled by the participants pre- and post-education; thereafter the data were analyzed using SPSS 13 software. Results: The total score of the participants increased from 22.02 (4.49 to 28.54 (3.47. Moreover, the score of sections related to knowledge of the triage was a necessity and the mean score of the section related to the practice increased from 11.47 (2.15 to 13.63 (1.38, and 10.73 (3.57 to 14.93 (2.78, respectively, which were statistically significant. Conclusion: In this study, it was found that holding the educational classes of pre-hospital triage before the disasters is effective in improving the knowledge and practice of employees such as EMS technicians and this resulted to decreased error in performing this process as well as reduced overload in hospitals.

  17. The Effect of Start Triage Education on Knowledge and Practice of Emergency Medical Technicians in Disasters.

    Science.gov (United States)

    Pouraghaei, Mahboub; Sadegh Tabrizi, Jaafar; Moharamzadeh, Payman; Rajaei Ghafori, Rozbeh; Rahmani, Farzad; Najafi Mirfakhraei, Baharak

    2017-06-01

    Introduction: Pre-hospital triage is one of the most fundamental concepts in emergency management. Limited human resource changes triage to an inevitable solution in the management of disasters. The aim of this study was to evaluate the role of education of simple triage and rapid treatment (START) in the knowledge and practice of Emergency Medical Service (EMS) employees of Eastern Azerbaijan. Methods: This is a pre-and post-intervention study conducted on two hundred and five (205) of employees of EMS sector, in the disaster and emergency management center of Eastern Azerbaijan Province, 2015. The utilized tool is a questionnaire of the knowledge and practice of individuals regarding START triage. The questionnaire was filled by the participants pre- and post-education; thereafter the data were analyzed using SPSS 13 software. Results: The total score of the participants increased from 22.02 (4.49) to 28.54 (3.47). Moreover, the score of sections related to knowledge of the triage was a necessity and the mean score of the section related to the practice increased from 11.47 (2.15) to 13.63 (1.38), and 10.73 (3.57) to 14.93 (2.78), respectively, which were statistically significant. Conclusion: In this study, it was found that holding the educational classes of pre-hospital triage before the disasters is effective in improving the knowledge and practice of employees such as EMS technicians and this resulted to decreased error in performing this process as well as reduced overload in hospitals.

  18. Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

    NARCIS (Netherlands)

    Bezem, J.; Ploeg, C. van der; Numans, M.; Buitendijk, S.; Kocken, P.; Akker, E. van der

    2017-01-01

    Background. Triage in Preventive Child Health Care (PCH) assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6

  19. Hard coal; Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Loo, Kai van de; Sitte, Andreas-Peter [Gesamtverband Steinkohle e.V., Herne (Germany)

    2013-04-01

    The year 2012 benefited from a growth of the consumption of hard coal at the national level as well as at the international level. Worldwide, the hard coal still is the number one energy source for power generation. This leads to an increasing demand for power plant coal. In this year, the conversion of hard coal into electricity also increases in this year. In contrast to this, the demand for coking coal as well as for coke of the steel industry is still declining depending on the market conditions. The enhanced utilization of coal for the domestic power generation is due to the reduction of the nuclear power from a relatively bad year for wind power as well as reduced import prices and low CO{sub 2} prices. Both justify a significant price advantage for coal in comparison to the utilisation of natural gas in power plants. This was mainly due to the price erosion of the inexpensive US coal which partly was replaced by the expansion of shale gas on the domestic market. As a result of this, the inexpensive US coal looked for an outlet for sales in Europe. The domestic hard coal has continued the process of adaptation and phase-out as scheduled. Two further hard coal mines were decommissioned in the year 2012. RAG Aktiengesellschaft (Herne, Federal Republic of Germany) running the hard coal mining in this country begins with the preparations for the activities after the time of mining.

  20. Accounting for vulnerability to illness and social disadvantage in pandemic critical care triage.

    Science.gov (United States)

    Kaposy, Chris

    2010-01-01

    In a pandemic situation, resources in intensive care units may be stretched to the breaking point, and critical care triage may become necessary. In such a situation, I argue that a patient's combined vulnerability to illness and social disadvantage should be a justification for giving that patient some priority for critical care. In this article I present an example of a critical care triage protocol that recognizes the moral relevance of vulnerability to illness and social disadvantage, from the Canadian province of Newfoundland and Labrador.

  1. MANCHESTER TRIAGE SYSTEM IN PRIMARY HEALTH CARE: AMBIGUITIES AND CHALLENGES RELATED TO ACCESS

    OpenAIRE

    Danielle de Araújo Moreira; Hanna Beatriz Bacelar Tibães; Renata Cristina Rocha Batista; Cecília Maria Lima Cardoso; Maria José Menezes Brito

    2017-01-01

    Objetivo: comprender ambigüedades y desafíos relacionados con el acceso, después de la implantación del Sistema de Triage de Manchester en la atención primaria en salud. Método: investigación cualitativa, que utilizó la entrevista semiestructurada con enfermeros, médicos y auxiliares de enfermería, totalizando 22 profesionales. Los datos fueron analizados por medio de análisis de contenido temático . Resultados: el Sistema de Triage de Manchester interfirió de forma antagónica en el acce...

  2. Effect of self-triage on waiting times at a walk-in sexual health clinic.

    Science.gov (United States)

    Hitchings, Samantha; Barter, Janet

    2009-10-01

    Lengthy waiting times can be a major problem in walk-in sexual health clinics. They are stressful for both patients and staff and may lead to clients with significant health issues leaving the department before being seen by a clinician. A self-triage system may help reduce waiting times and duplication of work, improve patient pathways and decrease wasted visits. This paper describes implementation of a self-triage system in two busy sexual and reproductive health clinics. Patients were asked to complete a self-assessment form on registration to determine the reason for attendance. This then enabled patients to be directed to the most appropriate specialist or clinical service. The benefits of this approach were determined by measuring patient waiting times, reduction in unnecessary specialist review together with patient acceptability as tested by a patient satisfaction survey. The ease of comprehension of the triage form was also assessed by an independent readers' panel. A total of 193 patients were recruited over a 4-month period from November 2004 to February 2005. Patients from the November and December clinics were assigned to the 'traditional treatment' arm, with patients at subsequent clinics being assigned to the 'self-triage' system. Waiting times were collected by the receptionist and clinic staff. Ninety six patients followed the traditional route, 97 the new self-triage system. Sixty-nine (35.8%) patients completed the satisfaction survey. The self-triage system significantly reduced waiting time from 40 (22, 60) to 23 (10, 40) minutes [results expressed as median (interquartile range)]. There was a non-significant reduction in the proportion of patients seeing two clinicians from 21% to 13% (p = 0.17). Satisfaction levels were not significantly altered (95% compared to 97% satisfied, p = 0.64). The readers' panel found the triage form both easy to understand and to complete. Self-triage can effectively reduce clinic waiting times and allow better

  3. Safe driving for teens

    Science.gov (United States)

    Driving and teenagers; Teens and safe driving; Automobile safety - teenage drivers ... months before taking friends as passengers. Teenage-related driving deaths occur more often in certain conditions. OTHER SAFETY TIPS FOR TEENS Reckless driving is still a ...

  4. Field triage reduces treatment delay and improves long-term clinical outcome in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Pedersen, Sune H; Galatius, Soren; Hansen, Peter R

    2009-01-01

    by field triage and 821 by emergency departments. Baseline and angiographic variables were similar in the 2 populations. Patients admitted by field triage had a significantly shorter median door-to-balloon time compared with patients admitted by emergency department triage (83 min, interquartile range 67...... to 100 min vs. 103 min, interquartile range 80 to 135 min; p

  5. The Hard X-ray Sky: Recent Observational Progress

    International Nuclear Information System (INIS)

    Gehrels, Neil; Cannizzo, John K.

    2009-01-01

    The last fifty years have witnessed the birth, development, and maturation to full potential of hard X-ray astrophysics. The primary force driving the history of the field has been the development of space-based instrumentation optimized for getting the maximum science out of observations of high-energy photons from astrophysical sources. Hard X-ray telescopes are leading research in areas such as galactic diffuse emission, galactic transients, and active galactic nuclei.

  6. Appropriate statistical methods are required to assess diagnostic tests for replacement, add-on, and triage

    NARCIS (Netherlands)

    Hayen, Andrew; Macaskill, Petra; Irwig, Les; Bossuyt, Patrick

    2010-01-01

    To explain which measures of accuracy and which statistical methods should be used in studies to assess the value of a new binary test as a replacement test, an add-on test, or a triage test. Selection and explanation of statistical methods, illustrated with examples. Statistical methods for

  7. [Unmanned aerial vehicles: usefulness for victim searches and triage in disasters].

    Science.gov (United States)

    Pardo Ríos, Manuel; Pérez Alonso, Nuria; Lasheras Velasco, Joaquín; Juguera Rodríguez, Laura; López Ayuso, Belén; Muñoz Solera, Rubén; Martínez Riquelme, Carolina; Nieto Fernández-Pacheco, Antonio

    2016-01-01

    To analyze the influence of drones equipped with thermal cameras for finding victims and aiding triage during disasters. We carried out a prospective, cross-sectional analysis and 6 experimental simulations, each with 25 victims to locate and triage. Nurses were randomized to a control group or a drone group. Drone-group nurses were given access to images from the thermal cameras 10 minutes before the exercise started. The mean (SD) distance the nurses searched in the control group (1091.11 [146.41] m) was significantly greater than the distance searched by nurses in the drone group (920 [ 71.93] m (P = .0031). The control group found a mean of 66.7% of the victims, a significantly smaller percentage than the drone group's mean of 92% (P = .0001). Triage quality (undertriage and overtriage) was similar in the 2 groups as shown by maneuvers undertaken to open airways and control bleeding. Drones with thermal cameras were useful in searching for victims of simulated disasters in this study, although they had no impact on the quality of the nurses' triage.

  8. A DSS with dynamically pluggable rules take emergency triage as example.

    Science.gov (United States)

    Sheng, Yu-Hsiang; Chang, Polun

    2006-01-01

    We propose a new method to develop Decision Support System, which has the flexibility to install new rules into the system remotely during run time, and can change system behavior on the fly. Take OSGi as a platform we build an emergency triage system which can apply different decision-making strategy while facing different situation.

  9. Diagnostic triage for low back pain: a practical approach for primary care.

    Science.gov (United States)

    Bardin, Lynn D; King, Peter; Maher, Chris G

    2017-04-03

    Diagnostic triage is an essential guideline recommendation for low back pain (LBP), which is the most frequent musculoskeletal condition that general practitioners encounter in Australia. Clinical diagnosis of LBP - informed by a focused history and clinical examination - is the key initial step for GPs, and determines subsequent diagnostic workup and allied health and medical specialist referral. The goal of diagnostic triage of LBP is to exclude non-spinal causes and to allocate patients to one of three broad categories: specific spinal pathology (pain, radiculopathy and spinal stenosis. Differential diagnosis of back-related leg pain is complex and clinical manifestations are highly variable. However, distinctive clusters of characteristic history cues and positive clinical examination signs, particularly from neurological examination, guide differential diagnosis within this triage category. A diagnosis of NSLBP presumes exclusion of specific pathologies and nerve root involvement. A biopsychosocial model of care underpins NSLBP; this includes managing pain intensity and considering risk for disability, which directs matched pathways of care. Back pain is a symptom and not a diagnosis. Careful diagnostic differentiation is required and, in primary care, diagnostic triage of LBP is the anchor for a diagnosis.

  10. Operational Testing of a Combined Hardware-Software Strategy for Triage of Radiologically-Contaminated Persons.

    Science.gov (United States)

    Waller, Edward J

    2015-08-01

    After a radiological dispersal device (RDD) event, it is possible for radionuclides to enter the human body through inhalation, ingestion, and skin and wound absorption. The dominant pathway will be through inhalation. From a health physics perspective, it is important to know the magnitude of the intake to perform dosimetric assessments. From a medical perspective, removal of radionuclides leading to dose (hence risk) aversion is of high importance. The efficacy of medical decorporation strategies is extremely dependent upon the time of treatment delivery after intake. The "golden hour," or more realistically 3-4 h, is imperative when attempting to increase removal of radionuclides from extracellular fluids prior to cellular incorporation. To assist medical first response personnel in making timely decisions regarding appropriate treatment delivery modes, a software tool has been developed which compiles existing radionuclide decorporation therapy data and allows a user to perform simple triage leading to potential appropriate decorporation treatment strategies. Three triage algorithms were included: (1) multi-parameter model (MPM), (2) clinical decision guidance (CDG) model, and (3) annual limit on intake (ALI) model. A radiation triage mask (RTM) has simultaneously been developed to provide a simple and rapid hardware solution for first responders to triage internally exposed personnel in the field. The hardware/software strategy was field tested with a military medical unit and was found by end-users to be relatively simple to learn and use.

  11. Delivery room triage of large for gestational age infants of diabetic mothers.

    Science.gov (United States)

    Cordero, Leandro; Rath, Krista; Zheng, Katherine; Landon, Mark B; Nankervis, Craig A

    2014-01-01

    To review our 4-year experience (2008-2011) with delivery room triage of large for gestational age infants of diabetic mothers. Retrospective cohort investigation of 311 large for gestational age infants of diabetic mothers (White's Class A1 (77), A2 (87), B (77), and C-R (70)). Of 311 women, 31% delivered at 34-36 weeks gestational age and 69% at term. While 70% were delivered by cesarean, 30% were vaginal deliveries. A total of 160 asymptomatic infants were triaged from the delivery room to the well baby nursery. Of these, 55 (34%) developed hypoglycemia. In 43 cases, the hypoglycemia was corrected by early feedings; in the remaining 12, intravenous dextrose treatment was required. A total of 151 infants were triaged from the delivery room to the neonatal intensive care unit. Admission diagnoses included respiratory distress (51%), prevention of hypoglycemia (27%), prematurity (21%), and asphyxia (1%). Hypoglycemia affected 66 (44%) of all neonatal intensive care unit infants. Safe triage of asymptomatic large for gestational age infants of diabetic mothers from the delivery room to well baby nursery can be accomplished in the majority of cases. Those infants in need of specialized care can be accurately identified and effectively treated in the neonatal intensive care unit setting.

  12. Overweight and Body Image Perception in Adolescents with Triage of Eating Disorders

    Directory of Open Access Journals (Sweden)

    Roberta Stofeles Cecon

    2017-01-01

    Full Text Available Purpose. To verify the influence of overweight and alteration in the perception of the corporal image during the triage of eating disorders. Method. A food disorder triage was performed in adolescents with 10 to 19 years of age using the Eating Attitudes Test (EAT-26, Children’s Eating Attitudes Test (ChEAT, and Bulimic Investigatory Test Edinburgh (BITE, as well as a nutritional status evaluation. The perception of body image was evaluated in a subsample of adolescents with 10 to 14 years of age, using the Brazilian Silhouette Scale. The project was approved by the Human Research Ethics Committee of the Federal University of Viçosa, Minas Gerais, Brazil. Results. The prevalence of eating disorder triage was 11.4% (n=242 for the 2,123 adolescents evaluated. Overweight was present in 21.1% (n=447 of the students, being more prevalent in the early adolescence phase, which presented levels of distortion of 56.9% (n=740 and dissatisfaction of 79.3% (n=1031. Body dissatisfaction was considered as a risk factor, increasing by more than 13 times the chance of TA screening. Conclusion. Overweight was correlated with the ED triage and body dissatisfaction was considered as a risk factor, increasing the chances of these disorders by more than 13 times.

  13. The CAREFALL Triage instrument identifying risk factors for recurrent falls in elderly patients

    NARCIS (Netherlands)

    Hensbroek, van P. Boele; Dijk, van N.; Breda, van G.F.; Scheffer, A.C.; Cammen, van der T.J.; Lips, P.T.A.M.; Goslings, J.C.; Rooij, S.E.

    2009-01-01

    OBJECTIVE: To validate the CAREFALL Triage Instrument (CTI), a self-administered questionnaire concerning modifiable risk factors for recurrent falls in elderly patients who experienced fall. METHODS: This study in patients 65 years or older who experienced fall was performed at the accident and

  14. The CAREFALL Triage instrument identifying risk factors for recurrent falls in elderly patients

    NARCIS (Netherlands)

    Boele van Hensbroek, Pieter; van Dijk, Nynke; van Breda, G. Fenna; Scheffer, Alice C.; van der Cammen, Tischa J.; Lips, Paul; Goslings, J. Carel; de Rooij, Sophia E.

    2009-01-01

    Objective: To validate the CAREFALL Triage Instrument (CTI), a self-administered questionnaire concerning modifiable risk factors for recurrent falls in elderly patients who experienced fall. Methods: This study in patients 65 years or older who experienced fall was performed at the accident and

  15. Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

    LENUS (Irish Health Repository)

    Fennelly, Orna

    2018-06-01

    Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services.

  16. Point-of-Care Ultrasound for Pulmonary Concerns in Remote Spaceflight Triage Environments.

    Science.gov (United States)

    Johansen, Benjamin D; Blue, Rebecca S; Castleberry, Tarah L; Antonsen, Erik L; Vanderploeg, James M

    2018-02-01

    With the development of the commercial space industry, growing numbers of spaceflight participants will engage in activities with a risk for pulmonary injuries, including pneumothorax, ebullism, and decompression sickness, as well as other concomitant trauma. Medical triage capabilities for mishaps involving pulmonary conditions have not been systematically reviewed. Recent studies have advocated the use of point-of-care ultrasound to screen for lung injury or illness. The operational utility of portable ultrasound systems in disaster relief and other austere settings may be relevant to commercial spaceflight. A systematic review of published literature was conducted concerning the use of point-of-care pulmonary ultrasound techniques in austere environments, including suggested examination protocols for triage and diagnosis. Recent studies support the utility of pulmonary ultrasound examinations when performed by skilled operators, and comparability of the results to computed tomography and chest radiography for certain conditions, with important implications for trauma management in austere environments. Pulmonary injury and illness are among the potential health risks facing spaceflight participants. Implementation of point-of-care ultrasound protocols could aid in the rapid diagnosis, triage, and treatment of such conditions. Though operator-dependent, ultrasound, with proper training, experience, and equipment, could be a valuable tool in the hands of a first responder supporting remote spaceflight operations.Johansen BD, Blue RS, Castleberry TL, Antonsen EL, Vanderploeg JM. Point-of-care ultrasound for pulmonary concerns in remote spaceflight triage environments. Aerosp Med Hum Perform. 2018; 89(2):122-129.

  17. Information behavior and workplace procedures: The case of emergency-department triage

    DEFF Research Database (Denmark)

    Hertzum, Morten

    In workplace contexts the performance of many information tasks is prescribed in procedures. Knowledge of the relationship between workplace procedures and actors’ real information behavior is important to understanding information behavior. We explore this relationship by looking at how emergency...... clinicians’ information behavior relates to clinical triage guidelines....

  18. Observer agreement of the Manchester Triage System and the Emergency Severity Index: a simulation study

    NARCIS (Netherlands)

    Storm-Versloot, M. N.; Ubbink, D. T.; Chin a Choi, V.; Luitse, J. S. K.

    2009-01-01

    Objectives: To compare inter and intra-observer agreement of the Manchester Triage System (MTS) and the Emergency Severity Index (ESI). Methods: 50 representative emergency department (ED) scenarios derived from actual cases were presented to 18 ED nurses from three different hospitals. Eight of

  19. An evaluation of the use of the South African Triage Scale in an ...

    African Journals Online (AJOL)

    Background: Emergency centres in South Africa are among the busiest in the world and serve as entry points for hospital care for most of the population. The South African Triage Scale (SATS) is a validated tool introduced nationally in 2006 and intended to increase the efficiency of emergency centres through a process of ...

  20. Efficacy of Acute Pain Control Protocol in Triage Department on Analgesics Administration Time and Patients' Satisfaction

    Directory of Open Access Journals (Sweden)

    Seyedhossein Seyyedhoseini Davaraani

    2014-07-01

    Full Text Available Objective: Current study was conducted to develop a pain control protocol by Morphine Sulfate (MS Suppository in triage ward with the main primary outcomes of first analgesic administration time, patients' satisfaction and also the changes in pain intensity. Methods: In this randomized clinical trial, 318 consecutive patients attending to an academic tertiary health care center in Tehran, Iran in 2011 and 2012 were enrolled. The patients were randomly assigned to receive either routine pain control by emergency medicine residents in emergency department (n=132 or pain control protocol in triage level by nurses (n=186. Those with pain in control group were treated with conventional pain control program and those in intervention group with pain intensities higher than four were treated with suppository stat 10 mg dose of MS administered by nurses in triage ward. Results: The mean change in pain intensity was significantly (P<0.0001 higher in intervention group (4.2 versus 0.2 and the first analgesic administration time was significantly different between groups (P<0.05 being less in the intervention group (43.1 versus 4.6. Also the patients' satisfaction was significantly higher in the intervention group (P<0.0001. No drug adverse effects were seen. Conclusions: Totally, according to the obtained results, it may be concluded that acute pain control protocol in triage department by suppository of MS would result in reduced analgesics administration time and higher patients' satisfaction.   Keywords: Analgesia; Emergency Department; Pain Control

  1. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.D.; Bredenoord, A.

    2014-01-01

    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  2. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    de Groot, N. L.; van Oijen, M. G. H.; Kessels, K.; Hemmink, M.; Weusten, B. L. A. M.; Timmer, R.; Hazen, W. L.; van Lelyveld, N.; Vermeijden, J. R.; Curvers, W. L.; Baak, L. C.; Verburg, R.; Bosman, J. H.; de Wijkerslooth, L. R. H.; de Rooij, J.; Venneman, N. G.; Pennings, M.; van Hee, K.; Scheffer, R. C. H.; van Eijk, R. L.; Meiland, R.; Siersema, P. D.; Bredenoord, A. J.

    2014-01-01

    Introduction: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  3. Triage, education, and group meetings: efficient use of the interdisciplinary team with chronic psychiatric outpatients.

    Science.gov (United States)

    Rosenthal, R H; Thomas, N S; Vandiveer, C A

    1979-04-01

    The caseload of chronic patients of a large mental health outpatient clinic was triaged into medication groups with educational and socialization emphasis. Organization, division of staff responsibilities, and longitudinal clinic responses are described, and advantages and pitfalls of the group format are presented.

  4. Soft and hard pomerons

    International Nuclear Information System (INIS)

    Maor, Uri; Tel Aviv Univ.

    1995-09-01

    The role of s-channel unitarity screening corrections, calculated in the eikonal approximation, is investigated for soft Pomeron exchange responsible for elastic and diffractive hadron scattering in the high energy limit. We examine the differences between our results and those obtained from the supercritical Pomeron-Regge model with no such corrections. It is shown that screening saturation is attained at different scales for different channels. We then proceed to discuss the new HERA data on hard (PQCD) Pomeron diffractive channels and discuss the relationship between the soft and hard Pomerons and the relevance of our analysis to this problem. (author). 18 refs, 9 figs, 1 tab

  5. Hard exclusive QCD processes

    Energy Technology Data Exchange (ETDEWEB)

    Kugler, W.

    2007-01-15

    Hard exclusive processes in high energy electron proton scattering offer the opportunity to get access to a new generation of parton distributions, the so-called generalized parton distributions (GPDs). This functions provide more detailed informations about the structure of the nucleon than the usual PDFs obtained from DIS. In this work we present a detailed analysis of exclusive processes, especially of hard exclusive meson production. We investigated the influence of exclusive produced mesons on the semi-inclusive production of mesons at fixed target experiments like HERMES. Further we give a detailed analysis of higher order corrections (NLO) for the exclusive production of mesons in a very broad range of kinematics. (orig.)

  6. Hard-hat day

    CERN Multimedia

    2003-01-01

    CERN will be organizing a special information day on Friday, 27th June, designed to promote the wearing of hard hats and ensure that they are worn correctly. A new prevention campaign will also be launched.The event will take place in the hall of the Main Building from 11.30 a.m. to 2.00 p.m., when you will be able to come and try on various models of hard hat, including some of the very latest innovative designs, ask questions and pass on any comments and suggestions.

  7. Smooth driving of Moessbauer electromechanical transducers

    Energy Technology Data Exchange (ETDEWEB)

    Veiga, A., E-mail: veiga@fisica.unlp.edu.ar; Mayosky, M. A. [Universidad Nacional de La Plata, Facultad de Ingenieria (Argentina); Martinez, N.; Mendoza Zelis, P.; Pasquevich, G. A.; Sanchez, F. H. [Instituto de Fisica La Plata, CONICET (Argentina)

    2011-11-15

    Quality of Moessbauer spectra is strongly related to the performance of source velocity modulator. Traditional electromechanical driving techniques demand hard-edged square or triangular velocity waveforms that introduce long settling times and demand careful driver tuning. For this work, the behavior of commercial velocity transducers and drive units was studied under different working conditions. Different velocity reference waveforms in constant-acceleration, constant-velocity and programmable-velocity techniques were tested. Significant improvement in spectrometer efficiency and accuracy was achieved by replacing triangular and square hard edges with continuous smooth-shaped transitions. A criterion for best waveform selection and synchronization is presented and attainable enhancements are evaluated. In order to fully exploit this driving technique, a compact microprocessor-based architecture is proposed and a suitable data acquisition system implementation is presented. System linearity and efficiency characterization are also shown.

  8. Are triage questions sufficient to assign fall risk precautions in the ED?

    Science.gov (United States)

    Southerland, Lauren T; Slattery, Lauren; Rosenthal, Joseph A; Kegelmeyer, Deborah; Kloos, Anne

    2017-02-01

    The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls. Prospective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered. The 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n=23) as at risk for falls, whereas the 4SBT identified 43% (n=25). Combining triage questions with the 4SBT identified 60.3% (n=35) as at high risk for falls, as compared with 39.7% (n=23) with triage questions alone (Ppatients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses). Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Hard times; Schwere Zeiten

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, Markus

    2012-10-02

    The prices of silicon and solar wafers keep dropping. According to market research specialist IMS research, this is the result of weak traditional solar markets and global overcapacities. While many manufacturers are facing hard times, big producers of silicon are continuing to expand.

  10. Hardness of Clustering

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Hardness of Clustering. Both k-means and k-medians intractable (when n and d are both inputs even for k =2). The best known deterministic algorithms. are based on Voronoi partitioning that. takes about time. Need for approximation – “close” to optimal.

  11. Rock-hard coatings

    OpenAIRE

    Muller, M.

    2007-01-01

    Aircraft jet engines have to be able to withstand infernal conditions. Extreme heat and bitter cold tax coatings to the limit. Materials expert Dr Ir. Wim Sloof fits atoms together to develop rock-hard coatings. The latest invention in this field is known as ceramic matrix composites. Sloof has signed an agreement with a number of parties to investigate this material further.

  12. Rock-hard coatings

    NARCIS (Netherlands)

    Muller, M.

    2007-01-01

    Aircraft jet engines have to be able to withstand infernal conditions. Extreme heat and bitter cold tax coatings to the limit. Materials expert Dr Ir. Wim Sloof fits atoms together to develop rock-hard coatings. The latest invention in this field is known as ceramic matrix composites. Sloof has

  13. Hardness and excitation energy

    Indian Academy of Sciences (India)

    It is shown that the first excitation energy can be given by the Kohn-Sham hardness (i.e. the energy difference of the ground-state lowest unoccupied and highest occupied levels) plus an extra term coming from the partial derivative of the ensemble exchange-correlation energy with respect to the weighting factor in the ...

  14. Inside Solid State Drives (SSDs)

    CERN Document Server

    Micheloni, Rino; Eshghi, Kam

    2013-01-01

    Solid State Drives (SSDs) are gaining momentum in enterprise and client applications, replacing Hard Disk Drives (HDDs) by offering higher performance and lower power. In the enterprise, developers of data center server and storage systems have seen CPU performance growing exponentially for the past two decades, while HDD performance has improved linearly for the same period. Additionally, multi-core CPU designs and virtualization have increased randomness of storage I/Os. These trends have shifted performance bottlenecks to enterprise storage systems. Business critical applications such as online transaction processing, financial data processing and database mining are increasingly limited by storage performance. In client applications, small mobile platforms are leaving little room for batteries while demanding long life out of them. Therefore, reducing both idle and active power consumption has become critical. Additionally, client storage systems are in need of significant performance improvement as well ...

  15. Machine-Learning-Based Electronic Triage More Accurately Differentiates Patients With Respect to Clinical Outcomes Compared With the Emergency Severity Index.

    Science.gov (United States)

    Levin, Scott; Toerper, Matthew; Hamrock, Eric; Hinson, Jeremiah S; Barnes, Sean; Gardner, Heather; Dugas, Andrea; Linton, Bob; Kirsch, Tom; Kelen, Gabor

    2018-05-01

    Standards for emergency department (ED) triage in the United States rely heavily on subjective assessment and are limited in their ability to risk-stratify patients. This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. A multisite, retrospective, cross-sectional study of 172,726 ED visits from urban and community EDs was conducted. E-triage is composed of a random forest model applied to triage data (vital signs, chief complaint, and active medical history) that predicts the need for critical care, an emergency procedure, and inpatient hospitalization in parallel and translates risk to triage level designations. Predicted outcomes and secondary outcomes of elevated troponin and lactate levels were evaluated and compared with the Emergency Severity Index (ESI). E-triage predictions had an area under the curve ranging from 0.73 to 0.92 and demonstrated equivalent or improved identification of clinical patient outcomes compared with ESI at both EDs. E-triage provided rationale for risk-based differentiation of the more than 65% of ED visits triaged to ESI level 3. Matching the ESI patient distribution for comparisons, e-triage identified more than 10% (14,326 patients) of ESI level 3 patients requiring up triage who had substantially increased risk of critical care or emergency procedure (1.7% ESI level 3 versus 6.2% up triaged) and hospitalization (18.9% versus 45.4%) across EDs. E-triage more accurately classifies ESI level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking. Further prospective validation is needed. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  16. Comparison of the 1999 and 2006 Trauma Triage Guidelines: Where do Patients Go?

    Science.gov (United States)

    Lerner, E. Brooke; Shah, Manish N.; Swor, Robert; Cushman, Jeremy T.; Guse, Clare E.; Brasel, Karen; Blatt, Alan; Jurkovich, Gregory J.

    2010-01-01

    In 2006, the CDC released a revised Field Triage Decision Scheme. It is unknown how this modified scheme will affect the number of patients identified by EMS for transport to a trauma center. Objective To determine the change in the number of patients transported by EMS who meet the 2006 scheme, compared to the 1999 scheme, and to determine how the scheme change would affect under- and over-triage rates. Methods EMS providers in charge of care for injured adult patients transported to a regional trauma center in three mid-sized cities were interviewed immediately after completing transport. All injured patients were included, regardless of severity. The interview included patient demographics, vital signs, apparent anatomic injury, and the mechanism of injury. Included patients were then followed through hospital discharge. The 1999 and 2006 scheme criteria were each retrospectively applied to the collected data. The number of patients identified by the two schemes was determined. Patients were considered to have needed a trauma center if they had non-orthopedic surgery within 24 hours, ICU admission, or died. Data were analyzed using descriptive statistics including 95% confidence intervals. Results EMS interviews were conducted for 11,892 patients and outcome data was unavailable for one patient. Average patient age was 48 years; 51% were men. Providers reported bringing 54% of the enrolled patients to the trauma center based on their local trauma protocol. 12% of enrolled patients were identified as needing a trauma center based on medical record review. Use of the 2006 scheme would have resulted in 1,423 fewer patients (12%; 95% CI:11-13%) being identified as needing a trauma center by EMS providers (40%; 95%CI:39-41% versus 28%; 95%CI:27-29%). 1,344 of those patients did not actually need the resources of a trauma center (94%). 78 (6%) of those patients actually needed the resources of a trauma center and would have been under-triaged. Conclusion Use of the

  17. Hard Electromagnetic Processes

    International Nuclear Information System (INIS)

    Richard, F.

    1987-09-01

    Among hard electromagnetic processes, I will use the most recent data and focus on quantitative test of QCD. More specifically, I will retain two items: - hadroproduction of direct photons, - Drell-Yan. In addition, I will briefly discuss a recent analysis of ISR data obtained with AFS (Axial Field Spectrometer) which sheds a new light on the e/π puzzle at low P T

  18. Preventive child health care at elementary school age: The costs of routine assessments with a triage approach.

    Directory of Open Access Journals (Sweden)

    Janine Bezem

    Full Text Available Triage in Preventive Child Health Care (PCH assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6 years and 10/11 years. In a triage approach, PCH assistants conduct pre-assessments to identify children requiring follow-up assessments by a physician or nurse. In the usual approach, all children are assessed by a physician and an assistant (children aged 5/6 years or a nurse (children aged 10/11 years.All the direct costs of conducting routine PCH assessments with the triage and usual approach were assessed using a bottom-up micro-costing approach. In four PCH services in the Netherlands, two using triage and two the usual approach, professionals completed questionnaires about time spent on assessments, including time related to non-attendance at assessments, the referral of children and administration.The projected costs for PCH professionals working on PCH assessments amounted to €5.2 million per cohort of 100,000 children aged 5/6 years in the triage approach, and €7.6 million in the usual approach. The projected costs in both approaches for children aged 10/11 years were about €4 million per 100,000 children.The triage approach to PCH resulted in a projected cost reduction of about one-third, compared with usual practice, for routine assessments by physicians of children aged 5/6 years. There are minimal cost savings in the group of children aged 10/11 years when nurses are involved and so other considerations such as workforce shortages would be required to justify a change to a triage approach. Further research is needed to investigate the differences in costs of care after the completion of the routine assessments.

  19. The Value of Initial Ionized Calcium as a Predictor of Mortality and Triage Tool in Adult Trauma Patients

    OpenAIRE

    Choi, Young Cheol; Hwang, Seong Youn

    2008-01-01

    Ionized hypocalcemia is a common finding in critically ill patients, but the relationship between ionized hypocalcemia and mortality risk in trauma patients has not been well established. The aim of this study was to assess the usefulness of initial ionized calcium (iCa) in predicting mortality in the trauma population, and evaluate its superiority over the three other triage tools: base deficit, systemic inflammatory response syndrome (SIRS) score, and triage-revised trauma score (t-RTS). A ...

  20. War casualties: recent trends in evacuation, triage and the golden hour

    International Nuclear Information System (INIS)

    Safdar, C. A.

    2010-01-01

    Prompt medical treatment and early evacuation is the goal of military medicine in the battlefield. 'Triage' is a process of sorting the casualties according to the severity of injury and the prioritization of treatment. In trauma management 'Golden Hour' is the first sixty minutes or so after injury; this emphasizes that the chances of the victim's survival are the greatest if definitive care is given as early as possible. Our evacuation protocols follow the triage but the time to treatment is beyond sixty minutes. Many Armies have developed evacuation systems which allow the casualty to be seen within this specified time. This has been achieved by streamlining the evacuation chain, extensive incorporation of air transport and training of paramedics in advanced life support measures. In line with the modern trends we need to modernize our own system of casualty evacuation and treatment. (author)

  1. Trauma Quality Improvement: Reducing Triage Errors by Automating the Level Assignment Process.

    Science.gov (United States)

    Stonko, David P; O Neill, Dillon C; Dennis, Bradley M; Smith, Melissa; Gray, Jeffrey; Guillamondegui, Oscar D

    2018-04-12

    Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error. It was conducted as part of the formal undergraduate medical education curriculum at this institution. A QI team was assembled and baseline data were collected, then 2 Plan-Do-Study-Act (PDSA) cycles were implemented sequentially. During the first cycle, a novel web tool was developed and implemented in order to automate the level assignment process (it takes EMS-provided data and automatically determines the level); the tool was based on the existing trauma activation protocol. The second PDSA cycle focused on improving triage accuracy in isolated, less than 10% total body surface area burns, which we identified to be a point of common error. Traumas were reviewed and tabulated at the end of each PDSA cycle, and triage accuracy was followed with a run chart. This study was performed at Vanderbilt University Medical Center and Medical School, which has a large level 1 trauma center covering over 75,000 square miles, and which sees urban, suburban, and rural trauma. The baseline assessment period and each PDSA cycle lasted 2 weeks. During this time, all activated, adult, direct traumas were reviewed. There were 180 patients during the baseline period, 189 after the first test of change, and 150 after the second test of change. All were included in analysis. Of 180 patients, 30 were inappropriately triaged during baseline analysis (3 undertriaged and 27 overtriaged) versus 16 of 189 (3 undertriaged and 13

  2. Emergency Severity Index version 4: a valid and reliable tool in pediatric emergency department triage.

    Science.gov (United States)

    Green, Nicole A; Durani, Yamini; Brecher, Deena; DePiero, Andrew; Loiselle, John; Attia, Magdy

    2012-08-01

    The Emergency Severity Index version 4 (ESI v.4) is the most recently implemented 5-level triage system. The validity and reliability of this triage tool in the pediatric population have not been extensively established. The goals of this study were to assess the validity of ESI v.4 in predicting hospital admission, emergency department (ED) length of stay (LOS), and number of resources utilized, as well as its reliability in a prospective cohort of pediatric patients. The first arm of the study was a retrospective chart review of 780 pediatric patients presenting to a pediatric ED to determine the validity of ESI v.4. Abstracted data included acuity level assigned by the triage nurse using ESI v.4 algorithm, disposition (admission vs discharge), LOS, and number of resources utilized in the ED. To analyze the validity of ESI v.4, patients were divided into 2 groups for comparison: higher-acuity patients (ESI levels 1, 2, and 3) and lower-acuity patients (ESI levels 4 and 5). Pearson χ analysis was performed for categorical variables. For continuous variables, we conducted a comparison of means based on parametric distribution of variables. The second arm was a prospective cohort study to determine the interrater reliability of ESI v.4 among and between pediatric triage (PT) nurses and pediatric emergency medicine (PEM) physicians. Three raters (2 PT nurses and 1 PEM physician) independently assigned triage scores to 100 patients; k and interclass correlation coefficient were calculated among PT nurses and between the primary PT nurses and physicians. In the validity arm, the distribution of ESI score levels among the 780 cases are as follows: ESI 1: 2 (0.25%); ESI 2: 73 (9.4%); ESI 3: 289 (37%); ESI 4: 251 (32%); and ESI 5: 165 (21%). Hospital admission rates by ESI level were 1: 100%, 2: 42%, 3: 14.9%, 4: 1.2%, and 5: 0.6%. The admission rate of the higher-acuity group (76/364, 21%) was significantly greater than the lower-acuity group (4/415, 0.96%), P group was

  3. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S

    2017-01-01

    OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using...... invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. RESULTS: CCTA detects significant (>50...... in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population....

  4. Triage for action: Systematic assessment and dissemination of construction health and safety research.

    Science.gov (United States)

    Baker, Robin; Chang, Charlotte; Bunting, Jessica; Betit, Eileen

    2015-08-01

    Research translation too often relies on passive methods that fail to reach those who can impact the workplace. The need for better research to practice (r2p) approaches is especially pressing in construction, where a disproportionate number of workers suffer serious injury illness. A triage process was designed and used to systematically review completed research, assess r2p readiness, establish priorities, and launch dissemination follow-up efforts. A mixed quantitative and qualitative approach was used. The process proved effective in ensuring that significant findings and evidence-based solutions are disseminated actively. Key factors emerged in the selection of follow-up priorities, including availability of partners able to reach end users, windows of opportunity, and cross-cutting approaches that can benefit multiple dissemination efforts. Use of a systematic triage process may have an important role to play in building r2p capacity in construction safety and health. © 2015 Wiley Periodicals, Inc.

  5. Outcomes of nighttime refusal of admission to the intensive care unit: The role of the intensivist in triage.

    Science.gov (United States)

    Hinds, Nicholas; Borah, Amit; Yoo, Erika J

    2017-06-01

    To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. Retrospective, observational study of patients refused MICU admission at an urban university hospital. Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=.20). Daytime triage refusals were more likely to be staffed by an intensivist (P=.01). After risk-adjustment, daytime refusals had a lower odds of subsequent ICU admission (OR 0.46, 95% CI 0.22-0.95, P=.04) than patients triaged at night. There was no evidence for interaction between time of triage and intensivist staffing of the patient (P=.99). Patients refused MICU admission overnight are more likely to be later admitted to an ICU than patients refused during the day. However, the mechanism for this observation does not appear to depend on the intensivist's direct evaluation of the patient. Further investigation into the clinician-specific effects of ICU triage and identification of potentially modifiable hospital triage practices will help to improve both ICU utilization and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Support to triage and public risk perception considering long-term response to a Cs-137 radiological dispersive device scenario.

    Science.gov (United States)

    Andrade, Cristiane Ps; Souza, Cláudio J; Camerini, Eduardo Sn; Alves, Isabela S; Vital, Hélio C; Healy, Matthew Jf; Ramos De Andrade, Edson

    2018-01-01

    A radiological dispersive device (RDD) spreads radioactive material, complicates the treatment of physical injuries, raises cancer risk, and induces disproportionate fear. Simulating such an event enables more effective and efficient utilization of the triage and treatment resources of staff, facilities, and space. Fast simulation can give detail on events in progress or future events. The resources for triage and treatment of contaminated trauma victims can differ for pure exposure individuals, while discouraging the "worried well" from presenting in the crisis phase by media announcement would relieve pressure on hospital facilities. The proposed methodology integrates capabilities from different platforms in a convergent way composed of three phases: (a) scenario simulation, (b) data generation, and (c) risk assessment for triage focused on follow-up epidemiological assessment. Simulations typically indicate that most of the affected population does not require immediate medical assistance. Medical triage for the few severely injured and the radiological triage to diminish the contamination with radioactivity will always be the priority. For this study, however, higher priorities should be given to individuals from radiological "warm" and "hot" zones as required by risk criteria. The proposed methodology could thus help to (a) filter and reduce the number of individuals to be attended, (b) optimize the prioritization of medical care, (c) reduce or prepare for future costs, (d) effectively locate the operational triage site to avoid possible contamination on the main facility, and (e) provide the scientific data needed to develop an adequate approach to risk and its proper communication.

  7. Extended driving impairs nocturnal driving performances.

    Directory of Open Access Journals (Sweden)

    Patricia Sagaspe

    Full Text Available Though fatigue and sleepiness at the wheel are well-known risk factors for traffic accidents, many drivers combine extended driving and sleep deprivation. Fatigue-related accidents occur mainly at night but there is no experimental data available to determine if the duration of prior driving affects driving performance at night. Participants drove in 3 nocturnal driving sessions (3-5 am, 1-5 am and 9 pm-5 am on open highway. Fourteen young healthy men (mean age [+/-SD] = 23.4 [+/-1.7] years participated Inappropriate line crossings (ILC in the last hour of driving of each session, sleep variables, self-perceived fatigue and sleepiness were measured. Compared to the short (3-5 am driving session, the incidence rate ratio of inappropriate line crossings increased by 2.6 (95% CI, 1.1 to 6.0; P<.05 for the intermediate (1-5 am driving session and by 4.0 (CI, 1.7 to 9.4; P<.001 for the long (9 pm-5 am driving session. Compared to the reference session (9-10 pm, the incidence rate ratio of inappropriate line crossings were 6.0 (95% CI, 2.3 to 15.5; P<.001, 15.4 (CI, 4.6 to 51.5; P<.001 and 24.3 (CI, 7.4 to 79.5; P<.001, respectively, for the three different durations of driving. Self-rated fatigue and sleepiness scores were both positively correlated to driving impairment in the intermediate and long duration sessions (P<.05 and increased significantly during the nocturnal driving sessions compared to the reference session (P<.01. At night, extended driving impairs driving performances and therefore should be limited.

  8. The Role of the Goal in Solving Hard Computational Problems: Do People Really Optimize?

    Science.gov (United States)

    Carruthers, Sarah; Stege, Ulrike; Masson, Michael E. J.

    2018-01-01

    The role that the mental, or internal, representation plays when people are solving hard computational problems has largely been overlooked to date, despite the reality that this internal representation drives problem solving. In this work we investigate how performance on versions of two hard computational problems differs based on what internal…

  9. Incorporation monitoring with triage measurements in Switzerland; Inkorporationsueberwachung mit Triagemessungen in der Schweiz

    Energy Technology Data Exchange (ETDEWEB)

    Elmiger, Raphael [Bundesamt fuer Gesundheit BAG, Liebefeld (Switzerland). Abteilung Strahlenschutz

    2017-08-01

    The actual valid concept of incorporation monitoring in Switzerland was implemented in 1999 with the regulation on personal dosimetry based on the recommendations of an expert group for dosimetry of the Helvetian commission for radiation protection (KSR). IN the sense of an uncomplicated and practical solution for the respective companies it is a two-step monitoring using two different measuring methods: a simplified triage measurement performed by the company and the incorporation measurement by an authorized dosimetry station.

  10. Scope of practice review: providers for triage and assessment of spine-related disorders

    Directory of Open Access Journals (Sweden)

    Boakye O

    2016-05-01

    Full Text Available Omenaa Boakye,1 Arden Birney,1 Esther Suter,1 Leah Adeline Phillips,2 Victoria YM Suen3 1Workforce Research and Evaluation, Alberta Health Services, Calgary, 2College of Licensed Practical Nurses of Alberta, Edmonton, 3Addiction and Mental Health SCN, Alberta Health Services, Edmonton, AB, Canada Purpose: This study explored which health care providers could be involved in centralized intake for patients with nonspecific low back pain to enhance access, continuity, and appropriateness of care. Methods: We reviewed the scope of practice regulations for a range of health care providers. We also conducted telephone interviews with 17 individuals representing ten provincial colleges and regulatory bodies to further understand providers' legislated scopes of practice. Activities relevant to triaging and assessing patients with low back pain were mapped against professionals' scope of practice. Results: Family physicians and nurse practitioners have the most comprehensive scopes and can complete all restricted activities for spine assessment and triage, while the scope of registered nurses and licensed practical nurses are progressively narrower. Chiropractors, occupational therapists, physiotherapists, and athletic therapists are considered experts in musculoskeletal assessments and appear best suited for musculoskeletal specific assessment and triage. Other providers may play a complementary role depending on the individual patient needs. Conclusion: These findings indicate that an interprofessional assessment and triage team that includes allied health professionals would be a feasible option to create a centralized intake model. Implementation of such teams would require removing barriers that currently prevent providers from delivering on their full scope of practice. Keywords: scope of practice review, low back pain, integrated service model, centralized intake, interprofessional team

  11. Ontology-Driven Search and Triage: Design of a Web-Based Visual Interface for MEDLINE.

    Science.gov (United States)

    Demelo, Jonathan; Parsons, Paul; Sedig, Kamran

    2017-02-02

    Diverse users need to search health and medical literature to satisfy open-ended goals such as making evidence-based decisions and updating their knowledge. However, doing so is challenging due to at least two major difficulties: (1) articulating information needs using accurate vocabulary and (2) dealing with large document sets returned from searches. Common search interfaces such as PubMed do not provide adequate support for exploratory search tasks. Our objective was to improve support for exploratory search tasks by combining two strategies in the design of an interactive visual interface by (1) using a formal ontology to help users build domain-specific knowledge and vocabulary and (2) providing multi-stage triaging support to help mitigate the information overload problem. We developed a Web-based tool, Ontology-Driven Visual Search and Triage Interface for MEDLINE (OVERT-MED), to test our design ideas. We implemented a custom searchable index of MEDLINE, which comprises approximately 25 million document citations. We chose a popular biomedical ontology, the Human Phenotype Ontology (HPO), to test our solution to the vocabulary problem. We implemented multistage triaging support in OVERT-MED, with the aid of interactive visualization techniques, to help users deal with large document sets returned from searches. Formative evaluation suggests that the design features in OVERT-MED are helpful in addressing the two major difficulties described above. Using a formal ontology seems to help users articulate their information needs with more accurate vocabulary. In addition, multistage triaging combined with interactive visualizations shows promise in mitigating the information overload problem. Our strategies appear to be valuable in addressing the two major problems in exploratory search. Although we tested OVERT-MED with a particular ontology and document collection, we anticipate that our strategies can be transferred successfully to other contexts.

  12. Validating the implementation of the triage system in an emergency department in a University Hospital

    Directory of Open Access Journals (Sweden)

    Abdulaziz Bin Saeed

    2017-01-01

    Conclusion: The nurses' overall results were below expectations. Statistically significant variables affecting correct categorisation included age, experience, education level and nationality of the nurses. Nurses above the age of 45 years with more years of experience, obtained top scores. Nurses with the highest level of education also scored significantly higher. Filipino nurses scored better than nurses of other nationalities. With the widespread utilisation of triage systems in the region, further studies that evaluate their implementation are needed.

  13. Malware Analysis: From Large-Scale Data Triage to Targeted Attack Recognition (Dagstuhl Seminar 17281)

    OpenAIRE

    Zennou, Sarah; Debray, Saumya K.; Dullien, Thomas; Lakhothia, Arun

    2018-01-01

    This report summarizes the program and the outcomes of the Dagstuhl Seminar 17281, entitled "Malware Analysis: From Large-Scale Data Triage to Targeted Attack Recognition". The seminar brought together practitioners and researchers from industry and academia to discuss the state-of-the art in the analysis of malware from both a big data perspective and a fine grained analysis. Obfuscation was also considered. The meeting created new links within this very diverse community.

  14. ED Triage Process Improvement: Timely Vital Signs for Less Acute Patients.

    Science.gov (United States)

    Falconer, Stella S; Karuppan, Corinne M; Kiehne, Emily; Rama, Shravan

    2018-06-13

    Vital signs can result in an upgrade of patients' Emergency Severity Index (ESI) levels. It is therefore preferable to obtain vital signs early in the triage process, particularly for ESI level 3 patients. Emergency departments have an opportunity to redesign triage processes to meet required protocols while enhancing the quality and experience of care. We performed process analyses to redesign the door-to-vital signs process. We also developed spaghetti diagrams to reconfigure the patient arrival area. The door-to-vital signs time was reduced from 43.1 minutes to 6.44 minutes. Both patients and triage staff seemed more satisfied with the new process. The patient arrival area was less congested and more welcoming. Performing activities in parallel reduces flow time with no additional resources. Staff involvement in process planning, redesign, and control ensures engagement and early buy-in. One should anticipate how changes to one process might affect other processes. Copyright © 2018. Published by Elsevier Inc.

  15. The Sydney Triage to Admission Risk Tool (START): A prospective validation study.

    Science.gov (United States)

    Ebker-White, Anja A; Bein, Kendall J; Dinh, Michael M

    2018-02-08

    The present study aims to prospectively validate the Sydney Triage to Admission Risk Tool (START) to predict ED disposition. This was a prospective validation study at two metropolitan EDs in Sydney, Australia. Consecutive triage encounters were observed by a trained researcher and START scores calculated. The primary outcome was patient disposition (discharge or inpatient admission) from the ED. Multivariable logistic regression was used to estimate area under curve of receiver operator characteristic (AUC ROC) for START scores as well as START score in combination with other variables such as frailty, general practitioner referral, overcrowding and major medical comorbidities. There were 894 patients analysed during the study period. The START score when applied to the data had AUC ROC of 0.80 (95% CI 0.77-0.83). The inclusion of other clinical variables identified at triage did not improve the overall performance of the model with an AUC ROC of 0.81 (95% CI 0.78-0.84) in the present study. The overall performance of the START tool with respect to model discrimination and accuracy has been prospectively validated. Further clinical trials are required to test the clinical effectiveness of the tool in improving patient flow and overall ED performance. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Single-Trial Event-Related Potential Based Rapid Image Triage System

    Directory of Open Access Journals (Sweden)

    Ke Yu

    2011-06-01

    Full Text Available Searching for points of interest (POI in large-volume imagery is a challenging problem with few good solutions. In this work, a neural engineering approach called rapid image triage (RIT which could offer about a ten-fold speed up in POI searching is developed. It is essentially a cortically-coupled computer vision technique, whereby the user is presented bursts of images at a speed of 6–15 images per second and then neural signals called event-related potential (ERP is used as the ‘cue’ for user seeing images of high relevance likelihood. Compared to past efforts, the implemented system has several unique features: (1 it applies overlapping frames in image chip preparation, to ensure rapid image triage performance; (2 a novel common spatial-temporal pattern (CSTP algorithm that makes use of both spatial and temporal patterns of ERP topography is proposed for high-accuracy single-trial ERP detection; (3 a weighted version of probabilistic support-vector-machine (SVM is used to address the inherent unbalanced nature of single-trial ERP detection for RIT. High accuracy, fast learning, and real-time capability of the developed system shown on 20 subjects demonstrate the feasibility of a brainmachine integrated rapid image triage system for fast detection of POI from large-volume imagery.

  17. HARMONIC DRIVE SELECTION

    Directory of Open Access Journals (Sweden)

    Piotr FOLĘGA

    2014-03-01

    Full Text Available The variety of types and sizes currently in production harmonic drive is a problem in their rational choice. Properly selected harmonic drive must meet certain requirements during operation, and achieve the anticipated service life. The paper discusses the problems associated with the selection of the harmonic drive. It also presents the algorithm correct choice of harmonic drive. The main objective of this study was to develop a computer program that allows the correct choice of harmonic drive by developed algorithm.

  18. Testing a videogame intervention to recalibrate physician heuristics in trauma triage: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mohan, Deepika; Rosengart, Matthew R; Fischhoff, Baruch; Angus, Derek C; Farris, Coreen; Yealy, Donald M; Wallace, David J; Barnato, Amber E

    2016-11-11

    Between 30 and 40 % of patients with severe injuries receive treatment at non-trauma centers (under-triage), largely because of physician decision making. Existing interventions to improve triage by physicians ignore the role that intuition (heuristics) plays in these decisions. One such heuristic is to form an initial impression based on representativeness (how typical does a patient appear of one with severe injuries). We created a video game (Night Shift) to recalibrate physician's representativeness heuristic in trauma triage. We developed Night Shift in collaboration with emergency medicine physicians, trauma surgeons, behavioral scientists, and game designers. Players take on the persona of Andy Jordan, an emergency medicine physician, who accepts a new job in a small town. Through a series of cases that go awry, they gain experience with the contextual cues that distinguish patients with minor and severe injuries (based on the theory of analogical encoding) and receive emotionally-laden feedback on their performance (based on the theory of narrative engagement). The planned study will compare the effect of Night Shift with that of an educational program on physician triage decisions and on physician heuristics. Psychological theory predicts that cognitive load increases reliance on heuristics, thereby increasing the under-triage rate when heuristics are poorly calibrated. We will randomize physicians (n = 366) either to play the game or to review an educational program, and will assess performance using a validated virtual simulation. The validated simulation includes both control and cognitive load conditions. We will compare rates of under-triage after exposure to the two interventions (primary outcome) and will compare the effect of cognitive load on physicians' under-triage rates (secondary outcome). We hypothesize that: a) physicians exposed to Night Shift will have lower rates of under-triage compared to those exposed to the educational program

  19. Revisiting the definition of local hardness and hardness kernel.

    Science.gov (United States)

    Polanco-Ramírez, Carlos A; Franco-Pérez, Marco; Carmona-Espíndola, Javier; Gázquez, José L; Ayers, Paul W

    2017-05-17

    An analysis of the hardness kernel and local hardness is performed to propose new definitions for these quantities that follow a similar pattern to the one that characterizes the quantities associated with softness, that is, we have derived new definitions for which the integral of the hardness kernel over the whole space of one of the variables leads to local hardness, and the integral of local hardness over the whole space leads to global hardness. A basic aspect of the present approach is that global hardness keeps its identity as the second derivative of energy with respect to the number of electrons. Local hardness thus obtained depends on the first and second derivatives of energy and electron density with respect to the number of electrons. When these derivatives are approximated by a smooth quadratic interpolation of energy, the expression for local hardness reduces to the one intuitively proposed by Meneses, Tiznado, Contreras and Fuentealba. However, when one combines the first directional derivatives with smooth second derivatives one finds additional terms that allow one to differentiate local hardness for electrophilic attack from the one for nucleophilic attack. Numerical results related to electrophilic attacks on substituted pyridines, substituted benzenes and substituted ethenes are presented to show the overall performance of the new definition.

  20. The Impact of Hard Disk Firmware Steganography on Computer Forensics

    Directory of Open Access Journals (Sweden)

    Iain Sutherland

    2009-06-01

    Full Text Available The hard disk drive is probably the predominant form of storage media and is a primary data source in a forensic investigation. The majority of available software tools and literature relating to the investigation of the structure and content contained within a hard disk drive concerns the extraction and analysis of evidence from the various file systems which can reside in the user accessible area of the disk. It is known that there are other areas of the hard disk drive which could be used to conceal information, such as the Host Protected Area and the Device Configuration Overlay. There are recommended methods for the detection and forensic analysis of these areas using appropriate tools and techniques. However, there are additional areas of a disk that have currently been overlooked.  The Service Area or Platter Resident Firmware Area is used to store code and control structures responsible for the functionality of the drive and for logging failing or failed sectors.This paper provides an introduction into initial research into the investigation and identification of issues relating to the analysis of the Platter Resident Firmware Area. In particular, the possibility that the Platter Resident Firmware Area could be manipulated and exploited to facilitate a form of steganography, enabling information to be concealed by a user and potentially from a digital forensic investigator.

  1. Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication: a mixed methods study.

    Science.gov (United States)

    Gamst-Jensen, Hejdi; Lippert, Freddy K; Egerod, Ingrid

    2017-05-15

    Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark. Explanatory simultaneous mixed method with thematic analysis and descriptive statistics was chosen. The study was carried out in an Out-Of-Hours service (OOH) in the Capital Region of Denmark, Copenhagen. Under-triage was defined as Potentially Under-Triaged Calls (PUTC) by specific criteria to an OOH Hotline, and identification by integration of three databases: Medical Hotline database, Emergency number database, including the Ambulance database, and electronic patient records. Distribution of PUTC were carried out using ICD-10 codes to identify diagnosis and main themes identified by qualitative analysis of audio recorded under-triaged calls. Study period was October 15 th to November 30 th 2014. Three hundred twenty seven PUTC were identified, representing 0.04% of all calls (n = 937.056) to the OOH. Distribution of PUTC according to diagnoses was: digestive (24%), circulatory (19%), respiratory (15%) and all others (42%). Thematic analysis of the voice logs suggested that inadequate communication and non-normative symptom description contributed to under-triage. The incidence of potentially under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem

  2. Hard and Soft Governance

    DEFF Research Database (Denmark)

    Moos, Lejf

    2009-01-01

    of Denmark, and finally the third layer: the leadership used in Danish schools. The use of 'soft governance' is shifting the focus of governance and leadership from decisions towards influence and power and thus shifting the focus of the processes from the decision-making itself towards more focus......The governance and leadership at transnational, national and school level seem to be converging into a number of isomorphic forms as we see a tendency towards substituting 'hard' forms of governance, that are legally binding, with 'soft' forms based on persuasion and advice. This article analyses...... and discusses governance forms at several levels. The first layer is the global: the methods of 'soft governance' that are being utilised by transnational agencies. The second layer is the national and local: the shift in national and local governance seen in many countries, but here demonstrated in the case...

  3. Zirconium nitride hard coatings

    International Nuclear Information System (INIS)

    Roman, Daiane; Amorim, Cintia Lugnani Gomes de; Soares, Gabriel Vieira; Figueroa, Carlos Alejandro; Baumvol, Israel Jacob Rabin; Basso, Rodrigo Leonardo de Oliveira

    2010-01-01

    Zirconium nitride (ZrN) nanometric films were deposited onto different substrates, in order to study the surface crystalline microstructure and also to investigate the electrochemical behavior to obtain a better composition that minimizes corrosion reactions. The coatings were produced by physical vapor deposition (PVD). The influence of the nitrogen partial pressure, deposition time and temperature over the surface properties was studied. Rutherford backscattering spectrometry (RBS), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), scanning electron microscopy (SEM) and corrosion experiments were performed to characterize the ZrN hard coatings. The ZrN films properties and microstructure changes according to the deposition parameters. The corrosion resistance increases with temperature used in the films deposition. Corrosion tests show that ZrN coating deposited by PVD onto titanium substrate can improve the corrosion resistance. (author)

  4. Electric Vehicle - Economical driving

    DEFF Research Database (Denmark)

    Jensen, VCE, Steen V.; Schøn, Henriette

    1999-01-01

    Instruct the reader in getting most satisfaction out of an EV, especially concerning driving and loading.......Instruct the reader in getting most satisfaction out of an EV, especially concerning driving and loading....

  5. Dementia and driving

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000028.htm Dementia and driving To use the sharing features on ... please enable JavaScript. If your loved one has dementia , deciding when they can no longer drive may ...

  6. Janka hardness using nonstandard specimens

    Science.gov (United States)

    David W. Green; Marshall Begel; William Nelson

    2006-01-01

    Janka hardness determined on 1.5- by 3.5-in. specimens (2×4s) was found to be equivalent to that determined using the 2- by 2-in. specimen specified in ASTM D 143. Data are presented on the relationship between Janka hardness and the strength of clear wood. Analysis of historical data determined using standard specimens indicated no difference between side hardness...

  7. Development and implementation of a custom integrated database with dashboards to assist with hematopathology specimen triage and traffic

    Directory of Open Access Journals (Sweden)

    Elizabeth M Azzato

    2014-01-01

    Full Text Available Background: At some institutions, including ours, bone marrow aspirate specimen triage is complex, with hematopathology triage decisions that need to be communicated to downstream ancillary testing laboratories and many specimen aliquot transfers that are handled outside of the laboratory information system (LIS. We developed a custom integrated database with dashboards to facilitate and streamline this workflow. Methods: We developed user-specific dashboards that allow entry of specimen information by technologists in the hematology laboratory, have custom scripting to present relevant information for the hematopathology service and ancillary laboratories and allow communication of triage decisions from the hematopathology service to other laboratories. These dashboards are web-accessible on the local intranet and accessible from behind the hospital firewall on a computer or tablet. Secure user access and group rights ensure that relevant users can edit or access appropriate records. Results: After database and dashboard design, two-stage beta-testing and user education was performed, with the first focusing on technologist specimen entry and the second on downstream users. Commonly encountered issues and user functionality requests were resolved with database and dashboard redesign. Final implementation occurred within 6 months of initial design; users report improved triage efficiency and reduced need for interlaboratory communications. Conclusions: We successfully developed and implemented a custom database with dashboards that facilitates and streamlines our hematopathology bone marrow aspirate triage. This provides an example of a possible solution to specimen communications and traffic that are outside the purview of a standard LIS.

  8. Evaluation of the on-site immunoassay drug-screening device Triage-TOX in routine forensic autopsy.

    Science.gov (United States)

    Tominaga, Mariko; Michiue, Tomomi; Maeda, Hitoshi

    2015-11-01

    Instrumental identification of drugs with quantification is essential in forensic toxicology, while on-site immunoassay urinalysis drug-screening devices conveniently provide preliminary information when adequately used. However, suitable or sufficient urine specimens are not always available. The present study evaluated the efficacy of a new on-site immunoassay drug-screening device Triage-TOX (Alere Inc., San Diego, CA, USA), which has recently been developed to provide objective data on the one-step automated processor, using 51 urine and 19 pericardial fluid samples from 66 forensic autopsy cases, compared with Triage-Drug of Abuse (DOA) and Monitect-9. For benzodiazepines, the positive predictive value and specificity of Triage-TOX were higher than those of Triage-DOA; however, sensitivity was higher with Monitect-9, despite frequent false-positives. The results for the other drugs with the three devices also included a few false-negatives and false-positives. These observations indicate the applicability of Triage-TOX in preliminary drug screening using urine or alternative materials in routine forensic autopsy, when a possible false-negative is considered, especially for benzodiazepines, providing objective information; however, the combined use of another device such as Monitect-9 can help minimize misinterpretation prior to instrumental analysis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Gear bearing drive

    Science.gov (United States)

    Mavroidis, Constantinos (Inventor); Vranish, John M. (Inventor); Weinberg, Brian (Inventor)

    2011-01-01

    A gear bearing drive provides a compact mechanism that operates as an actuator providing torque and as a joint providing support. The drive includes a gear arrangement integrating an external rotor DC motor within a sun gear. Locking surfaces maintain the components of the drive in alignment and provide support for axial loads and moments. The gear bearing drive has a variety of applications, including as a joint in robotic arms and prosthetic limbs.

  10. Antihistamines and driving safety.

    Science.gov (United States)

    O'Hanlon, J F

    1988-10-27

    The results of two placebo-controlled driving performance studies confirm laboratory data showing that the nonsedating antihistamine terfenadine does not influence the driving performance of users. The amplitude of vehicle weaving calculated for drivers who received this agent did not differ from control values. Neither terfenadine nor loratadine, another nonsedating antihistamine, potentiated the adverse effects of alcohol on driving performance.

  11. Driving After a Stroke

    Science.gov (United States)

    ... 23,2015 Can I drive after a stroke? Driving is often a major concern after someone has a stroke. It’s not unusual for stroke survivors to want to drive. Being able to get around after a stroke is important. Safety behind the wheel is even more important after ...

  12. Sequential Dependencies in Driving

    Science.gov (United States)

    Doshi, Anup; Tran, Cuong; Wilder, Matthew H.; Mozer, Michael C.; Trivedi, Mohan M.

    2012-01-01

    The effect of recent experience on current behavior has been studied extensively in simple laboratory tasks. We explore the nature of sequential effects in the more naturalistic setting of automobile driving. Driving is a safety-critical task in which delayed response times may have severe consequences. Using a realistic driving simulator, we find…

  13. Simple Driving Techniques

    DEFF Research Database (Denmark)

    Rosendahl, Mads

    2002-01-01

    -like language. Our aim is to extract a simple notion of driving and show that even in this tamed form it has much of the power of more general notions of driving. Our driving technique may be used to simplify functional programs which use function composition and will often be able to remove intermediate data...

  14. TIA triage in emergency department using acute MRI (TIA-TEAM): a feasibility and safety study.

    Science.gov (United States)

    Vora, Nirali; Tung, Christie E; Mlynash, Michael; Garcia, Madelleine; Kemp, Stephanie; Kleinman, Jonathan; Zaharchuk, Greg; Albers, Gregory; Olivot, Jean-Marc

    2015-04-01

    Positive diffusion weighted imaging (DWI) on MRI is associated with increased recurrent stroke risk in TIA patients. Acute MRI aids in TIA risk stratification and diagnosis. To evaluate the feasibility and safety of TIA triage directly from the emergency department (ED) with acute MRI and neurological consultation. Consecutive ED TIA patients assessed by a neurologist underwent acute MRI/MRA of head/neck per protocol and were hospitalized if positive DWI, symptomatic vessel stenosis, or per clinical judgment. Stroke neurologist adjudicated the final TIA diagnosis as definite, possible, or not a cerebrovascular event. Stroke recurrence rates were calculated at 7, 90, 365 days and compared with predicted stroke rates derived from historical DWI and ABCD(2) score data. One hundred twenty-nine enrolled patients had a mean age of 69 years (± 17) and median ABCD(2) score of 3 (interquartile range [IQR] 3-4). During triage, 112 (87%) patients underwent acute MRI after a median of 16 h (IQR 10-23) from symptom onset. No patients experienced a recurrent event before imaging. Twenty-four (21%) had positive DWI and 8 (7%) had symptomatic vessel stenosis. Of the total cohort, 83 (64%) were discharged and 46 (36%) were hospitalized. By one-year follow-up, one patient in each group had experienced a stroke. Of 92 patients with MRI and index cerebrovascular event, recurrent stroke rates were 1.1% at 7 and 90 days. These were similar to predicted recurrence rates. TIA triage in the ED using a protocol with neurological consultation and acute MRI is feasible and safe. The majority of patients were discharged without hospitalization and rates of recurrent stroke were not higher than predicted. © 2014 World Stroke Organization.

  15. Pain assessment by emergency nurses at triage in the emergency department: A qualitative study.

    Science.gov (United States)

    Vuille, Marilène; Foerster, Maryline; Foucault, Eliane; Hugli, Olivier

    2018-02-01

    To investigate the assessment of pain intensity in the specific context of triage. Acute pain affects most patients admitted to emergency departments, but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management. According to good practice guidelines, clinicians must accept a patient's statement, regardless of their own opinions. A qualitative methodology rooted in interactionist sociology and on the Grounded theory was used to provide an opportunity to uncover complex decision-making processes, such as those involved in assessing pain. A sociologist conducted semi-structured interviews during the 2013-2014 winter months with twelve nurses and trained in the use of an established protocol, focusing on the assessment of pain intensity. The interviews were recorded, fully transcribed and analysed. The most frequently used pain scale was the Verbal Numerical Rating Scale. Discrepancies between self-assessment and evaluation by a nurse were common. To restore congruence between the two, nurses used various tactics, such as using different definitions of the high-end anchor of the scale, providing additional explanations about the scale, or using abnormal vital signs or the acceptance of morphine as a proof of the validity of severe pain ratings. Nurses cannot easily suspend their own judgement. Their tactics do not express a lack of professionalism, but are consistent with the logic of professional intervention. This article presents triage nurses' reality in a time-pressured environment, and understanding this conflict may outline new educational targets to further improve pain management in ED. © 2017 John Wiley & Sons Ltd.

  16. Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service.

    Science.gov (United States)

    Bath, Brenna; Janzen, Bonnie

    2012-01-01

    To evaluate participant and referring care provider satisfaction associated with a spinal triage assessment service delivered by physiotherapists in collaboration with orthopedic surgeons. People with low back-related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists. Measures of patient and provider satisfaction were completed at approximately 4 weeks after the assessment. The satisfaction surveys were analyzed quantitatively with descriptive statistics and qualitatively with an inductive thematic approach of open and axial coding. A total of 108/115 participants completed the posttest satisfaction survey. Sixty-six percent of participants were "very satisfied" with the service and 55% were "very satisfied" with the recommendations that were made. Only 18% of referring care providers completed the satisfaction survey and 90.5% of those were "very satisfied" with the recommendations. Sixty-one participants and 14 care providers provided comments which revealed a diverse range of themes which were coded into positive (ie, understanding the problem, communication, customer service, efficiency, and management direction), negative (ie, lack of detail, time to follow-up, cost) and neutral related to the triage service, and an "other" category unrelated to the service (ie, chronic symptoms, comorbidities, and limited access to health care.) The quantitative results of the participant survey demonstrated very high levels of satisfaction with the service and slightly less satisfaction with the recommendations that were made. Satisfaction of referring care providers with the recommendations and report was also high, but given the low response rate, these results should be interpreted with caution. Qualitative analysis of participant and provider comments revealed a diverse range of themes. These other issues may be important contextual factors that have the potential to impact patient relevant outcomes.

  17. Biological dosimetry by the triage dicentric chromosome assay - Further validation of international networking

    Energy Technology Data Exchange (ETDEWEB)

    Wilkins, Ruth C., E-mail: Ruth.Wilkins@hc-sc.gc.ca [Health Canada, Ottawa, ON K1A 0K9 (Canada); Romm, Horst; Oestreicher, Ursula [Bundesamt fur Strahlenschutz, 38226 Salzgitter (Germany); Marro, Leonora [Health Canada, Ottawa, ON K1A 0K9 (Canada); Yoshida, Mitsuaki A. [Biological Dosimetry Section, Dept. of Dose Assessment, Research Center for Radiation Emergency Medicine, NIRS, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 (Japan); Department Radiation Biology, Institute of Radiation Emergency Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, Aomori 036-8564 (Japan); Suto, Y. [Biological Dosimetry Section, Dept. of Dose Assessment, Research Center for Radiation Emergency Medicine, NIRS, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555 (Japan); Prasanna, Pataje G.S. [National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program, 6130 Executive Blvd., MSC 7440, Bethesda, MD 20892-7440 (United States)

    2011-09-15

    Biological dosimetry is an essential tool for estimating radiation doses received to personnel when physical dosimetry is not available or inadequate. The current preferred biodosimetry method is based on the measurement of radiation-specific dicentric chromosomes in exposed individuals' peripheral blood lymphocytes. However, this method is labor-, time- and expertise-demanding. Consequently, for mass casualty applications, strategies have been developed to increase its throughput. One such strategy is to develop validated cytogenetic biodosimetry laboratory networks, both national and international. In a previous study, the dicentric chromosome assay (DCA) was validated in our cytogenetic biodosimetry network involving five geographically dispersed laboratories. A complementary strategy to further enhance the throughput of the DCA among inter-laboratory networks is to use a triage DCA where dose assessments are made by truncating the labor-demanding and time-consuming metaphase spread analysis to 20 - 50 metaphase spreads instead of routine 500 - 1000 metaphase spread analysis. Our laboratory network also validated this triage DCA, however, these dose estimates were made using calibration curves generated in each laboratory from the blood samples irradiated in a single laboratory. In an emergency situation, dose estimates made using pre-existing calibration curves which may vary according to radiation type and dose rate and therefore influence the assessed dose. Here, we analyze the effect of using a pre-existing calibration curve on assessed dose among our network laboratories. The dose estimates were made by analyzing 1000 metaphase spreads as well as triage quality scoring and compared to actual physical doses applied to the samples for validation. The dose estimates in the laboratory partners were in good agreement with the applied physical doses and determined to be adequate for guidance in the treatment of acute radiation syndrome.

  18. Sample triage : an overview of Environment Canada's program

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, P.; Goldthorp, M.; Fingas, M. [Environment Canada, Ottawa, ON (Canada). Emergencies Science and Technology Division, Environmental Technology Centre, Science and Technology Branch

    2006-07-01

    The Chemical, biological and radiological/nuclear Research and Technology Initiative (CRTI) is a program led by Canada's Department of National Defence in an effort to improve the capability of providing technical and analytical support in the event of a terrorist-related event. This paper summarized the findings from the CRTI Sample Triage Working Group and reviewed information on Environment Canada's triage program and its' mobile sample inspection facility that was designed to help examine samples of hazardous materials in a controlled environment to minimize the risk of exposure. A sample triage program is designed to deal with administrative, health and safety issues by facilitating the safe transfer of samples to an analytical laboratory. It refers to the collation of all results including field screening information, intelligence and observations for the purpose of prioritizing and directing the sample to the appropriate laboratory for analysis. A central component of Environment Canada's Emergency Response Program has been its capacity to respond on site during an oil or chemical spill. As such, the Emergencies Science and Technology Division has acquired a new mobile sample inspection facility in 2004. It is constructed to work with a custom designed decontamination unit and Ford F450 tow vehicle. The criteria and general design of the trailer facility was described. This paper also outlined the steps taken following a spill of hazardous materials into the environment so that potentially dangerous samples could be safety assessed. Several field trials will be carried out in order to develop standard operating procedures for the mobile sample inspection facility. 6 refs., 6 figs., 4 appendices.

  19. Improving Staff Communication and Transitions of Care Between Obstetric Triage and Labor and Delivery.

    Science.gov (United States)

    O'Rourke, Kathleen; Teel, Joseph; Nicholls, Erika; Lee, Daniel D; Colwill, Alyssa Covelli; Srinivas, Sindhu K

    2018-03-01

    To improve staff perception of the quality of the patient admission process from obstetric triage to the labor and delivery unit through standardization. Preassessment and postassessment online surveys. A 13-bed labor and delivery unit in a quaternary care, Magnet Recognition Program, academic medical center in Pennsylvania. Preintervention (n = 100), postintervention (n = 52), and 6-month follow-up survey respondents (n = 75) represented secretaries, registered nurses, surgical technicians, certified nurse-midwives, nurse practitioners, maternal-fetal medicine fellows, anesthesiologists, and obstetric and family medicine attending and resident physicians from triage and labor and delivery units. We educated staff and implemented interventions, an admission huddle and safety time-out whiteboard, to standardize the admission process. Participants were evaluated with the use of preintervention, postintervention, and 6-month follow-up surveys about their perceptions regarding the admission process. Data tracked through the electronic medical record were used to determine compliance with the admission huddle and whiteboards. A 77% reduction (decrease of 49%) occurred in the perception of incomplete patient admission processes from baseline to 6-month follow-up after the intervention. Postintervention and 6-month follow-up survey results indicated that 100% of respondents responded strongly agree/agree/neutral that the new admission process improved communication surrounding care for patients. Data in the electronic medical record indicated that compliance with use of admission huddles and whiteboards increased from 50% to 80% by 6 months. The new patient admission process, including a huddle and safety time-out board, improved staff perception of the quality of admission from obstetric triage to the labor and delivery unit. Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  20. Hard processes. Vol. 1

    International Nuclear Information System (INIS)

    Ioffe, B.L.; Khoze, V.A.; Lipatov, L.N.

    1984-01-01

    Deep inelastic (hard) processes are now at the epicenter of modern high-energy physics. These processes are governed by short-distance dynamics, which reveals the intrinsic structure of elementary particles. The theory of deep inelastic processes is now sufficiently well settled. The authors' aim was to give an effective tool to theoreticians and experimentalists who are engaged in high-energy physics. This book is intended primarily for physicists who are only beginning to study the field. To read the book, one should be acquainted with the Feynman diagram technique and with some particular topics from elementary particle theory (symmetries, dispersion relations, Regge pole theory, etc.). Theoretical consideration of deep inelastic processes is now based on quantum chromodynamics (QCD). At the same time, analysis of relevant physical phenomena demands a synthesis of QCD notions (quarks, gluons) with certain empirical characteristics. Therefore, the phenomenological approaches presented are a necessary stage in a study of this range of phenomena which should undoubtedly be followed by a detailed description based on QCD and electroweak theory. The authors were naturally unable to dwell on experimental data accumulated during the past decade of intensive investigations. Priority was given to results which allow a direct comparison with theoretical predictions. (Auth.)

  1. Hard coal; Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Loo, Kai van de; Sitte, Andreas-Peter [Gesamtverband Steinkohle e.V. (GVSt), Herne (Germany)

    2015-07-01

    International the coal market in 2014 was the first time in a long time in a period of stagnation. In Germany, the coal consumption decreased even significantly, mainly due to the decrease in power generation. Here the national energy transition has now been noticable affected negative for coal use. The political guidances can expect a further significant downward movement for the future. In the present phase-out process of the German hard coal industry with still three active mines there was in 2014 no decommissioning. But the next is at the end of 2015, and the plans for the time after mining have been continued. [German] International war der Markt fuer Steinkohle 2014 erstmals seit langem wieder von einer Stagnation gekennzeichnet. In Deutschland ging der Steinkohlenverbrauch sogar deutlich zurueck, vor allem wegen des Rueckgangs in der Stromerzeugung. Hier hat sich die nationale Energiewende nun spuerbar und fuer die Steinkohlennutzung negativ ausgewirkt. Die politischen Weichenstellungen lassen fuer die Zukunft eine weitere erhebliche Abwaertsbewegung erwarten. Bei dem im Auslaufprozess befindlichen deutschen Steinkohlenbergbau mit noch drei aktiven Bergwerken gab es 2014 keine Stilllegung. Doch die naechste steht zum Jahresende 2015 an, und die Planungen fuer die Zeit nach dem Bergbau sind fortgefuehrt worden.

  2. Biological dosimetry intercomparison exercise: an evaluation of Triage and routine mode results by robust methods

    International Nuclear Information System (INIS)

    Di Giorgio, M.; Vallerga, M.B.; Radl, A.; Taja, M.R.; Barquinero, J.F.; Seoane, A.; De Luca, J.; Guerrero Carvajal, Y.C.; Stuck Oliveira, M.S.; Valdivia, P.; García Lima, O.; Lamadrid, A.; González Mesa, J.; Romero Aguilera, I.; Mandina Cardoso, T.; Arceo Maldonado, C.; Espinoza, M.E.; Martínez López, W.; Lloyd, D.C.; Méndez Acuña, L.; Di Tomaso, M.V.; Roy, L.; Lindholm, C.; Romm, H.; Güçlü, I.

    2011-01-01

    Well-defined protocols and quality management standards are indispensable for biological dosimetry laboratories. Participation in periodic proficiency testing by interlaboratory comparisons is also required. This harmonization is essential if a cooperative network is used to respond to a mass casualty event. Here we present an international intercomparison based on dicentric chromosome analysis for dose assessment performed in the framework of the IAEA Regional Latin American RLA/9/054 Project. The exercise involved 14 laboratories, 8 from Latin America and 6 from Europe. The performance of each laboratory and the reproducibility of the exercise were evaluated using robust methods described in ISO standards. The study was based on the analysis of slides from samples irradiated with 0.75 (DI) and 2.5 Gy (DII). Laboratories were required to score the frequency of dicentrics and convert them to estimated doses, using their own dose-effect curves, after the analysis of 50 or 100 cells (triage mode) and after conventional scoring of 500 cells or 100 dicentrics. In the conventional scoring, at both doses, all reported frequencies were considered as satisfactory, and two reported doses were considered as questionable. The analysis of the data dispersion among the dicentric frequencies and among doses indicated a better reproducibility for estimated doses (15.6% for DI and 8.8% for DII) than for frequencies (24.4% for DI and 11.4% for DII), expressed by the coefficient of variation. In the two triage modes, although robust analysis classified some reported frequencies or doses as unsatisfactory or questionable, all estimated doses were in agreement with the accepted error of ±0.5 Gy. However, at the DI dose and for 50 scored cells, 5 out of the 14 reported confidence intervals that included zero dose and could be interpreted as false negatives. This improved with 100 cells, where only one confidence interval included zero dose. At the DII dose, all estimations fell within

  3. Implementing RFID technology in a novel triage system during a simulated mass casualty situation.

    Science.gov (United States)

    Jokela, Jorma; Simons, Tomi; Kuronen, Pentti; Tammela, Juha; Jalasvirta, Pertti; Nurmi, Jouni; Harkke, Ville; Castrén, Maaret

    2008-01-01

    The purpose of this study is to determine the applicability of Radio Frequency Identification (RFID) technology and commercial cellular networks to provide an online triage system for handling mass casualty situations. This was tested by a using a pilot system for a simulated mass casualty situation during a military field exercise. The system proved to be usable. Compared to the currently used system, it also dramatically improves the general view of mass casualty situations and enhances medical emergency readiness in a military medical setting. The system can also be adapted without any difficulties by the civilian sector for the management of mass casualty disasters.

  4. Creation and Delphi-method refinement of pediatric disaster triage simulations.

    Science.gov (United States)

    Cicero, Mark X; Brown, Linda; Overly, Frank; Yarzebski, Jorge; Meckler, Garth; Fuchs, Susan; Tomassoni, Anthony; Aghababian, Richard; Chung, Sarita; Garrett, Andrew; Fagbuyi, Daniel; Adelgais, Kathleen; Goldman, Ran; Parker, James; Auerbach, Marc; Riera, Antonio; Cone, David; Baum, Carl R

    2014-01-01

    There is a need for rigorously designed pediatric disaster triage (PDT) training simulations for paramedics. First, we sought to design three multiple patient incidents for EMS provider training simulations. Our second objective was to determine the appropriate interventions and triage level for each victim in each of the simulations and develop evaluation instruments for each simulation. The final objective was to ensure that each simulation and evaluation tool was free of bias toward any specific PDT strategy. We created mixed-methods disaster simulation scenarios with pediatric victims: a school shooting, a school bus crash, and a multiple-victim house fire. Standardized patients, high-fidelity manikins, and low-fidelity manikins were used to portray the victims. Each simulation had similar acuity of injuries and 10 victims. Examples include children with special health-care needs, gunshot wounds, and smoke inhalation. Checklist-based evaluation tools and behaviorally anchored global assessments of function were created for each simulation. Eight physicians and paramedics from areas with differing PDT strategies were recruited as Subject Matter Experts (SMEs) for a modified Delphi iterative critique of the simulations and evaluation tools. The modified Delphi was managed with an online survey tool. The SMEs provided an expected triage category for each patient. The target for modified Delphi consensus was ≥85%. Using Likert scales and free text, the SMEs assessed the validity of the simulations, including instances of bias toward a specific PDT strategy, clarity of learning objectives, and the correlation of the evaluation tools to the learning objectives and scenarios. After two rounds of the modified Delphi, consensus for expected triage level was >85% for 28 of 30 victims, with the remaining two achieving >85% consensus after three Delphi iterations. To achieve consensus, we amended 11 instances of bias toward a specific PDT strategy and corrected 10

  5. Melting of polydisperse hard disks

    NARCIS (Netherlands)

    Pronk, S.; Frenkel, D.

    2004-01-01

    The melting of a polydisperse hard-disk system is investigated by Monte Carlo simulations in the semigrand canonical ensemble. This is done in the context of possible continuous melting by a dislocation-unbinding mechanism, as an extension of the two-dimensional hard-disk melting problem. We find

  6. The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

    Directory of Open Access Journals (Sweden)

    Stephane T. Tshitenge

    2016-07-01

    Full Text Available Background: The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS tool at the Mahalapye District Hospital - Emergency Department (MDH-ED, a setting where the majority of the nurses were not formally trained on the use of the SATS. Methods: This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage. Results: From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green, 146 (46% and 125 (40%, respectively, or in the urgent category (yellow, they assigned 140 (44% and 111 (35% cases, respectively.Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5, although the level of agreement was satisfactory. Conclusion: Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6.

  7. Using novel biomarkers to triage young adult women with minor cervical lesions: a cost-effectiveness analysis.

    Science.gov (United States)

    Pedersen, K; Sørbye, S W; Kristiansen, I S; Burger, E A

    2017-02-01

    To evaluate the short-term consequences and cost-effectiveness associated with the use of novel biomarkers to triage young adult women with minor cervical cytological lesions. Model-based economic evaluation using primary epidemiological data from Norway, supplemented with data from European and American clinical trials. Organised cervical cancer screening in Norway. Women aged 25-33 years with minor cervical cytological lesions detected at their primary screening test. We expanded an existing simulation model to compare 12 triage strategies involving alternative biomarkers (i.e. reflex human papillomavirus (HPV) DNA/mRNA testing, genotyping, and dual staining) with the current Norwegian triage guidelines. The number of high-grade precancers detected and resource use (e.g. monetary costs and colposcopy referrals) for a single screening round (3 years) for each triage strategy. Cost-efficiency, defined as the additional cost per additional precancer detected of each strategy compared with the next most costly strategy. Five strategies were identified as cost-efficient, and are projected to increase the precancer detection rate between 18 and 57%, compared with current guidelines; however, the strategies did not uniformly require additional resources. Strategies involving HPV mRNA testing required fewer resources, whereas HPV DNA-based strategies detected >50% more precancers, but were more costly and required twice as many colposcopy referrals compared with the current guidelines. Strategies involving biomarkers to triage younger women with minor cervical cytological lesions have the potential to detect additional precancers, yet the optimal strategy depends on the resources available as well as decision-makers' and women's acceptance of additional screening procedures. Women with minor cervical lesions may be triaged more accurately and effectively using novel biomarkers. © 2016 Royal College of Obstetricians and Gynaecologists.

  8. Measurements in the Addictions for Triage and Evaluation (MATE): an instrument based on the World Health Organization family of international classifications

    NARCIS (Netherlands)

    Schippers, Gerard M.; Broekman, Theo G.; Buchholz, Angela; Koeter, Maarten W. J.; van den Brink, Wim

    2010-01-01

    Aims To present and evaluate a measurement tool for assessing characteristics of people with drug and/or alcohol problems for triage and evaluation in treatment. Measurements in the Addictions for Triage and Evaluation (MATE) is composed of 10 modules, selected on the basis of a detailed set of

  9. Processed Apple Product Marketing Analysis: Hard Cider and Apple Wine

    OpenAIRE

    Rowles, Kristin

    2000-01-01

    Hard cider and apple wine offer new value-added marketing opportunities to the apple industry. Both products are situated in rapidly growing categories of the beverage industry. The development of effective marketing strategies for these products requires an understanding of the forces driving competition in these markets. This paper provides background information to support competitive analysis and strategy development. Development of these markets will be positive for the apple industry, b...

  10. A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service

    Directory of Open Access Journals (Sweden)

    Crespo de Carvalho J

    2013-12-01

    Full Text Available José Crespo de Carvalho,1 Madalena Ramos,1 Carina Paixão2 1Business School, University Institute of Lisbon, Lisbon, Portugal; 2Instituto Português de Oncologia, Lisbon, Portugal Abstract: Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination. The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed 'remote' triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking

  11. Reading characteristics of deaf and hard-of-hearing pupils

    Directory of Open Access Journals (Sweden)

    Karić Jasmina

    2012-01-01

    Full Text Available Background/Aim. Speech motor mechanisms play a crucial role in the process of demutization, due to the fact that they cover all the elements of the successive development of spech production movements leading to speech formation (socalled kinesthesia in speach. The aim of this study was to estimate the impact of perceptual motor actions on the cognitive process of reading in 130 students in regular schools and schools for the deaf and hard-of-hearing children in the Republic of Serbia. Methods. Kostić and Vladisavljević test consisted of the ten levels weight was used for the assessment of reading speed. To assess understanding of text read by verbal responses, we used three-dimensional adapted reading test of Helene Sax. Results. The triage-articulation test for assessing reading speed (Kostić and Vladisavljević’s test according to the weight of ten levels, revealed that students in regular schools statistically significantly faster read texts as compared to the deaf students. The results of the threedimensional adapted reading test of Helena Sax, show that the words learned by deaf children exist in isolation in their mind, ie, if there is no standard of acoustic performance for graphic image, in deaf child every word, printed or written, is just the sum of letters without meaning. Conclusion. There is a significant difference in text reading speed and its understanding among the children who hear and the deaf and hard of-hearing children. It is essential that in deaf and heard-of hearing children education, apart from the development of speech, parallelly use the concept of semantic processing in order to get each word by the fullness of its content and the possibility of expanding its meaning in a variety of assets.

  12. [Reading characteristics of deaf and hard-of-hearing pupils].

    Science.gov (United States)

    Karić, Jasmina; Ristić, Sinisa; Medenica, Snezana; Tadić, Vaska; Slavnić, Svetlana

    2012-10-01

    Speech motor mechanisms play a crucial role in the process of demutization, due to the fact that they cover all the elements of the successive development of spech production movements leading to speech formation (so-called kinesthesia in speach). The aim of this study was to estimate the impact of perceptual motor actions on the cognitive process of reading in 130 students in regular schools and schools for the deaf and hard-of-hearing children in the Republic of Serbia. Kostić and Vladisavljević test consisted of the ten levels weight was used for the assessment of reading speed. To assess understanding of text read by verbal responses, we used three-dimensional adapted reading test of Helene Sax. The triage-articulation test for assessing reading speed (Kostié and Vladisavljević's test according to the weight of ten levels, revealed that students in regular schools statistically significantly faster read texts as compared to the deaf students. The results of the three-dimensional adapted reading test of Helena Sax, show that the words learned by deaf children exist in isolation in their mind, i.e., if there is no standard of acoustic performance for graphic image, in deaf child every word, printed or written, is just the sum of letters without meaning. There is a significant difference in text reading speed and its understanding among the children who hear and the deaf and hard-of-hearing children. It is essential that in deaf and heard-of-hearing children education, apart from the development of speech, parallelly use the concept of semantic processing in order to get each word by the fullness of its content and the possibility of expanding its meaning in a variety of assets.

  13. Control rod drive

    International Nuclear Information System (INIS)

    Okutani, Tetsuro.

    1988-01-01

    Purpose: To provide a simple and economical control rod drive using a control circuit requiring no pulse circuit. Constitution: Control rods in a BWR type reactor are driven by hydraulic pressure and inserted or withdrawn in the direction of applying the hydraulic pressure. The direction of the hydraulic pressure is controlled by a direction control valve. Since the driving for the control rod is extremely important in view of the operation, a self diagnosis function is disposed for rapid inspection of possible abnormality. In the present invention, two driving contacts are disposed each by one between the both ends of a solenoid valve of the direction control valve for driving the control rod and the driving power source, and diagnosis is conducted by alternately operating them. Therefore, since it is only necessary that the control circuit issues a driving instruction only to one of the two driving contacts, the pulse circuit is no more required. Further, since the control rod driving is conducted upon alignment of the two driving instructions, the reliability of the control rod drive can be improved. (Horiuchi, T.)

  14. High laboratory cost predicted per tuberculosis case diagnosed with increased case finding without a triage strategy.

    Science.gov (United States)

    Dunbar, R; Naidoo, P; Beyers, N; Langley, I

    2017-09-01

    Cape Town, South Africa. To model the effects of increased case finding and triage strategies on laboratory costs per tuberculosis (TB) case diagnosed. We used a validated operational model and published laboratory cost data. We modelled the effect of varying the proportion with TB among presumptive cases and Xpert cartridge price reductions on cost per TB case and per additional TB case diagnosed in the Xpert-based vs. smear/culture-based algorithms. In our current scenario (18.3% with TB among presumptive cases), the proportion of cases diagnosed increased by 8.7% (16.7% vs. 15.0%), and the cost per case diagnosed increased by 142% (US$121 vs. US$50). The cost per additional case diagnosed was US$986. This would increase to US$1619 if the proportion with TB among presumptive cases was 10.6%. At 25.9-30.8% of TB prevalence among presumptive cases and a 50% reduction in Xpert cartridge price, the cost per TB case diagnosed would range from US$50 to US$59 (comparable to the US$48.77 found in routine practice with smear/culture). The operational model illustrates the effect of increased case finding on laboratory costs per TB case diagnosed. Unless triage strategies are identified, the approach will not be sustainable, even if Xpert cartridge prices are reduced.

  15. A technician-delivered 'virtual clinic' for triaging low-risk glaucoma referrals.

    Science.gov (United States)

    Kotecha, A; Brookes, J; Foster, P J

    2017-06-01

    PurposeThe purpose of this study is to describe the outcomes of a technician-delivered glaucoma referral triaging service with 'virtual review' of resultant data by a consultant ophthalmologist.Patients and methodsThe Glaucoma Screening Clinic reviewed new optometrist or GP-initiated glaucoma suspect referrals into a specialist ophthalmic hospital. Patients underwent testing by three ophthalmic technicians in a dedicated clinical facility. Data were reviewed at a different time and date by a consultant glaucoma ophthalmologist. Approximately 10% of discharged patients were reviewed in a face-to-face consultant-led clinic to examine the false-negative rate of the service.ResultsBetween 1 March 2014 and 31 March 2016, 1380 patients were seen in the clinic. The number of patients discharged following consultant virtual review was 855 (62%). The positive predictive value of onward referrals was 84%. Three of the 82 patients brought back for face-to-face review were deemed to require treatment, equating to negative predictive value of 96%.ConclusionsOur technician-delivered glaucoma referral triaging clinic incorporates consultant 'virtual review' to provide a service model that significantly reduces the number of onward referrals into the glaucoma outpatient department. This model may be an alternative to departments where there are difficulties in implementing optometrist-led community-based referral refinement schemes.

  16. Is a mobile emergency severity index (ESI) triage better than the paper ESI?

    Science.gov (United States)

    Savatmongkorngul, Sorravit; Yuksen, Chaiyaporn; Suwattanasilp, Chanakarn; Sawanyawisuth, Kittisak; Sittichanbuncha, Yuwares

    2017-12-01

    This study aims to evaluate the mobile emergency severity index (ESI) tool in terms of validity compared with the original ESI triage. The original ESI and mobile ESI were used with patients at the Department of Emergency Medicine, Ramathibodi Hospital, Thailand. Eligible patients were evaluated by sixth-year medical students/emergency physicians using either the original or mobile ESI. The ESI results for each patient were compared with the standard ESI. Concordance and kappa statistics were calculated for pairs of the evaluators. There were 486 patients enrolled in the study; 235 patients (48.4%) were assessed using the mobile ESI, and 251 patients (51.6%) were in the original ESI group. The baseline characteristics of patients in both groups were mostly comparable except for the ED visit time. The percentages of concordance and kappa statistics in the original ESI group were lower than in the mobile group in all three comparisons (medical students vs gold standard, emergency physicians vs gold standard, and medical students vs emergency physicians). The highest kappa in the original ESI group is 0.69, comparing emergency physicians vs gold standard, while the lowest kappa in the application group is 0.84 comparing the medical students vs gold standard. Both medical students and emergency physicians are more confident with the mobile ESI application triage. In conclusion, the mobile ESI has better inter-rater reliability, and is more user-friendly than the original paper form.

  17. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    Science.gov (United States)

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

  18. Hardness variability in commercial technologies

    International Nuclear Information System (INIS)

    Shaneyfelt, M.R.; Winokur, P.S.; Meisenheimer, T.L.; Sexton, F.W.; Roeske, S.B.; Knoll, M.G.

    1994-01-01

    The radiation hardness of commercial Floating Gate 256K E 2 PROMs from a single diffusion lot was observed to vary between 5 to 25 krad(Si) when irradiated at a low dose rate of 64 mrad(Si)/s. Additional variations in E 2 PROM hardness were found to depend on bias condition and failure mode (i.e., inability to read or write the memory), as well as the foundry at which the part was manufactured. This variability is related to system requirements, and it is shown that hardness level and variability affect the allowable mode of operation for E 2 PROMs in space applications. The radiation hardness of commercial 1-Mbit CMOS SRAMs from Micron, Hitachi, and Sony irradiated at 147 rad(Si)/s was approximately 12, 13, and 19 krad(Si), respectively. These failure levels appear to be related to increases in leakage current during irradiation. Hardness of SRAMs from each manufacturer varied by less than 20%, but differences between manufacturers are significant. The Qualified Manufacturer's List approach to radiation hardness assurance is suggested as a way to reduce variability and to improve the hardness level of commercial technologies

  19. Friction degradation and set-up effects in hard clays offshore Congo and Angola

    International Nuclear Information System (INIS)

    Colliat, J.L.; Vergobbi, P.; Puech, A.

    1993-01-01

    Piles driven into stiff to hard clays encountered offshore Congo and Angola clearly show both clay-type effects which are (1) friction degradation, with very low driving resistances during continuous driving, and (2) set-up after driving interruptions. Both phenomena were studied by back-analysis of driving records, including results of pile driving monitoring. It allowed one to deduce the friction distribution along the piles during driving; show how the shaft friction at any depth reduces as the pile is driven further into the ground; and show that the shaft friction after driving delays can be close to the estimated static friction capacity of the piles. The SRD calculation method proposed by the authors takes the friction degradation effect into account, leading to improved pile drivability predictions. Four case histories are presented to illustrate the results obtained

  20. Using driving simulators to assess driving safety.

    Science.gov (United States)

    Boyle, Linda Ng; Lee, John D

    2010-05-01

    Changes in drivers, vehicles, and roadways pose substantial challenges to the transportation safety community. Crash records and naturalistic driving data are useful for examining the influence of past or existing technology on drivers, and the associations between risk factors and crashes. However, they are limited because causation cannot be established and technology not yet installed in production vehicles cannot be assessed. Driving simulators have become an increasingly widespread tool to understand evolving and novel technologies. The ability to manipulate independent variables in a randomized, controlled setting also provides the added benefit of identifying causal links. This paper introduces a special issue on simulator-based safety studies. The special issue comprises 25 papers that demonstrate the use of driving simulators to address pressing transportation safety problems and includes topics as diverse as neurological dysfunction, work zone design, and driver distraction. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  1. On scale dependence of hardness

    International Nuclear Information System (INIS)

    Shorshorov, M.Kh.; Alekhin, V.P.; Bulychev, S.I.

    1977-01-01

    The concept of hardness as a structure-sensitive characteristic of a material is considered. It is shown that in conditions of a decreasing stress field under the inventor the hardness function is determined by the average distance, Lsub(a), between the stops (fixed and sessile dislocations, segregation particles, etc.). In the general case, Lsub(a) depends on the size of the impression and explains the great diversity of hardness functions. The concept of average true deformation rate on depression is introduced

  2. Superluminal warp drive

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez-Diaz, Pedro F. [Colina de los Chopos, Centro de Fisica ' Miguel A. Catalan' , Instituto de Matematicas y Fisica Fundamental, Consejo Superior de Investigaciones Cientificas, Serrano 121, 28006 Madrid (Spain)], E-mail: p.gonzalezdiaz@imaff.cfmac.csic.es

    2007-09-20

    In this Letter we consider a warp drive spacetime resulting from that suggested by Alcubierre when the spaceship can only travel faster than light. Restricting to the two dimensions that retains most of the physics, we derive the thermodynamic properties of the warp drive and show that the temperature of the spaceship rises up as its apparent velocity increases. We also find that the warp drive spacetime can be exhibited in a manifestly cosmological form.

  3. Photon technology. Hard photon technology; Photon technology. Hard photon gijutsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    Research results of hard photon technology have been summarized as a part of novel technology development highly utilizing the quantum nature of photon. Hard photon technology refers to photon beam technologies which use photon in the 0.1 to 200 nm wavelength region. Hard photon has not been used in industry due to the lack of suitable photon sources and optical devices. However, hard photon in this wavelength region is expected to bring about innovations in such areas as ultrafine processing and material synthesis due to its atom selective reaction, inner shell excitation reaction, and spatially high resolution. Then, technological themes and possibility have been surveyed. Although there are principle proposes and their verification of individual technologies for the technologies of hard photon generation, regulation and utilization, they are still far from the practical applications. For the photon source technology, the laser diode pumped driver laser technology, laser plasma photon source technology, synchrotron radiation photon source technology, and vacuum ultraviolet photon source technology are presented. For the optical device technology, the multi-layer film technology for beam mirrors and the non-spherical lens processing technology are introduced. Also are described the reduction lithography technology, hard photon excitation process, and methods of analysis and measurement. 430 refs., 165 figs., 23 tabs.

  4. Medications and impaired driving.

    Science.gov (United States)

    Hetland, Amanda; Carr, David B

    2014-04-01

    To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives.

  5. Universal Drive Train Facility

    Data.gov (United States)

    Federal Laboratory Consortium — This vehicle drive train research facility is capable of evaluating helicopter and ground vehicle power transmission technologies in a system level environment. The...

  6. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident.

    Science.gov (United States)

    Lee, James S; Franc, Jeffrey M

    2015-08-01

    A high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise. Hypothesis/Problem It was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone. Physicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes. There were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar

  7. Can interprofessional teamwork reduce patient throughput times? A longitudinal single-centre study of three different triage processes at a Swedish emergency department.

    Science.gov (United States)

    Liu, Jenny; Masiello, Italo; Ponzer, Sari; Farrokhnia, Nasim

    2018-04-19

    To determine the impact on emergency department (ED) throughput times and proportion of patients who leave without being seen by a physician (LWBS) of two triage interventions, where comprehensive nurse-led triage was first replaced by senior physician-led triage and then by interprofessional teamwork. Single-centre before-and-after study. Adult ED of a Swedish urban hospital. Patients arriving on weekdays 08:00 to 21:00 during three 1-year periods in the interval May 2012 to November 2015. A total of 185 806 arrivals were included. Senior physicians replaced triage nurses May 2013 to May 2014. Interprofessional teamwork replaced the triage process on weekdays 08:00 to 21:00 November 2014 to November 2015. Primary outcomes were the median time to physician (TTP) and the median length of stay (LOS). Secondary outcome was the LWBS rate. The crude median LOS was shortest for teamwork, 228 min (95% CI 226.4 to 230.5) compared with 232 min (95% CI 230.8 to 233.9) for nurse-led and 250 min (95% CI 248.5 to 252.6) for physician-led triage. The adjusted LOS for the teamwork period was 16 min shorter than for nurse-led triage and 23 min shorter than for physician-led triage. The median TTP was shortest for physician-led triage, 56 min (95% CI 54.5 to 56.6) compared with 116 min (95% CI 114.4 to 117.5) for nurse-led triage and 74 min (95% CI 72.7 to 74.8) for teamwork. The LWBS rate was 1.9% for nurse-led triage, 1.2% for physician-led triage and 3.2% for teamwork. All outcome measure differences had two-tailed p valuesteamwork had the shortest length of stay, a shorter time to physician than nurse-led triage, but a higher LWBS rate. Interprofessional teamwork may be a useful approach to reducing ED throughput times. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department.

    Science.gov (United States)

    Kantonen, Jarmo; Lloyd, Robert; Mattila, Juho; Kauppila, Timo; Menezes, Ricardo

    2015-06-01

    To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the "right" use of emergency services, on the division of work between ED nurses and general practitioners (GPs). An observational and quasi-experimental study based on before-after comparisons. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. GPs and nurses from two different primary care EDs. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

  9. Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient.

    Science.gov (United States)

    Hodge, Stacie; Helliar, Sebastian; Macdonald, Hamish Ian; Mackey, Paul

    2018-01-01

    Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple 'plan-do-study-act' cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of 'red' and 'amber' patients' observations were communicated to the surgical team. The average time for a registrar to review a 'red' patient was 37 min and 79% of 'green' patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.

  10. An Intervention to Improve the Comfort And Satisfaction of Nurses in the Telephone Triage of Child Maltreatment Calls.

    Science.gov (United States)

    Hunter, Julie

    2015-01-01

    Nurses are mandated reporters of actual or suspected child maltreatment or the threat thereof. The purpose of this quality improvement project was to determine the knowledge and comfort of nurses in telephone triage in pediatric clinics when dealing with suspected or actual child abuse calls. Nurses (N = 17) from three pediatric primary care clinics and one specialty care orthopedic clinic were surveyed. Based on results of the survey showing a lack of knowledge and adequate referral resources perceived by the nursing staff, resources and staff education were developed, along with a script for guiding maltreatment calls toward standardization of care. Following the intervention, nurses reported an increased comfort level when doing telephone triage for child maltreatment calls, an increase in knowledge of risk factors for county resources. Further, they reported a substantial shift in opinion about the need for a standardized script when responding to child maltreatment telephone calls. Nurses undertaking telephone triage of high-risk child maltreatment calls can improve their comfort and knowledge through a survey of their needs and directed education and resource development for the management of child maltreatment telephone triage.

  11. Assessing the need for hospital admission by the Cape Triage discriminator presentations and the simple clinical score.

    LENUS (Irish Health Repository)

    Emmanuel, Andrew

    2010-11-01

    There is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.

  12. Patient and referring health care provider satisfaction with a physiotherapy spinal triage assessment service

    Directory of Open Access Journals (Sweden)

    Bath B

    2011-12-01

    Full Text Available Brenna Bath1, Bonnie Janzen21School of Physical Therapy, College of Medicine, University of Saskatchewan, 2Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaPurpose: To evaluate participant and referring care provider satisfaction associated with a spinal triage assessment service delivered by physiotherapists in collaboration with orthopedic surgeons.Methods: People with low back-related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists. Measures of patient and provider satisfaction were completed at approximately 4 weeks after the assessment. The satisfaction surveys were analyzed quantitatively with descriptive statistics and qualitatively with an inductive thematic approach of open and axial coding.Results: A total of 108/115 participants completed the posttest satisfaction survey. Sixty-six percent of participants were “very satisfied” with the service and 55% were “very satisfied” with the recommendations that were made. Only 18% of referring care providers completed the satisfaction survey and 90.5% of those were “very satisfied” with the recommendations. Sixty-one participants and 14 care providers provided comments which revealed a diverse range of themes which were coded into positive (ie, understanding the problem, communication, customer service, efficiency, and management direction, negative (ie, lack of detail, time to follow-up, cost and neutral related to the triage service, and an “other” category unrelated to the service (ie, chronic symptoms, comorbidities, and limited access to health care.Conclusion: The quantitative results of the participant survey demonstrated very high levels of satisfaction with the service and slightly less satisfaction with the recommendations that were made. Satisfaction of referring care providers with the recommendations and report was also high, but given

  13. Predicting mortality in sick African children: the FEAST Paediatric Emergency Triage (PET) Score.

    Science.gov (United States)

    George, Elizabeth C; Walker, A Sarah; Kiguli, Sarah; Olupot-Olupot, Peter; Opoka, Robert O; Engoru, Charles; Akech, Samuel O; Nyeko, Richard; Mtove, George; Reyburn, Hugh; Berkley, James A; Mpoya, Ayub; Levin, Michael; Crawley, Jane; Gibb, Diana M; Maitland, Kathryn; Babiker, Abdel G

    2015-07-31

    Mortality in paediatric emergency care units in Africa often occurs within the first 24 h of admission and remains high. Alongside effective triage systems, a practical clinical bedside risk score to identify those at greatest risk could contribute to reducing mortality. Data collected during the Fluid As Expansive Supportive Therapy (FEAST) trial, a multi-centre trial involving 3,170 severely ill African children, were analysed to identify clinical and laboratory prognostic factors for mortality. Multivariable Cox regression was used to build a model in this derivation dataset based on clinical parameters that could be quickly and easily assessed at the bedside. A score developed from the model coefficients was externally validated in two admissions datasets from Kilifi District Hospital, Kenya, and compared to published risk scores using Area Under the Receiver Operating Curve (AUROC) and Hosmer-Lemeshow tests. The Net Reclassification Index (NRI) was used to identify additional laboratory prognostic factors. A risk score using 8 clinical variables (temperature, heart rate, capillary refill time, conscious level, severe pallor, respiratory distress, lung crepitations, and weak pulse volume) was developed. The score ranged from 0-10 and had an AUROC of 0.82 (95 % CI, 0.77-0.87) in the FEAST trial derivation set. In the independent validation datasets, the score had an AUROC of 0.77 (95 % CI, 0.72-0.82) amongst admissions to a paediatric high dependency ward and 0.86 (95 % CI, 0.82-0.89) amongst general paediatric admissions. This discriminative ability was similar to, or better than other risk scores in the validation datasets. NRI identified lactate, blood urea nitrogen, and pH to be important prognostic laboratory variables that could add information to the clinical score. Eight clinical prognostic factors that could be rapidly assessed by healthcare staff for triage were combined to create the FEAST Paediatric Emergency Triage (PET) score and externally

  14. Piezoelectric drive circuit

    Science.gov (United States)

    Treu, C.A. Jr.

    1999-08-31

    A piezoelectric motor drive circuit is provided which utilizes the piezoelectric elements as oscillators and a Meacham half-bridge approach to develop feedback from the motor ground circuit to produce a signal to drive amplifiers to power the motor. The circuit automatically compensates for shifts in harmonic frequency of the piezoelectric elements due to pressure and temperature changes. 7 figs.

  15. Wrong-way driving.

    NARCIS (Netherlands)

    2006-01-01

    Wrong-way driving is a phenomenon that mainly happens on motorways. Although the number of wrong-way crashes is relatively limited, their consequences are much more severe than the consequences of other motorway injury crashes. The groups most often causing wrong-way driving accidents are young,

  16. Recognizing driving in haste

    NARCIS (Netherlands)

    Rendón-Vélez, E.

    2014-01-01

    One can often hear people discussing the reasons why a road accident has happened: “She had to pick up her kids in the school before four o’clock and she was driving in haste and careless”, “He was stressed, he wanted to reach the beginning of the football match, tried to drive faster and didn't

  17. Control rod drives

    International Nuclear Information System (INIS)

    Futatsugi, Masao.

    1980-01-01

    Purpose: To secure the reactor operation safety by the provision of a fluid pressure detecting section for control rod driving fluid and a control rod interlock at the midway of the flow pass for supplying driving fluid to the control rod drives. Constitution: Between a driving line and a direction control valve are provided a pressure detecting portion, an alarm generating device, and a control rod inhibition interlock. The driving fluid from a driving fluid source is discharged by way of a pump and a manual valve into the reactor in which the control rods and reactor fuels are contained. In addition, when the direction control valve is switched and the control rods are inserted and extracted by the control rod drives, the pressure in the driving line is always detected by the pressure detection section, whereby if abnormal pressure is resulted, the alarm generating device is actuated to warn the abnormality and the control rod inhibition interlock is actuated to lock the direction control valve thereby secure the safety operation of the reactor. (Seki, T.)

  18. Switched reluctance motor drives

    Indian Academy of Sciences (India)

    Davis RM, Ray WF, Blake RJ 1981 Inverter drive for switched reluctance: circuits and component ratings. Inst. Elec. Eng. Proc. B128: 126-136. Ehsani M. 1991 Position Sensor elimination technique for the switched reluctance motor drive. US Patent No. 5,072,166. Ehsani M, Ramani K R 1993 Direct control strategies based ...

  19. Self-driving carsickness

    NARCIS (Netherlands)

    Diels, C.; Bos, J.E.

    2016-01-01

    This paper discusses the predicted increase in the occurrence and severity of motion sickness in self-driving cars. Self-driving cars have the potential to lead to significant benefits. From the driver's perspective, the direct benefits of this technology are considered increased comfort and

  20. Self-driving carsickness.

    NARCIS (Netherlands)

    Diels, C.; Bos, J.E.

    2016-01-01

    This paper discusses the predicted increase in the occurrence and severity of motion sickness in self-driving cars. Self-driving cars have the potential to lead to significant benefits. From the driver's perspective, the direct benefits of this technology are considered increased comfort and

  1. Fundamentals of electrical drives

    CERN Document Server

    Veltman, André; De Doncker, Rik W

    2007-01-01

    Provides a comprehensive introduction to various aspects of electrical drive systems. This volume provides a presentation of dynamic generic models that cover all major electrical machine types and modulation/control components of a drive as well as dynamic and steady state analysis of transformers and electrical machines.

  2. Electric Vehicle - Economical driving

    DEFF Research Database (Denmark)

    Jensen, VCE, Steen V.; Schøn, Henriette

    1999-01-01

    How do you reduce the energy-wast when driving and loading EV's - or rather: How do I get more km/l out of an EV......How do you reduce the energy-wast when driving and loading EV's - or rather: How do I get more km/l out of an EV...

  3. Control rod drives

    International Nuclear Information System (INIS)

    Nakamura, Akira.

    1984-01-01

    Purpose: To enable to monitor the coupling state between a control rod and a control rod drive. Constitution: After the completion of a control rod withdrawal, a coolant pressure is applied to a control rod drive being adjusted so as to raise only the control rod drive and, in a case where the coupling between the control rod drive and the control rod is detached, the former is elevated till it contacts the control rod and then stopped. The actual stopping position is detected by an actual position detection circuit and compared with a predetermined position stored in a predetermined position detection circuit. If both of the positions are not aligned with each other, it is judged by a judging circuit that the control rod and the control rod drives are not combined. (Sekiya, K.)

  4. Short-term predictive capacity of two different triage systems in patients with acute heart failure: TRICA-EAHFE study.

    Science.gov (United States)

    Miró, Òscar; Tost, Josep; Herrero, Pablo; Jacob, Javier; Martín-Sánchez, Francisco Javier; Gil, Víctor; Fernández-Pérez, Cristina; Escoda, Rosa; Llorens, Pere

    2016-12-01

    To evaluate whether prioritization of patients with acute heart failure (AHF) in the Andorran Triage Model/Spanish Triage System (MAT/SET) and the Manchester Triage System (MTS) also allows the identification of different profiles of outcome and prognosis and determine whether either system has a better predictive capacity of outcomes. Patients with AHF included in the Spanish EAHFE registry from hospitals using the MAT/SET or MTS were selected and divided according to the triage system used. Outcome variables included hospital admission, length of stay, death during admission, 3, 7, and 30-day all-cause mortality, and emergency department (ED) reconsultation at 30 days. The results were compared according to the level of priority and the triage system used. We included 3837 patients (MAT/SET=2474; MTS=1363) classified as follows: 4.0% level 1; 34.7% level 2; 55.1% level 3; and 6.3% levels 4-5. Both systems associated greater priority with higher rates of admission and mortality; the MTS associated greater priority with greater ED reconsultation and the MAT/SET found greater priority to be associated with less ED reconsultation. The discriminative capacity of the two scales for adverse outcomes was statistically significant, albeit poor, for almost all the outcome events and it was of scarce clinical relevance (Area under the curve of the receiver operating characteristic between 0.458 and 0.661). The prediction of the outcome of patients with AHF determined with the MAT/SET or MTS showed scarce differences between the two systems, and their discriminative capacity does not seem to be clinically relevant.

  5. A framework for comparative evaluation of dosimetric methods to triage a large population following a radiological event

    International Nuclear Information System (INIS)

    Flood, Ann Barry; Nicolalde, Roberto J.; Demidenko, Eugene; Williams, Benjamin B.; Shapiro, Alla; Wiley, Albert L.; Swartz, Harold M.

    2011-01-01

    Background: To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. Objective: To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. Methods: We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. Conclusions: This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods' strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation.

  6. Patient Ethnicity Affects Triage Assessments and Patient Prioritization in U.S. Department of Veterans Affairs Emergency Departments

    Science.gov (United States)

    Vigil, Jacob M.; Coulombe, Patrick; Alcock, Joe; Kruger, Eric; Stith, Sarah S.; Strenth, Chance; Parshall, Mark; Cichowski, Sara B.

    2016-01-01

    Abstract Ethnic minority patients receive lower priority triage assignments in Veteran's Affairs (VA) emergency departments (EDs) compared to White patients, but it is currently unknown whether this disparity arises from generalized biases across the triage assessment process or from differences in how objective and/or subjective institution-level or person-level information is incorporated into the triage assessment process, thus contributing to disparate treatment. The VA database of electronic medical records of patients who presented to the VA ED from 2008 to 2012 was used to measure patient ethnicity, self-reported pain intensity (PI) levels, heart rate (HR), respiratory rate (RR), and nurse-provided triage assignment, the Emergency Severity Index (ESI) score. Multilevel, random effects linear modeling was used to control for demographic and clinical characteristics of patients as well as age, gender, and experience of triage nurses. A total of 359,642 patient/provider encounters between 129,991 VA patients and 774 nurses were included in the study. Patients were 61% non-Hispanic White [NHW], 28% African-American, 7% Hispanic, 2% Asian-American, ESI ratings with lower PI when compared against African-American patients. NHW patients with low to moderate HRs also received higher priority ESI scoring than African-American, Hispanic, Asian-American, and Mixed-ethnicity patients; however, when HR was high NHWs received lower priority ESI ratings than each of the minority groups (except for African-Americans). This study provides evidence for systemic differences in how patients’ vital signs are applied for determining ESI scores for different ethnic groups. Additional prospective research will be needed to determine how this specific person-level mechanism affects healthcare quality and outcomes. PMID:27057847

  7. A framework for comparative evaluation of dosimetric methods to triage a large population following a radiological event

    Energy Technology Data Exchange (ETDEWEB)

    Flood, Ann Barry, E-mail: Ann.B.Flood@Dartmouth.Edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Nicolalde, Roberto J., E-mail: Roberto.J.Nicolalde@Dartmouth.Edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Demidenko, Eugene, E-mail: Eugene.Demidenko@Dartmouth.Edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Williams, Benjamin B., E-mail: Benjamin.B.Williams@Dartmouth.Edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Shapiro, Alla, E-mail: Alla.Shapiro@fda.hhs.gov [Food and Drug Administration (FDA), Rockville, MD (United States); Wiley, Albert L., E-mail: Albert.Wiley@orise.orau.gov [Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States); Swartz, Harold M., E-mail: Harold.M.Swartz@Dartmouth.Edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States)

    2011-09-15

    Background: To prepare for a possible major radiation disaster involving large numbers of potentially exposed people, it is important to be able to rapidly and accurately triage people for treatment or not, factoring in the likely conditions and available resources. To date, planners have had to create guidelines for triage based on methods for estimating dose that are clinically available and which use evidence extrapolated from unrelated conditions. Current guidelines consequently focus on measuring clinical symptoms (e.g., time-to-vomiting), which may not be subject to the same verification of standard methods and validation processes required for governmental approval processes of new and modified procedures. Biodosimeters under development have not yet been formally approved for this use. Neither set of methods has been tested in settings involving large-scale populations at risk for exposure. Objective: To propose a framework for comparative evaluation of methods for such triage and to evaluate biodosimetric methods that are currently recommended and new methods as they are developed. Methods: We adapt the NIH model of scientific evaluations and sciences needed for effective translational research to apply to biodosimetry for triaging very large populations following a radiation event. We detail criteria for translating basic science about dosimetry into effective multi-stage triage of large populations and illustrate it by analyzing 3 current guidelines and 3 advanced methods for biodosimetry. Conclusions: This framework for evaluating dosimetry in large populations is a useful technique to compare the strengths and weaknesses of different dosimetry methods. It can help policy-makers and planners not only to compare the methods' strengths and weaknesses for their intended use but also to develop an integrated approach to maximize their effectiveness. It also reveals weaknesses in methods that would benefit from further research and evaluation.

  8. Perspectives of emergency department staff on the triage of mental health-related presentations: Implications for education, policy and practice.

    Science.gov (United States)

    Gerdtz, Marie F; Weiland, Tracey J; Jelinek, George A; Mackinlay, Claire; Hill, Nicole

    2012-10-01

    To explore ED staff perceptions of the factors that influence accuracy of triage for people with mental health problems. This qualitative learning needs analysis used a descriptive exploratory design. Participants were Australian emergency nurses and doctors. We used a criterion-based sampling approach. Recruitment was facilitated by the College of Emergency Nursing Australasia and the Australasian College for Emergency Medicine. A semi-structured interview schedule was developed. Telephone interviews were conducted, audio recorded and transcribed verbatim. Thematic analysis was used to identify factors perceived to affect triage outcomes and to explore strategies to optimise the accuracy of triage assessments. Thirty-six staff participated (16 nurses and 20 doctors). Four major factors were perceived to influence accuracy. These were: environmental factors (physical structure, time pressures, activity levels, and interruptions), policy and education (guidelines, training and resources), staff factors (knowledge, experience, attitudes) and patient factors (police presence, patient behaviour, clinical condition). Differences of opinion were expressed by emergency doctors about the validity of the time to treatment objectives included in the Australasian Triage Scale for mental health presentations, and the utility of the scale to differentiate urgency for psychiatric conditions. Clinical guidelines and training have been developed to support the use of the Australasian Triage Scale. Further evaluation of the application of this scale to assess mental health problems is indicated. Additional work is also required to reduce variance in urgency assignment based on staff knowledge and attitudes about the causes, assessment and early management of psychiatric disorders. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  9. Bilinear common spatial pattern for single-trial ERP-based rapid serial visual presentation triage

    Science.gov (United States)

    Yu, K.; Shen, K.; Shao, S.; Ng, W. C.; Li, X.

    2012-08-01

    Common spatial pattern (CSP) analysis is a useful tool for the feature extraction of event-related potentials (ERP). However, CSP is essentially time invariant, and thus unable to exploit the temporal information of ERP. This paper proposes a variant of CSP, namely bilinear common spatial pattern (BCSP), which is capable of accommodating both spatial and temporal information. BCSP generalizes CSP through iteratively optimizing bilinear filters. These bilinear filters constitute a spatio-temporal subspace in which the separation between two conditions is maximized. The method is unique in the sense that it is mathematically intuitive and simple, as all the bilinear filters are obtained by maximizing the power ratio as CSP does. The proposed method was evaluated on 20 subjects’ ERP data collected in rapid serial visual presentation triage experiments. The results show that BCSP achieved significantly higher average test accuracy (12.3% higher, p < 0.001).

  10. Ethical Considerations of Triage Following Natural Disasters: The IDF Experience in Haiti as a Case Study.

    Science.gov (United States)

    Ram-Tiktin, Efrat

    2017-07-01

    Natural disasters in populated areas may result in massive casualties and extensive destruction of infrastructure. Humanitarian aid delegations may have to cope with the complicated issue of patient prioritization under conditions of severe resource scarcity. A triage model, consisting of five principles, is proposed for the prioritization of patients, and it is argued that rational and reasonable agents would agree upon them. The Israel Defense Force's humanitarian mission to Haiti following the 2010 earthquake serves as a case study for the various considerations taken into account when designing the ethical-clinical policy of field hospitals. The discussion focuses on three applications: the decision to include an intensive care unit, the decision to include obstetrics and neonatal units, and the treatment policy for compound fractures. © 2017 John Wiley & Sons Ltd.

  11. Smooth driving of Mössbauer electromechanical transducers

    International Nuclear Information System (INIS)

    Veiga, A.; Mayosky, M. A.; Martínez, N.; Mendoza Zélis, P.; Pasquevich, G. A.; Sánchez, F. H.

    2011-01-01

    Quality of Mössbauer spectra is strongly related to the performance of source velocity modulator. Traditional electromechanical driving techniques demand hard-edged square or triangular velocity waveforms that introduce long settling times and demand careful driver tuning. For this work, the behavior of commercial velocity transducers and drive units was studied under different working conditions. Different velocity reference waveforms in constant-acceleration, constant-velocity and programmable-velocity techniques were tested. Significant improvement in spectrometer efficiency and accuracy was achieved by replacing triangular and square hard edges with continuous smooth-shaped transitions. A criterion for best waveform selection and synchronization is presented and attainable enhancements are evaluated. In order to fully exploit this driving technique, a compact microprocessor-based architecture is proposed and a suitable data acquisition system implementation is presented. System linearity and efficiency characterization are also shown.

  12. Optimizing the multimodal approach to pancreatic cyst fluid diagnosis: developing a volume-based triage protocol.

    Science.gov (United States)

    Chai, Siaw Ming; Herba, Karl; Kumarasinghe, M Priyanthi; de Boer, W Bastiaan; Amanuel, Benhur; Grieu-Iacopetta, Fabienne; Lim, Ee Mun; Segarajasingam, Dev; Yusoff, Ian; Choo, Chris; Frost, Felicity

    2013-02-01

    The objective of this study was to develop a triage algorithm to optimize diagnostic yield from cytology, carcinoembryonic antigen (CEA), and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) testing on different components of a single pancreatic cyst fluid specimen. The authors also sought to determine whether cell block supernatant was suitable for CEA and KRAS testing. Fifty-four pancreatic cysts were triaged according to a volume-dependent protocol to generate fluid (neat and supernatant) and cell block specimens for cytology, comparative CEA, and KRAS testing. Follow-up histology, diagnostic cytology, or a combined clinicopathologic interpretation was recorded as the final diagnosis. There were 26 mucinous cystic lesions and 28 nonmucinous cystic lesions with volumes ranging from 0.3 mL to 55 mL. Testing different components of the specimens (cell block, neat, and/or supernatant) enabled all laboratory investigations to be performed on 50 of 54 cyst fluids (92.6%). Interpretive concordance was observed in 17 of 17 cases (100%) and in 35 of 40 cases (87.5%) that had multiple components tested for CEA and KRAS mutations, respectively. An elevated CEA level (>192 ng/mL) was the most sensitive test for the detection of a mucinous cystic lesion (62.5%) versus KRAS mutation (56%) and "positive" cytology (61.5%). KRAS mutations were identified in 2 of 25 mucinous cystic lesions (8%) in which cytology and CEA levels were not contributory. A volume-based protocol using different components of the specimen was able to optimize diagnostic yield in pancreatic cyst fluids. KRAS mutation testing increased diagnostic yield when combined with cytology and CEA analysis. The current results demonstrated that supernatant is comparable to neat fluid and cell block material for CEA and KRAS testing. Copyright © 2012 American Cancer Society.

  13. A clinical algorithm for triaging patients with significant lymphadenopathy in primary health care settings in Sudan

    Directory of Open Access Journals (Sweden)

    Eltahir A.G. Khalil

    2013-06-01

    Full Text Available Background: Tuberculosis is a major health problem in developing countries. The distinction between tuberculous lymphadenitis, non-specific lymphadenitis and malignant lymph node enlargement has to be made at primary health care levels using easy, simple and cheap methods. Objective: To develop a reliable clinical algorithm for primary care settings to triage cases ofnon-specific, tuberculous and malignant lymphadenopathies. Methods: Calculation of the odd ratios (OR of the chosen predictor variables was carried out using logistic regression. The numerical score values of the predictor variables were weighed against their respective OR. The performance of the score was evaluated by the ROC (ReceiverOperator Characteristic curve. Results: Four predictor variables; Mantoux reading, erythrocytes sedimentation rate (ESR,nocturnal fever and discharging sinuses correlated significantly with TB diagnosis and were included in the reduced model to establish score A. For score B, the reduced model included Mantoux reading, ESR, lymph-node size and lymph-node number as predictor variables for malignant lymph nodes. Score A ranged 0 to 12 and a cut-off point of 6 gave a best sensitivity and specificity of 91% and 90% respectively, whilst score B ranged -3 to 8 and a cut-off point of3 gave a best sensitivity and specificity of 83% and 76% respectively. The calculated area underthe ROC curve was 0.964 (95% CI, 0.949 – 0.980 and -0.856 (95% CI, 0.787 ‑ 0.925 for scores Aand B respectively, indicating good performance. Conclusion: The developed algorithm can efficiently triage cases with tuberculous andmalignant lymphadenopathies for treatment or referral to specialised centres for furtherwork-up.

  14. Nursing students' assessment of pain and decision of triage for different ethnic groups: An experimental study.

    Science.gov (United States)

    Chan, Joanne C Y; Hamamura, Takeshi

    2015-08-01

    Pain management is a priority in nursing care but little is known about the factors that affect nursing students' assessment of pain expressed by patients of different ethnic backgrounds. This study examined undergraduate nursing students' assessment of pain and decision of triage when pain was expressed in different languages and their relation to students' empathy and social identity. Comparison between students with and without clinical experience was also carried out. This is a cross-sectional quantitative design. This study took place at a university in Hong Kong. 74 female undergraduate nursing students. Students listened to eight audio recordings in which an individual expressed pain in one of the two dialects of Chinese, either Cantonese or Putonghua. For each dialect, two recordings depicted mild pain and two depicted severe pain. After listening to each recording, students rated the pain level and indicated their decision of triage. Subsequently, students completed a questionnaire that measured their empathy and social identity and reported their demographics. The data were analyzed by descriptive statistics, correlational analyses, and t-tests. Severe pain described in Putonghua was rated as more intense than that described in Cantonese but it was not classified as more urgent. Students with clinical experience tended to perceive mild pain as less painful and less urgent than those without clinical experience. For mild pain described in Cantonese, students with clinical experience evaluated it as more urgent than those without such experience. The empathy level of students with and without clinical experience was comparable. Students with more empathy, especially those without clinical experience, reported heightened perceived intensity of severe pain described in Putonghua. Nurse educators should note that empathy, social identity, and clinical experience may alter students' pain assessment of patients from different ethnicities. Pain education needs to

  15. Rapid clinical assessment to facilitate the triage of adults with falciparum malaria, a retrospective analysis.

    Directory of Open Access Journals (Sweden)

    Josh Hanson

    Full Text Available Most adults dying from falciparum malaria will die within 48 hours of their hospitalisation. An essential component of early supportive care is the rapid identification of patients at greatest risk. In resource-poor settings, where most patients with falciparum malaria are managed, decisions regarding patient care must frequently be made using clinical evaluation alone.We retrospectively analysed 4 studies of 1801 adults with severe falciparum malaria to determine whether the presence of simple clinical findings might assist patient triage.If present on admission, shock, oligo-anuria, hypo- or hyperglycaemia, an increased respiratory rate, a decreased Glasgow Coma Score and an absence of fever were independently predictive of death. The variables were used to construct a simple clinical algorithm. When applied to the 1801 patients, this algorithm's positive predictive value for survival to 48 hours was 99.4 (95% confidence interval (CI 97.8-99.9 and for survival to discharge 96.9% (95% CI 94.3-98.5. In the 712 patients receiving artesunate, the algorithm's positive predictive value for survival to 48 hours was 100% (95% CI 97.3-100 and to discharge was 98.5% (95% CI 94.8-99.8.Simple clinical findings are closely linked to the pathophysiology of severe falciparum malaria in adults. A basic algorithm employing these indices can facilitate the triage of patients in settings where intensive care services are limited. Patients classified as low-risk by this algorithm can be safely managed initially on a general ward whilst awaiting senior clinical review and laboratory data.

  16. [Self-referrals at Emergency Care Access Points and triage by General Practitioner Cooperatives].

    Science.gov (United States)

    Smits, M; Rutten, M; Schepers, L; Giesen, P

    2017-01-01

    There is a trend for General Practitioner Cooperatives (GPCs) to co-locate with emergency departments (EDs) of hospitals at Emergency Care Access Points (ECAPs), where the GPCs generally conduct triage and treat a large part of self-referrals who would have gone to the ED by themselves in the past. We have examined patient and care characteristics of self-referrals at ECAPs where triage was conducted by GPCs, also to determine the percentage of self-referrals being referred to the ED. Retrospective cross-sectional observational study. Descriptive analyses of routine registration data from self-referrals of five ECAPs (n = 20.451). Patient age, gender, arrival time, urgency, diagnosis and referral were analysed. Of the self-referrals, 57.9% was male and the mean age was 32.7 years. The number of self-referrals per hour was highest during weekends, particularly between 11 a.m. and 5 p.m. On weekdays, there was a peak between 5 and 9 p.m. Self-referrals were mostly assigned a low-urgency grade (35.7% - U4 or U5) or a mid-urgency grade (49% - U3). Almost half of the self-referrals had trauma of the locomotor system (28%) or the skin (27.3%). In total, 23% of the patients was referred to the ED. Self-referred patients at GPCs are typically young, male and have low- to mid-urgency trauma-related problems. Many self-referrals present themselves on weekend days or early weekday evenings. Over three quarters of these patients can be treated by the GPCs, without referral to the ED. This reduces the workload at the ED.

  17. Informed cytology for triaging HPV-positive women: substudy nested in the NTCC randomized controlled trial.

    Science.gov (United States)

    Bergeron, Christine; Giorgi-Rossi, Paolo; Cas, Frederic; Schiboni, Maria Luisa; Ghiringhello, Bruno; Dalla Palma, Paolo; Minucci, Daria; Rosso, Stefano; Zorzi, Manuel; Naldoni, Carlo; Segnan, Nereo; Confortini, Massimo; Ronco, Guglielmo

    2015-02-01

    Human papillomavirus (HPV)-based screening needs triage. In most randomized controlled trials (RCTs) on HPV testing with cytological triage, cytology interpretation has been blind to HPV status. Women age 25 to 60 years enrolled in the New Technology in Cervical Cancer (NTCC) RCT comparing HPV testing with cytology were referred to colposcopy if HPV positive and, if no cervical intraepithelial neoplasia (CIN) was detected, followed up until HPV negativity. Cytological slides taken at the first colposcopy were retrieved and independently interpreted by an external laboratory, which was only aware of patients' HPV positivity. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were computed for histologically proven CIN2+ with HPV status-informed cytology for women with a determination of atypical squamous cells of undetermined significance (ASCUS) or more severe. All statistical tests were two-sided. Among HPV-positive women, informed cytology had cross-sectional sensitivity, specificity, PPV and 1-NPV for CIN2+ of 85.6% (95% confidence interval [CI] = 76.6 to 92.1), 65.9% (95% CI = 63.1 to 68.6), 16.2% (95% CI = 13.0 to 19.8), and 1.7 (95% CI = 0.9 to 2.8), respectively. Cytology was also associated with subsequent risk of newly diagnosed CIN2+ and CIN3+. The cross-sectional relative sensitivity for CIN2+ vs blind cytology obtained by referring to colposcopy and following up only HPV positive women who had HPV status-informed cytology greater than or equal to ASCUS was 1.58 (95% CI = 1.22 to 2.01), while the corresponding relative referral to colposcopy was 0.95 (95% CI = 0.86 to 1.04). Cytology informed of HPV positivity is more sensitive than blind cytology and could allow longer intervals before retesting HPV-positive, cytology-negative women. © The Author 2015. Published by Oxford University Press.

  18. Value of high-risk HPV-DNA testing in the triage of ASCUS.

    Science.gov (United States)

    Silverloo, Iréne; Andrae, Bengt; Wilander, Erik

    2009-01-01

    OBJECTIVE. Atypical squamous cells of undetermined significance (ASCUS) cells, occurring in organized cytological screening, may be either high-risk human papillomavirus (HPV) positive or negative. To refine the assessment of women with ASCUS, a high-risk HPV-DNA test is recommended as triage in Sweden. A total of 197 consecutive women (mean age 39 years, range 21-60) with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high-risk HPV-DNA test (hybrid capture 2). The women were categorized into four groups: Group A, Cytology + /HPV + ; Group B, Cytology-/HPV + ; Group C, Cytology + /HPV-; and Group D, Cytology-/ HPV-. Women within Groups A-C were admitted for colposcopy and cervical biopsy. The women in Group D were considered as a low-risk group for tumor development, and were re-examined after three years in the next round of the organized screening. In women in Group A (n=58) the prevalence of histological verified CIN2-3 was 41%, in Group B (n=41) 20%, and in Group C (n=9) 0%. In Group D (n=89), repeated primary screening three years later revealed CIN2-3 in two biopsies from 74 women studied (age in women with ASCUS. It was 74% in women or =50 years. Adding a high-risk HPV test in secondary screening increased the identification of women with CIN2-3 lesions by 33% in comparison with repeat cytology (p=0.01). The clinical significance of the ASCUS diagnosis varied with age of the women.

  19. The use of a new automatic device for patients' assessment at Triage in Emergency Department

    Directory of Open Access Journals (Sweden)

    Salvatore Di Somma

    2013-06-01

    Full Text Available Objectives: To assess time saving in an Emergency Department arising out of the introduction of automatic devices (Carescape™ V100 to measure vital signs compared to the manual devices. Methods: We performed a prospective, observational study of eligible patients referring to Sant’Andrea Hospital Emergency Department during the entire month of October 2009, randomly assigned into two groups. In the first group of 476 patients vital signs measurements were detected with manual devices, while in the second group of 477 patients with automatic device Carescape™ V100. Results: Data indicated that the comparison of the total time between the two groups gave a significant difference (1993 vs 1518 min, p < 0.001. No differences were found with respect to age, sex and priority codes. Significant differences were also found when comparing the subgroups of the same acuity categories: white codes 4.33 vs 2.27 (min, p < 0.05; green codes 4.28 vs 3.37 (min, p < 0.001; yellow codes 3.92 vs 2.72 (min, p < 0.001. Conclusions: Our data demonstrated a statistical significance between the two groups with a difference of 475 minutes spent in Triage procedures including vital signs measurements. In conclusion time saved by vital signs automatic device could allow ED physicians to make a qualified approach with an earlier diagnosis and a more rapid and effective therapy, possibly improving patients’ outcomes. ABSTRACT of data concerning vital signs quality assessment, because we did not compare the two methods in the same patient and we did not correlate Triage priority evaluation with patients’ outcomes. In the future further studies should be specifically aimed to address this issue. In conclusion time saved by vital signs automatic device could allow ED physicians to make a qualified approach to patient with an earlier diagnosis and a more rapid and effective therapy, possibly improving patients’ outcomes.

  20. A descriptive study of women presenting to an obstetric triage unit with no prenatal care.

    Science.gov (United States)

    Knight, Erin; Morris, Margaret; Heaman, Maureen

    2014-03-01

    To describe women presenting to an obstetric triage unit with no prenatal care (PNC), to identify gaps in care, and to compare care provided to World Health Organization (WHO) standards. We reviewed the charts of women who gave birth at Women's Hospital in Winnipeg and were discharged between April 1, 2008, and March 31, 2011, and identified those whose charts were coded with ICD-10 code Z35.3 (inadequate PNC) or who had fewer than 2 PNC visits. Three hundred eighty-two charts were identified, and sociodemographic characteristics, PNC history, investigations, and pregnancy outcomes were recorded. The care provided was compared with WHO guidelines. One hundred nine women presented to the obstetric triage unit with no PNC; 96 (88.1%) were in the third trimester. Only 39 women (35.8%) received subsequent PNC, with care falling short of WHO standards. Gaps in PNC included missing time-sensitive screening tests, mid-stream urine culture, and Chlamydia and gonorrhea testing. The mean maternal age was 26.1 years, and 93 women (85.3%) were multigravidas. More than one half of the women (51.4%) were involved with Child and Family Services, 64.2% smoked, 33.0% drank alcohol, and 32.1% used illicit drugs during pregnancy. Two thirds of the women (66.2%) lived in inner-city Winnipeg. Only 63.0% of neonates showed growth appropriate for gestational age. Two pregnancies ended in stillbirth; there was one neonatal death, and over one third of the births were preterm. Most women who present with no PNC do so late in pregnancy, proceed to deliver with little or no additional PNC, and have high rates of adverse outcomes. Thus, efforts to improve PNC must focus on facilitating earlier entry into care. This would also improve compliance with WHO guidelines for continuing care. Treatment protocols could improve gaps in obtaining urine culture and in Chlamydia and gonorrhea testing.

  1. Supplemented Triage and Rapid Treatment (START) improves performance measures in the emergency department.

    Science.gov (United States)

    White, Benjamin A; Brown, David F M; Sinclair, Julia; Chang, Yuchiao; Carignan, Sarah; McIntyre, Joyce; Biddinger, Paul D

    2012-03-01

    Emergency Department (ED) crowding is well recognized, and multiple studies have demonstrated its negative effect on patient care. This study aimed to assess the effect of an intervention, Supplemented Triage and Rapid Treatment (START), on standard ED performance measures. The START program complemented standard ED triage with a team of clinicians who initiated the diagnostic work-up and selectively accelerated disposition in a subset of patients. This retrospective before-after study compared performance measures over two 3-month periods (September-November 2007 and 2008) in an urban, academic tertiary care ED. Data from an electronic patient tracking system were queried over 12,936 patients pre-intervention, and 14,220 patients post-intervention. Primary outcomes included: 1) overall length of stay (LOS), 2) LOS for discharged and admitted patients, and 3) the percentage of patients who left without complete assessment (LWCA). In the post-intervention period, patient volume increased 9% and boarder hours decreased by 1.3%. Median overall ED LOS decreased by 29 min (8%, 361 min pre-intervention, 332 min post-intervention; p < 0.001). Median LOS for discharged patients decreased by 23 min (7%, 318 min pre-intervention, 295 min post-intervention; p < 0.001), and by 31 min (7%, 431 min pre-intervention, 400 min post-intervention) for admitted patients. LWCA was decreased by 1.7% (4.1% pre-intervention, 2.4% post-intervention; p < 0.001). In this study, a comprehensive screening and clinical care program was associated with a significant decrease in overall ED LOS, LOS for discharged and admitted patients, and rate of LWCA, despite an increase in ED patient volume. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Turbulent current drive mechanisms

    Science.gov (United States)

    McDevitt, Christopher J.; Tang, Xian-Zhu; Guo, Zehua

    2017-08-01

    Mechanisms through which plasma microturbulence can drive a mean electron plasma current are derived. The efficiency through which these turbulent contributions can drive deviations from neoclassical predictions of the electron current profile is computed by employing a linearized Coulomb collision operator. It is found that a non-diffusive contribution to the electron momentum flux as well as an anomalous electron-ion momentum exchange term provide the most efficient means through which turbulence can modify the mean electron current for the cases considered. Such turbulent contributions appear as an effective EMF within Ohm's law and hence provide an ideal means for driving deviations from neoclassical predictions.

  3. Fast wave current drive

    International Nuclear Information System (INIS)

    Goree, J.; Ono, M.; Colestock, P.; Horton, R.; McNeill, D.; Park, H.

    1985-07-01

    Fast wave current drive is demonstrated in the Princeton ACT-I toroidal device. The fast Alfven wave, in the range of high ion-cyclotron harmonics, produced 40 A of current from 1 kW of rf power coupled into the plasma by fast wave loop antenna. This wave excites a steady current by damping on the energetic tail of the electron distribution function in the same way as lower-hybrid current drive, except that fast wave current drive is appropriate for higher plasma densities

  4. Identifying Method of Drunk Driving Based on Driving Behavior

    Directory of Open Access Journals (Sweden)

    Xiaohua Zhao

    2011-05-01

    Full Text Available Drunk driving is one of the leading causes contributing to traffic crashes. There are numerous issues that need to be resolved with the current method of identifying drunk driving. Driving behavior, with the characteristic of real-time, was extensively researched to identify impaired driving behaviors. In this paper, the drives with BACs above 0.05% were defined as drunk driving state. A detailed comparison was made between normal driving and drunk driving. The experiment in driving simulator was designed to collect the driving performance data of the groups. According to the characteristics analysis for the effect of alcohol on driving performance, seven significant indicators were extracted and the drunk driving was identified by the Fisher Discriminant Method. The discriminant function demonstrated a high accuracy of classification. The optimal critical score to differentiate normal from drinking state was found to be 0. The evaluation result verifies the accuracy of classification method.

  5. Using On-scene EMS Responders' Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers.

    Science.gov (United States)

    Scott, Greg; Clawson, Jeff; Fivaz, Mark C; McQueen, Jennie; Gardett, Marie I; Schultz, Bryon; Youngquist, Scott; Olola, Christopher H O

    2016-02-01

    Using the Medical Priority Dispatch System (MPDS) - a systematic 911 triage process - to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews. The primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews' patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN). In this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a "hot" (lights-and-siren) transport. Out of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren. With the exception of the low-acuity, ALPHA

  6. Hard diffraction and rapidity gaps

    International Nuclear Information System (INIS)

    Brandt, A.

    1995-09-01

    The field of hard diffraction, which studies events with a rapidity gap and a hard scattering, has expanded dramatically recently. A review of new results from CDF, D OE, H1 and ZEUS will be given. These results include diffractive jet production, deep-inelastic scattering in large rapidity gap events, rapidity gaps between high transverse energy jets, and a search for diffractive W-boson production. The combination of these results gives new insight into the exchanged object, believed to be the pomeron. The results axe consistent with factorization and with a hard pomeron that contains both quarks and gluons. There is also evidence for the exchange of a strongly interacting color singlet in high momentum transfer (36 2 ) events

  7. Initiative hard coal; Initiative Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, J.

    2007-08-02

    In order to decrease the import dependence of hard coal in the European Union, the author has submitted suggestions to the director of conventional sources of energy (directorate general for energy and transport) of the European community, which found a positive resonance. These suggestions are summarized in an elaboration 'Initiative Hard Coal'. After clarifying the starting situation and defining the target the presupposition for a better use of hard coal deposits as raw material in the European Union are pointed out. On that basis concrete suggestions for measures are made. Apart from the conditions of the deposits it concerns thereby also new mining techniques and mining-economical developments, connected with tasks for the mining-machine industry. (orig.)

  8. Photon technology. Hard photon technology; Photon technology. Hard photon gijutsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    For the application of photon to industrial technologies, in particular, a hard photon technology was surveyed which uses photon beams of 0.1-200nm in wavelength. Its features such as selective atom reaction, dense inner shell excitation and spacial high resolution by quantum energy are expected to provide innovative techniques for various field such as fine machining, material synthesis and advanced inspection technology. This wavelength region has been hardly utilized for industrial fields because of poor development of suitable photon sources and optical devices. The developmental meaning, usable time and issue of a hard photon reduction lithography were surveyed as lithography in ultra-fine region below 0.1{mu}m. On hard photon analysis/evaluation technology, the industrial use of analysis, measurement and evaluation technologies by micro-beam was viewed, and optimum photon sources and optical systems were surveyed. Prediction of surface and surface layer modification by inner shell excitation, the future trend of this process and development of a vacuum ultraviolet light source were also surveyed. 383 refs., 153 figs., 17 tabs.

  9. Linear step drive

    International Nuclear Information System (INIS)

    Haniger, L.; Elger, R.; Kocandrle, L.; Zdebor, J.

    1986-01-01

    A linear step drive is described developed in Czechoslovak-Soviet cooperation and intended for driving WWER-1000 control rods. The functional principle is explained of the motor and the mechanical and electrical parts of the drive, power control, and the indicator of position are described. The motor has latches situated in the reactor at a distance of 3 m from magnetic armatures, it has a low structural height above the reactor cover, which suggests its suitability for seismic localities. Its magnetic circuits use counterpoles; the mechanical shocks at the completion of each step are damped using special design features. The position indicator is of a special design and evaluates motor position within ±1% of total travel. A drive diagram and the flow chart of both the control electronics and the position indicator are presented. (author) 4 figs

  10. Fundamentals of electrical drives

    NARCIS (Netherlands)

    Veltman, A.; Pulle, D.W.J.; de Doncker, R.W.

    2016-01-01

    Comprehensive, user-friendly, color illustrated introductory text for electrical drive systems that simplifies the understanding of electrical machine principles Updated edition covers innovations in machine design, power semi-conductors, digital signal processors and simulation software Presents

  11. Science of driving.

    Science.gov (United States)

    2016-08-01

    The Science of Driving project focused on developing a collaborative relationship to develop curriculum units for middle school and high school students to engage them in exciting real-world scenarios. This effort involved faculty, staff, and student...

  12. Drugs and driving

    NARCIS (Netherlands)

    Walsh, J. Michael; De Gier, Johan J.; Christopherson, Asbjørg S.; Verstraete, Alain G.

    The authors present a global overview on the issue of drugs and driving covering four major areas: (1) Epidemiology and Prevalence-which reviews epidemiological research, summarizes available information, discusses the methodological shortcomings of extant studies, and makes recommendations for

  13. Evaluation of hard fossil fuel

    International Nuclear Information System (INIS)

    Zivkovic, S.; Nuic, J.

    1999-01-01

    Because of its inexhaustible supplies hard fossil fuel will represent the pillar of the power systems of the 21st century. Only high-calorie fossil fuels have the market value and participate in the world trade. Low-calorie fossil fuels ((brown coal and lignite) are fuels spent on the spot and their value is indirectly expressed through manufactured kWh. For the purpose of determining the real value of a tonne of low-calorie coal, the criteria that help in establishing the value of a tonne of hard coal have to be corrected and thus evaluated and assessed at the market. (author)

  14. Calorimeter triggers for hard collisions

    International Nuclear Information System (INIS)

    Landshoff, P.V.; Polkinghorne, J.C.

    1978-01-01

    We discuss the use of a forward calorimeter to trigger on hard hadron-hadron collisions. We give a derivation in the covariant parton model of the Ochs-Stodolsky scaling law for single-hard-scattering processes, and investigate the conditions when instead a multiple- scattering mechanism might dominate. With a proton beam, this mechanism results in six transverse jets, with a total average multiplicity about twice that seen in ordinary events. We estimate that its cross section is likely to be experimentally accessible at avalues of the beam energy in the region of 100 GeV/c

  15. Hardness of ion implanted ceramics

    International Nuclear Information System (INIS)

    Oliver, W.C.; McHargue, C.J.; Farlow, G.C.; White, C.W.

    1985-01-01

    It has been established that the wear behavior of ceramic materials can be modified through ion implantation. Studies have been done to characterize the effect of implantation on the structure and composition of ceramic surfaces. To understand how these changes affect the wear properties of the ceramic, other mechanical properties must be measured. To accomplish this, a commercially available ultra low load hardness tester has been used to characterize Al 2 O 3 with different implanted species and doses. The hardness of the base material is compared with the highly damaged crystalline state as well as the amorphous material

  16. Instant Google Drive starter

    CERN Document Server

    Procopio, Mike

    2013-01-01

    This book is a Starter which teaches you how to use Google Drive practically. This book is perfect for people of all skill levels who want to enjoy the benefits of using Google Drive to safely store their files online and in the cloud. It's also great for anyone looking to learn more about cloud computing in general. Readers are expected to have an Internet connection and basic knowledge of using the internet.

  17. Control rod driving mechanism

    International Nuclear Information System (INIS)

    Ooshima, Yoshio.

    1983-01-01

    Purpose: To perform reliable scram operation, even if abnormality should occur in a system instructing scram operation in FBR type reactors. Constitution: An aluminum alloy member to be melt at a predetermined temperature (about 600sup(o)C) is disposed to a connection part between a control rod and a driving mechanism, whereby the control rod is detached from the driving mechanism and gravitationally fallen to the reactor core. (Ikeda, J.)

  18. Modulated Current Drive Measurements

    International Nuclear Information System (INIS)

    Petty, C.C.; Lohr, J.; Luce, T.C.; Prater, R.; Cox, W.A.; Forest, C.B.; Jayakumar, R.J.; Makowski, M.A.

    2005-01-01

    A new measurement approach is presented which directly determines the noninductive current profile from the periodic response of the motional Stark effect (MSE) signals to the slow modulation of the external current drive source. A Fourier transform of the poloidal magnetic flux diffusion equation is used to analyze the MSE data. An example of this measurement technique is shown using modulated electron cyclotron current drive (ECCD) discharges from the DIII-D tokamak

  19. Belt drive construction improvement

    Directory of Open Access Journals (Sweden)

    I.Yu. Khomenko

    2012-08-01

    Full Text Available The possibility of the traction capacity increase of the belt drive TRK is examined. This was done for the purpose of air conditioning system of passenger car with double-generator system energy supplying. Belts XPC (made by the German firm «Continental ContiTech» testing were conducted. The results confirmed the possibility of their usage in order to improve belt drive TRK characteristics.

  20. Chemical hardness and density functional theory

    Indian Academy of Sciences (India)

    Unknown

    RALPH G PEARSON. Chemistry Department, University of California, Santa Barbara, CA 93106, USA. Abstract. The concept of chemical hardness is reviewed from a personal point of view. Keywords. Hardness; softness; hard & soft acids bases (HSAB); principle of maximum hardness. (PMH) density functional theory (DFT) ...

  1. In 'big bang' major incidents do triage tools accurately predict clinical priority?: a systematic review of the literature.

    Science.gov (United States)

    Kilner, T M; Brace, S J; Cooke, M W; Stallard, N; Bleetman, A; Perkins, G D

    2011-05-01

    The term "big bang" major incidents is used to describe sudden, usually traumatic,catastrophic events, involving relatively large numbers of injured individuals, where demands on clinical services rapidly outstrip the available resources. Triage tools support the pre-hospital provider to prioritise which patients to treat and/or transport first based upon clinical need. The aim of this review is to identify existing triage tools and to determine the extent to which their reliability and validity have been assessed. A systematic review of the literature was conducted to identify and evaluate published data validating the efficacy of the triage tools. Studies using data from trauma patients that report on the derivation, validation and/or reliability of the specific pre-hospital triage tools were eligible for inclusion.Purely descriptive studies, reviews, exercises or reports (without supporting data) were excluded. The search yielded 1982 papers. After initial scrutiny of title and abstract, 181 papers were deemed potentially applicable and from these 11 were identified as relevant to this review (in first figure). There were two level of evidence one studies, three level of evidence two studies and six level of evidence three studies. The two level of evidence one studies were prospective validations of Clinical Decision Rules (CDR's) in children in South Africa, all the other studies were retrospective CDR derivation, validation or cohort studies. The quality of the papers was rated as good (n=3), fair (n=7), poor (n=1). There is limited evidence for the validity of existing triage tools in big bang major incidents.Where evidence does exist it focuses on sensitivity and specificity in relation to prediction of trauma death or severity of injury based on data from single or small number patient incidents. The Sacco system is unique in combining survivability modelling with the degree by which the system is overwhelmed in the triage decision system. The

  2. Helicopter emergency medical services (HEMS) over-triage and the financial implications for major trauma centres in NSW, Australia.

    Science.gov (United States)

    Taylor, Colman B; Curtis, Kate; Jan, Stephen; Newcombe, Mark

    2013-07-01

    In NSW Australia, a formal trauma system including the use of helicopter emergency medical services (HEMS) has existed for over 20 years. Despite providing many advantages in NSW, HEMS patients are frequently over-triaged; leading to financial implications for major trauma centres that receive HEMS patients. The aim of this study was to investigate the financial implications of HEMS over-triage from the perspective of major trauma centres in NSW. The study sample included all trauma patients transported via HEMS to 12 major trauma centres in NSW during the period: 1 July 2008 to 30 June 2009. Clinical data were gathered from individual hospital trauma registries and merged with financial information obtained from casemix units at respective hospitals. HEMS over-triage was estimated based on the local definition of minor to moderate trauma (ISS≤12) and hospital length of stay of less than 24 hrs. The actual treatment costs were determined and compared to state-wide peer group averages to obtain estimates of potential funding discrepancies. A total of 707 patients transported by HEMS were identified, including 72% pre-hospital (PH; n=507) and 28% inter-hospital (IH; n=200) transports. Over-triage was estimated at 51% for PH patients and 29% for IH patients. Compared to PH patients, IH patients were more costly to treat on average (IH: $42,604; PH: $25,162), however PH patients were more costly overall ($12,329,618 [PH]; $8,265,152 [IH]). When comparing actual treatment costs to peer group averages we found potential funding discrepancies ranging between 4% and 32% across patient groups. Using a sensitivity analysis, the potential funding discrepancy increased with increasing levels of over-triage. HEMS patients are frequently over-triaged in NSW, leading to funding implications for major trauma centres. In general, HEMS patient treatment costs are higher than the peer group average and the potential funding discrepancy varies by injury severity and the type of

  3. Self-driving carsickness.

    Science.gov (United States)

    Diels, Cyriel; Bos, Jelte E

    2016-03-01

    This paper discusses the predicted increase in the occurrence and severity of motion sickness in self-driving cars. Self-driving cars have the potential to lead to significant benefits. From the driver's perspective, the direct benefits of this technology are considered increased comfort and productivity. However, we here show that the envisaged scenarios all lead to an increased risk of motion sickness. As such, the benefits this technology is assumed to bring may not be capitalised on, in particular by those already susceptible to motion sickness. This can negatively affect user acceptance and uptake and, in turn, limit the potential socioeconomic benefits that this emerging technology may provide. Following a discussion on the causes of motion sickness in the context of self-driving cars, we present guidelines to steer the design and development of automated vehicle technologies. The aim is to limit or avoid the impact of motion sickness and ultimately promote the uptake of self-driving cars. Attention is also given to less well known consequences of motion sickness, in particular negative aftereffects such as postural instability, and detrimental effects on task performance and how this may impact the use and design of self-driving cars. We conclude that basic perceptual mechanisms need to be considered in the design process whereby self-driving cars cannot simply be thought of as living rooms, offices, or entertainment venues on wheels. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  4. Dementia and driving.

    Science.gov (United States)

    O'Neill, D; Neubauer, K; Boyle, M; Gerrard, J; Surmon, D; Wilcock, G K

    1992-04-01

    Many European countries test cars, but not their drivers, as they age. There is evidence to suggest that human factors are more important than vehicular factors as causes of motor crashes. The elderly also are involved in more accidents per distance travelled than middle-aged drivers. As the UK relies on self-certification of health by drivers over the age of 70 years, we examined the driving practices of patients with dementia attending a Memory Clinic. Nearly one-fifth of 329 patients with documented dementia continued to drive after the onset of dementia, and impaired driving ability was noted in two-thirds of these. Their families experienced great difficulty in persuading patients to stop driving, and had to invoke outside help in many cases. Neuropsychological tests did not help to identify those who drove badly while activity of daily living scores were related to driving ability. These findings suggest that many patients with dementia drive in an unsafe fashion after the onset of the illness. The present system of self-certification of health by the elderly for driver-licensing purposes needs to be reassessed.

  5. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef

    2012-01-01

    on mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request......RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions...... care unit rejections than younger patients and have a higher mortality when admitted, the mortality benefit appears greater for the elderly. Physicians should consider changing their intensive care unit triage practices for the elderly....

  6. Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden.

    Science.gov (United States)

    Ostensson, Ellinor; Fröberg, Maria; Hjerpe, Anders; Zethraeus, Niklas; Andersson, Sonia

    2010-10-01

    To assess the cost-effectiveness of using human papillomavirus testing (HPV triage) in the management of women with minor cytological abnormalities in Sweden. An economic analysis based on a clinical trial, complemented with data from published meta-analyses on accuracy of HPV triage. The study takes perspective of the Swedish healthcare system. The Swedish population-based cervical cancer screening program. A decision analytic model was constructed to evaluate cost-effectiveness of HPV triage compared to repeat cytology and immediate colposcopy with biopsy, stratifying by index cytology (ASCUS = atypical squamous cells of undetermined significance, and LSIL = low-grade squamous intraepithelial lesion) and age (23-60 years, cytological abnormalities. Today, immediate colposcopy with biopsy is a cost-effective alternative compared to HPV triage and repeat cytology.

  7. Seismic signals hard clipping overcoming

    Science.gov (United States)

    Olszowa, Paula; Sokolowski, Jakub

    2018-01-01

    In signal processing the clipping is understand as the phenomenon of limiting the signal beyond certain threshold. It is often related to overloading of a sensor. Two particular types of clipping are being recognized: soft and hard. Beyond the limiting value soft clipping reduces the signal real gain while the hard clipping stiffly sets the signal values at the limit. In both cases certain amount of signal information is lost. Obviously if one possess the model which describes the considered signal and the threshold value (which might be slightly more difficult to obtain in the soft clipping case), the attempt of restoring the signal can be made. Commonly it is assumed that the seismic signals take form of an impulse response of some specific system. This may lead to belief that the sine wave may be the most appropriate to fit in the clipping period. However, this should be tested. In this paper the possibility of overcoming the hard clipping in seismic signals originating from a geoseismic station belonging to an underground mine is considered. A set of raw signals will be hard-clipped manually and then couple different functions will be fitted and compared in terms of least squares. The results will be then analysed.

  8. Hard equality constrained integer knapsacks

    NARCIS (Netherlands)

    Aardal, K.I.; Lenstra, A.K.; Cook, W.J.; Schulz, A.S.

    2002-01-01

    We consider the following integer feasibility problem: "Given positive integer numbers a 0, a 1,..., a n, with gcd(a 1,..., a n) = 1 and a = (a 1,..., a n), does there exist a nonnegative integer vector x satisfying ax = a 0?" Some instances of this type have been found to be extremely hard to solve

  9. Stress in hard metal films

    NARCIS (Netherlands)

    Janssen, G.C.A.M.; Kamminga, J.D.

    2004-01-01

    In the absence of thermal stress, tensile stress in hard metal films is caused by grain boundary shrinkage and compressive stress is caused by ion peening. It is shown that the two contributions are additive. Moreover tensile stress generated at the grain boundaries does not relax by ion

  10. Control rod drive

    International Nuclear Information System (INIS)

    Hawke, B.C.

    1986-01-01

    A reactor core, one or more control rods, and a control rod drive are described for selectively inserting and withdrawing the one or more control rods into and from the reactor core, which consists of: a support structure secured beneath the reactor core; control rod positioning means supported by the support structure for movably supporting the control rod for movement between a lower position wherein the control rod is located substantially beneath the reactor core and an upper position wherein at least an upper portion of the control rod extends into the reactor core; transmission means; primary drive means connected with the control rod positioning means by the transmission means for positioning the control rod under normal operating conditions; emergency drive means for moving the control rod from the lower position to the upper position under emergency conditions, the emergency drive means including a weight movable between an upper and a lower position, means for movably supporting the weight, and means for transmitting gravitational force exerted on the weight to the control rod positioning means to move the control rod upwardly when the weight is pulled downwardly by gravity; the transmission means connecting the control rod positioning means with the emergency drive means so that the primary drive means effects movement of the weight and the control rod in opposite directions under normal conditions, thus providing counterbalancing to reduce the force required for upward movement of the control rod under normal conditions; and restraint means for restraining the fall of the weight under normal operating conditions and disengaging the primary drive means to release the weight under emergency conditions

  11. Hard processes in hadronic interactions

    International Nuclear Information System (INIS)

    Satz, H.; Wang, X.N.

    1995-01-01

    Quantum chromodynamics is today accepted as the fundamental theory of strong interactions, even though most hadronic collisions lead to final states for which quantitative QCD predictions are still lacking. It therefore seems worthwhile to take stock of where we stand today and to what extent the presently available data on hard processes in hadronic collisions can be accounted for in terms of QCD. This is one reason for this work. The second reason - and in fact its original trigger - is the search for the quark-gluon plasma in high energy nuclear collisions. The hard processes to be considered here are the production of prompt photons, Drell-Yan dileptons, open charm, quarkonium states, and hard jets. For each of these, we discuss the present theoretical understanding, compare the resulting predictions to available data, and then show what behaviour it leads to at RHIC and LHC energies. All of these processes have the structure mentioned above: they contain a hard partonic interaction, calculable perturbatively, but also the non-perturbative parton distribution within a hadron. These parton distributions, however, can be studied theoretically in terms of counting rule arguments, and they can be checked independently by measurements of the parton structure functions in deep inelastic lepton-hadron scattering. The present volume is the work of Hard Probe Collaboration, a group of theorists who are interested in the problem and were willing to dedicate a considerable amount of their time and work on it. The necessary preparation, planning and coordination of the project were carried out in two workshops of two weeks' duration each, in February 1994 at CERn in Geneva andin July 1994 at LBL in Berkeley

  12. Senior doctor triage (SDT), a qualitative study of clinicians' views on senior doctors' involvement in triage and early assessment of emergency patients.

    Science.gov (United States)

    Abdulwahid, Maysam Ali; Turner, Janette; Mason, Suzanne M

    2018-07-01

    Despite the focus during the last decade on introducing interventions such as senior doctor initial assessment or senior doctor triage (SDT) to reduce emergency department (ED) crowding, there has been little attempt to identify the views of emergency healthcare professionals on such interventions. The aim of this study was to gain an understanding of SDT from the perspective of emergency hospital staff. A secondary aim of this study was to develop a definition of SDT based on the interview findings and the available literature on this process. Qualitative semi-structured telephone interviews were conducted with participants of different backgrounds including senior doctors, nurses, paramedics and ED managers. Textual data were analysed using a template analysis approach. 27 participants from 13 EDs across England were interviewed. SDT was viewed as a safety mechanism and a measure to control patient flow. The most prominent positive aspect was the ability to initiate early investigations and treatment. Various shortcomings of SDT were described such as the lack of standardisation of the process and its cost implications. Participants identified a number of barriers to this process including insufficient resources and exit block, and called for solutions focused on these issues. A proposed definition of an 'ideal' SDT was developed where it is described as a systematic brief assessment of patients arriving at the ED by a senior doctor-led team, which takes place in a dedicated unit. The aim of this assessment is to facilitate early investigation and management of patients, early patient disposition and guide junior staff to deliver safe and high-quality clinical care. This is the first national study to explore the opinions of various emergency and managerial staff on the SDT model. It revealed variable interpretations of this model and what it can and cannot offer. This has led to a standard definition of the SDT process, which can be useful for clinicians and

  13. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial

    Science.gov (United States)

    Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Angus, Derek C; Yealy, Donald M; Wallace, David J; Barnato, Amber E

    2017-01-01

    Abstract Objective To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Design Randomized clinical trial. Setting Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. Participants 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Interventions Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Main outcome measures Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. Results 149 (81%) physicians in the game arm and 148 (80%) in the traditional

  14. Booster: Development of a Toolbox for Triage of a Large Group of Individuals Exposed to Radioactive Material

    International Nuclear Information System (INIS)

    Schoepff, V.; Carrel, F.; Gmar, M.; Lemaire, H.; Carvajal, F.; Perez-Llopis, I.; Gaboriau, D.-C.; Morrison, C.-G.; Almasi, I.; Szabo, S.; Kovacs, A; Szeles, E.; Amgarou, K.; Menaa, N.; Morat, L.; Testard, I.; Ugolin, N.; Viau, M.; Becker, F.; Raskob, W.; Trybushnyi, D.; Vincze, A.

    2013-06-01

    The effective management of an event involving the exposure of a large number of people to radioactive material requires a mechanism for fast triage of exposed people. BOOSTER is a project founded by the European Union under the Seventh Framework Programme, addressing this requirement. It is a capability project designed to provide an integrated system which could easily be deployed and used. For this purpose, the BOOSTER consortium, relying on the expertise of seven members, researches and develops new approaches to allow an effective and fast management of most kind of nuclear threats. BOOSTER System was designed to help first responders mitigating the crisis by providing the necessary information to quickly assess the radiological situation, to support triage staff in performing an efficient and fast categorization of the potentially affected victims, and to give medical staff crucial information for further treatment at medium or long term post-accident. (authors)

  15. War time experiences of triage and resuscitation: Australian Army nurses in the Vietnam War, 1967-1971.

    Science.gov (United States)

    Biedermann, N E; Harvey, N R

    2001-07-01

    The experiences of nurses in war is prolifically described in the North American scholarly literature, and in the Australian nursing literature to a lesser extent. The literature describes the plights and achievements of nurses caring for soldiers and civilians often under the most undesirable of circumstances. A central focus of war time nursing is the resuscitation of critically wounded soldiers. This paper addresses the experiences of the Australian Army nurses who were involved in the triage and resuscitation of critically wounded allied and enemy soldiers in the Vietnam War between 1967 and 1971. As part of a research study to explore and analyse the nature of nursing work in the Vietnam War, seventeen Vietnam veteran nurses were interviewed about their experiences. This paper explores the progression of the triage department in the Australian military hospital in Vung Tau, and it highlights that the majority of the nurses who took part in this study were clinically unprepared, particularly as emergency nurses.

  16. Control rod drives

    International Nuclear Information System (INIS)

    Hayakawa, Hiroyasu.

    1979-01-01

    Purpose: To enable rapid control in a simple circuit by providing a motor control device having an electric capacity capable of simultaneously driving all of the control rods rapidly only in the inserting direction as well as a motor controlling device capable of fine control for the insertion and extraction at usual operation. Constitution: The control rod drives comprise a first motor control device capable of finely controlling the control rods both in inserting and extracting directions, a second motor control device capable of rapidly driving the control rods only in the inserting direction, and a first motor switching circuit and a second motor switching circuit switched by switches. Upon issue of a rapid insertion instruction for the control rods, the second motor switching circuit is closed by the switch and the second motor control circuit and driving motors are connected. Thus, each of the control rod driving motors is driven at a high speed in the inserting direction to rapidly insert all of the control rods. (Yoshino, Y.)

  17. Epilepsy and driving

    Directory of Open Access Journals (Sweden)

    Matej Mavrič

    2015-05-01

    Full Text Available Epilepsy poses a risk for all participants in road traffic; therefore people with epilepsy do not meet the criteria for an unlimited driving license. Their driving is affected not only by epileptic seizures causing impaired consciousness and involuntary movements, but also by antiepileptic drugs with their many unwanted affects. The experts have not yet agreed on whether people with epilepsy have an increased risk of experiencing a road traffic accident. However, recent data suggests that the overall risk is lower compared to other medical conditions. Scientific evidence forms the basis of legislation, which by limiting people with epilepsy, enables all participants in road traffic to drive in the safest possible environment. The legislation that governs epilepsy and driving in Slovenia has been recently thoroughly reformed and thus allows a less discriminatory management of people with epilepsy. Although people with epilepsy experience many issues in their daily life, including their personal relationships and employment, they often list the need for driving as a top concern in surveys. General physicians play an important role in managing the issues of people with epilepsy.

  18. A physiotherapy triage assessment service for people with low back disorders: evaluation of short-term outcomes

    Directory of Open Access Journals (Sweden)

    Bath B

    2012-06-01

    Full Text Available Brenna Bath, Punam PahwaCollege of Medicine, University of Saskatchewan, Saskatoon, CanadaPurpose: To determine the short-term effects of physiotherapy triage assessments on self-reported pain, functioning, and general well-being and quality of life in people with low back-related disorders.Methods: Participants with low back–related complaints were recruited from those referred to a spinal triage assessment program delivered by physiotherapists (PTs. Before undergoing the triage assessment, the participants completed a battery of questionnaires covering a range of sociodemographic, clinical, and psychosocial features. The study used the Numeric Pain Rating Scale (NPRS, the Oswestry Disability Index (ODI, and the Medical Outcomes Survey 36-item short-form version 2 (SF-36v2 to assess self-reported pain, function, and quality of life. Baseline measures and variables were analyzed using a descriptive analysis method (ie, proportions, means, medians. Paired samples t-tests or Wilcoxon matched-pair signed-rank tests were used to analyze the overall group differences between the pretest and posttest outcome measures where appropriate.Results: A total of 108 out of 115 (93.9% participants completed the posttest survey. The Physical Component Summary of the SF36v2 was the only measure that demonstrated significant improvement (P < 0.001.Conclusion: A spinal triage assessment program delivered by PTs can be viewed as a complex intervention that may have the potential to affect a wide range of patient-related outcomes. Further research is needed to examine the long-term outcomes and explore potential mechanisms of improvement using a biopsychosocial framework.Keywords: interprofessional practice, quality of life, back pain, orthopedics

  19. The DUNDRUM-1 structured professional judgment for triage to appropriate levels of therapeutic security: retrospective-cohort validation study.

    LENUS (Irish Health Repository)

    Flynn, Grainne

    2011-01-01

    The assessment of those presenting to prison in-reach and court diversion services and those referred for admission to mental health services is a triage decision, allocating the patient to the appropriate level of therapeutic security. This is a critical clinical decision. We set out to improve on unstructured clinical judgement. We collated qualitative information and devised an 11 item structured professional judgment instrument for this purpose then tested for validity.

  20. Self-rated Driving and Driving Safety in Older Adults

    OpenAIRE

    Ross, Lesley A.; Dodson, Joan; Edwards, Jerri D.; Ackerman, Michelle L.; Ball, Karlene

    2012-01-01

    Many U.S. states rely on older adults to self-regulate their driving and determine when driving is no longer a safe option. However, the relationship of older adults’ self-rated driving in terms of actual driving competency outcomes is unclear. The current study investigates self-rated driving in terms of (1) systematic differences between older adults with high (good/excellent) versus low (poor/fair/average) self-ratings, and (2) the predictive nature of self-rated driving to adverse driving...

  1. Los sistemas de triage: respuesta a la saturación en las salas de urgencias

    Directory of Open Access Journals (Sweden)

    Consuelo Cubero Alpízar

    2014-10-01

    Full Text Available Antecedentes. Las estrategias para la atención de usuarios en las salas de urgencias a nivel hospitalario se han vuelto imprescindibles para el buen funcionamiento de estos servicios, debido al incremento de en la demanda cada vez mayor de prestación de servicios en. En este contexto, se plantea un proyecto de investigación cuyo objetivo se centró en analizar la efectividad de los sistemas de atención de urgencias hospitalarias a nivel mundial.Método. Se revisó toda aquella evidencia publicada durante los últimos 15 años, y que incluya observación del personal que los aplica, los tipos de sistema de triage, así como los tiempos de espera antes de la atención y la calidad de la atención brindada al paciente. La estrategia de búsqueda se utilizó para identificar estudios clínicos en diferentes bases de datos como Pubmed, Cochrane library, EBSCO y google académico.Resultado. Entre los resultados más relevantes se identificó la saturación en las salas de urgencias como un problema real originado del aumento en la demanda de tales servicios a nivel mundial, lo cual redunda en una menor calidad en el servicio que se presta y también en un aumento en la mortalidad por los tiempos de espera. Se identificó que no se compara la atención aleatoria por llegada y los sistemas estructurados, además de que históricamente son las enfermeras las que mejor cumplen dicha tarea.Conclusión. Es urgente revisar los sistemas de clasificación de pacientes en el momento en el que llegan al área de urgencias del sistema hospitalario, con el objetivo de adaptar los sistemas de triage a las necesidades reales del país.

  2. An electronic screen for triaging adolescent substance use by risk levels.

    Science.gov (United States)

    Levy, Sharon; Weiss, Roger; Sherritt, Lon; Ziemnik, Rosemary; Spalding, Allegra; Van Hook, Shari; Shrier, Lydia A

    2014-09-01

    Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions. To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use. Adolescent patients (age range, 12-17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview-Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses. For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview-Substance Abuse Module as the criterion standard. Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84% (95% CI, 76%-89%) for identifying nontobacco substance use, 90% (95% CI, 77%-96%) and 94% (95% CI, 89%-96%) for substance use disorders, 100% and 94% (95% CI, 90%-96%) for severe substance use disorders, and 75% (95% CI, 52%-89%) and 98% (95% CI, 95%-100%) for nicotine dependence. No significant

  3. A cohort study of cervical screening using partial HPV typing and cytology triage.

    Science.gov (United States)

    Schiffman, Mark; Hyun, Noorie; Raine-Bennett, Tina R; Katki, Hormuzd; Fetterman, Barbara; Gage, Julia C; Cheung, Li C; Befano, Brian; Poitras, Nancy; Lorey, Thomas; Castle, Philip E; Wentzensen, Nicolas

    2016-12-01

    HPV testing is more sensitive than cytology for cervical screening. However, to incorporate HPV tests into screening, risk-stratification ("triage") of HPV-positive women is needed to avoid excessive colposcopy and overtreatment. We prospectively evaluated combinations of partial HPV typing (Onclarity, BD) and cytology triage, and explored whether management could be simplified, based on grouping combinations yielding similar 3-year or 18-month CIN3+ risks. We typed ∼9,000 archived specimens, taken at enrollment (2007-2011) into the NCI-Kaiser Permanente Northern California (KPNC) HPV Persistence and Progression (PaP) cohort. Stratified sampling, with reweighting in the statistical analysis, permitted risk estimation of HPV/cytology combinations for the 700,000+-woman KPNC screening population. Based on 3-year CIN3+ risks, Onclarity results could be combined into five groups (HPV16, else HPV18/45, else HPV31/33/58/52, else HPV51/35/39/68/56/66/68, else HPV negative); cytology results fell into three risk groups ("high-grade," ASC-US/LSIL, NILM). For the resultant 15 HPV group-cytology combinations, 3-year CIN3+ risks ranged 1,000-fold from 60.6% to 0.06%. To guide management, we compared the risks to established "benchmark" risk/management thresholds in this same population (e.g., LSIL predicted 3-year CIN3+ risk of 5.8% in the screening population, providing the benchmark for colposcopic referral). By benchmarking to 3-year risk thresholds (supplemented by 18-month estimates), the widely varying risk strata could be condensed into four action bands (very high risk of CIN3+ mandating consideration of cone biopsy if colposcopy did not find precancer; moderate risk justifying colposcopy; low risk managed by intensified follow-up to permit HPV "clearance"; and very low risk permitting routine screening.) Overall, the results support primary HPV testing, with management of HPV-positive women using partial HPV typing and cytology. © 2016 UICC.

  4. Radiation-hard/high-speed parallel optical links

    Energy Technology Data Exchange (ETDEWEB)

    Gan, K.K., E-mail: gan@mps.ohio-state.edu [Department of Physics, The Ohio State University, Columbus, OH 43210 (United States); Buchholz, P.; Heidbrink, S. [Fachbereich Physik, Universität Siegen, Siegen (Germany); Kagan, H.P.; Kass, R.D.; Moore, J.; Smith, D.S. [Department of Physics, The Ohio State University, Columbus, OH 43210 (United States); Vogt, M.; Ziolkowski, M. [Fachbereich Physik, Universität Siegen, Siegen (Germany)

    2016-09-21

    We have designed and fabricated a compact parallel optical engine for transmitting data at 5 Gb/s. The device consists of a 4-channel ASIC driving a VCSEL (Vertical Cavity Surface Emitting Laser) array in an optical package. The ASIC is designed using only core transistors in a 65 nm CMOS process to enhance the radiation-hardness. The ASIC contains an 8-bit DAC to control the bias and modulation currents of the individual channels in the VCSEL array. The performance of the optical engine up at 5 Gb/s is satisfactory.

  5. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

    Energy Technology Data Exchange (ETDEWEB)

    Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich [University Hospital Munich, Department of Clinical Radiology, Munich (Germany); Huber-Wagner, Stefan; Kanz, Karl-Georg [University Hospital Munich, Department of Surgery, Munich (Germany)

    2009-08-15

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

  6. Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises

    International Nuclear Information System (INIS)

    Koerner, Markus; Kroetz, Michael M.; Wirth, Stefan; Boehm, Holger F.; Reiser, Maximilian; Linsenmaier, Ulrich; Huber-Wagner, Stefan; Kanz, Karl-Georg

    2009-01-01

    The purpose of this study was to evaluate the feasibility, stability, and reproducibility of a dedicated CT protocol for the triage of patients in two separate large-scale exercises that simulated a mass casualty incident (MCI). In both exercises, a bomb explosion at the local soccer stadium that had caused about 100 casualties was simulated. Seven casualties who were rated ''critical'' by on-site field triage were admitted to the emergency department and underwent whole-body CT. The CT workflow was simulated with phantoms. The history of the casualties was matched to existing CT examinations that were used for evaluation of image reading under MCI conditions. The times needed for transfer and preparation of patients, examination, image reconstruction, total time in the CT examination room, image transfer to PACS, and image reading were recorded, and mean capacities were calculated and compared using the Mann-Whitney U test. We found no significant time differences in transfer and preparation of patients, duration of CT data acquisition, image reconstruction, total time in the CT room, and reading of the images. The calculated capacities per hour were 9.4 vs. 9.8 for examinations completed, and 8.2 vs. 7.2 for reports completed. In conclusion, CT triage is feasible and produced constant results with this dedicated and fast protocol. (orig.)

  7. Managing Ethiopian Cities II: Informality in Ethiopia: Taxing the Hard to Tax

    NARCIS (Netherlands)

    A. Bongwa (Aloysius)

    2009-01-01

    textabstractLarge informal (hard to tax) sectors are an integral part of the economies of developing countries (Ethiopia included). In much of Africa, the informal, or gray economy that escapes tax collectors and government regulators, is the hidden dynamic driving economic growth. The informal

  8. Gears and gear drives

    CERN Document Server

    Jelaska, Damir T

    2012-01-01

    Understanding how gears are formed and how they interact or 'mesh' with each other is essential when designing equipment that uses gears or gear trains. The way in which gear teeth are formed and how they mesh is determined by their geometry and kinematics, which is the topic of this book.  Gears and Gear Drives provides the reader with comprehensive coverage of gears and gear drives. Spur, helical, bevel, worm and planetary gears are all covered, with consideration given to their classification, geometry, kinematics, accuracy control, load capacity and manufacturing. Cylindric

  9. Toyota hybrid synergy drive

    Energy Technology Data Exchange (ETDEWEB)

    Gautschi, H.

    2008-07-01

    This presentation made at the Swiss 2008 research conference on traffic by Hannes Gautschi, director of service and training at the Toyota company in Switzerland, takes a look at Toyota's hybrid drive vehicles. The construction of the vehicles and their combined combustion engines and electric generators and drives is presented and the combined operation of these components is described. Braking and energy recovery are discussed. Figures on the performance, fuel consumption and CO{sub 2} output of the hybrid vehicles are compared with those of conventional vehicles.

  10. Hard-to-fill vacancies.

    Science.gov (United States)

    Williams, Ruth

    2010-09-29

    Skills for Health has launched a set of resources to help healthcare employers tackle hard-to-fill entry-level vacancies and provide sustainable employment for local unemployed people. The Sector Employability Toolkit aims to reduce recruitment and retention costs for entry-level posts and repare people for employment through pre-job training programmes, and support employers to develop local partnerships to gain access to wider pools of candidates and funding streams.

  11. CMS results on hard diffraction

    CERN Document Server

    INSPIRE-00107098

    2013-01-01

    In these proceedings we present CMS results on hard diffraction. Diffractive dijet production in pp collisions at $\\sqrt{s}$=7 TeV is discussed. The cross section for dijet production is presented as a function of $\\tilde{\\xi}$, representing the fractional momentum loss of the scattered proton in single-diffractive events. The observation of W and Z boson production in events with a large pseudo-rapidity gap is also presented.

  12. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department.

    Science.gov (United States)

    Weston, Victoria; Jain, Sushil K; Gottlieb, Michael; Aldeen, Amer; Gravenor, Stephanie; Schmidt, Michael J; Malik, Sanjeev

    2017-06-01

    Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI). Secondary outcomes were defined as differences in median ED length of stay (LOS), median door-to-provider (DTP) time, proportion of left without being seen (LWBS), and proportion of "very good" overall patient satisfaction scores. Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs) equated to a gain (ROI: 54%) for resident TLPs and a loss (ROI: -31%) for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317%) and for attending TLPs (ROI: 86%). Median DTP time for resident TLPs was significantly lower (phistorical control. Proportion of "very good" patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  13. Machine Learning or Information Retrieval Techniques for Bug Triaging: Which is better?

    Directory of Open Access Journals (Sweden)

    Anjali Goyal

    2017-07-01

    Full Text Available Bugs are the inevitable part of a software system. Nowadays, large software development projects even release beta versions of their products to gather bug reports from users. The collected bug reports are then worked upon by various developers in order to resolve the defects and make the final software product more reliable. The high frequency of incoming bugs makes the bug handling a difficult and time consuming task. Bug assignment is an integral part of bug triaging that aims at the process of assigning a suitable developer for the reported bug who corrects the source code in order to resolve the bug. There are various semi and fully automated techniques to ease the task of bug assignment. This paper presents the current state of the art of various techniques used for bug report assignment. Through exhaustive research, the authors have observed that machine learning and information retrieval based bug assignment approaches are most popular in literature. A deeper investigation has shown that the trend of techniques is taking a shift from machine learning based approaches towards information retrieval based approaches. Therefore, the focus of this work is to find the reason behind the observed drift and thus a comparative analysis is conducted on the bug reports of the Mozilla, Eclipse, Gnome and Open Office projects in the Bugzilla repository. The results of the study show that the information retrieval based technique yields better efficiency in recommending the developers for bug reports.

  14. Rethinking transitions of care: An interprofessional transfer triage protocol in post-acute care.

    Science.gov (United States)

    Patel, Radha V; Wright, Lauri; Hay, Brittany

    2017-09-01

    Readmissions to hospitals from post-acute care (PAC) units within long-term care settings have been rapidly increasing over the past decade, and are drivers of increased healthcare costs. With an average of $11,000 per admission, there is a need for strategies to reduce 30-day preventable hospital readmission rates. In 2018, incentives and penalties will be instituted for long-term care facilities failing to meet all-cause, all-condition hospital readmission rate performance measures. An interprofessional team (IPT) developed and implemented a Transfer Triage Protocol used in conjunction with the INTERACT programme to enhance clinical decision-making and assess the potential to reduce the facility's 30-day preventable hospital readmission rates by 10% within 6 weeks of implementation. Results from quantitative analysis demonstrated an overall 35.2% reduction in the 30-day preventable hospital readmission rate. Qualitative analysis revealed the need for additional staff education, improved screening and communication upon admission and prior to hospital transfer, and the need for more IPT on-site availability. This pilot study demonstrates the benefits and implications for practice of an IPT to improve the quality of care within PAC and decrease 30-day preventable hospital readmissions.

  15. Earthquakes and trauma: review of triage and injury-specific, immediate care.

    Science.gov (United States)

    Gautschi, Oliver P; Cadosch, Dieter; Rajan, Gunesh; Zellweger, René

    2008-01-01

    Earthquakes present a major threat to mankind. Increasing knowledge about geophysical interactions, progressing architectural technology, and improved disaster management algorithms have rendered modern populations less susceptible to earthquakes. Nevertheless, the mass casualties resulting from earthquakes in Great Kanto (Japan), Ancash (Peru), Tangshan (China), Guatemala, Armenia, and Izmit (Turkey) or the recent earthquakes in Bhuj (India), Bam (Iran), Sumatra (Indonesia) and Kashmir (Pakistan) indicate the devastating effect earthquakes can have on both individual and population health. Appropriate preparation and implementation of crisis management algorithms are of utmost importance to ensure a large-scale medical-aid response is readily available following a devastating event. In particular, efficient triage is vital to optimize the use of limited medical resources and to effectively mobilize these resources so as to maximize patient salvage. However, the main priorities of disaster rescue teams are the rescue and provision of emergency care for physical trauma. Furthermore, the establishment of transport evacuation corridors, a feature often neglected, is essential in order to provide the casualties with a chance for survival. The optimal management of victims under such settings is discussed, addressing injuries of the body and psyche by means of simple diagnostic and therapeutic procedures globally applicable and available.

  16. Triage for suspected acute Pulmonary Embolism: Think before opening Pandora's Box

    Energy Technology Data Exchange (ETDEWEB)

    Levin, David [Department of Radiology, Mayo Clinic, Rochester, MN (United States); Seo, Joon Beom [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kiely, David G. [Sheffield Pulmonary Vascular Disease Unit, M-15, M-Floor, Royal Hallamshire Hospital, Sheffield (United Kingdom); Hatabu, Hiroto [Department of Radiology, Brigham and Women' s Hospital and Harvard Medical School Boston, MA (United States); Gefter, Warren [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA (United States); Beek, Edwin J.R. van [Clinical Research Imaging Centre, University of Edinburgh, Scotland (United Kingdom); Schiebler, Mark L., E-mail: mschiebler@uwhealth.org [Department of Radiology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-3252 (United States)

    2015-06-15

    This is a review of the current strengths and weaknesses of the various imaging modalities available for the diagnosis of suspected non-massive Pulmonary Embolism (PE). Without careful consideration for the clinical presentation, and the timely application of clinical decision support (CDS) methodology, the current overutilization of imaging resources for this disease will continue. For a patient with a low clinical risk profile and a negative D-dimer there is no reason to consider further workup with imaging; as the negative predictive value in this scenario is the same as imaging. While the current efficacy and effectiveness data support the continued use of Computed Tomographic angiography (CTA) as the imaging golden standard for the diagnosis of PE; this test does have the unintended consequences of radiation exposure, possible overdiagnosis and overuse. There is a persistent lack of appreciation on the part of ordering physicians for the effectiveness of the alternatives to CTA (ventilation–perfusion imaging and contrast enhanced magnetic resonance angiography) in these patients. Careful use of standardized protocols for patient triage and the application of CDS will allow for a better use of imaging resources.

  17. HPV-Based Screening, Triage, Treatment, and Followup Strategies in the Management of Cervical Intraepithelial Neoplasia

    Directory of Open Access Journals (Sweden)

    Oscar Peralta-Zaragoza

    2013-01-01

    Full Text Available Cervical cancer is the second most common cause of death from cancer in women worldwide, and the development of new diagnostic, prognostic, and treatment strategies merits special attention. Many efforts have been made to design new drugs and develop immunotherapy and gene therapy strategies to treat cervical cancer. HPV genotyping has potentially valuable applications in triage of low-grade abnormal cervical cytology, assessment of prognosis and followup of cervical intraepithelial neoplasia, and in treatment strategies for invasive cervical cancer. It is known that during the development of cervical cancer associated with HPV infection, a cascade of abnormal events is induced, including disruption of cellular cycle control, alteration of gene expression, and deregulation of microRNA expression. Thus, the identification and subsequent functional evaluation of host proteins associated with HPV E6 and E7 oncoproteins may provide useful information in understanding cervical carcinogenesis, identifying cervical cancer molecular markers, and developing specific targeting strategies against tumor cells. Therefore, in this paper, we discuss the main diagnostic methods, management strategies, and followup of HPV-associated cervical lesions and review clinical trials applying gene therapy strategies against the development of cervical cancer.

  18. [Admission, discharge and triage guidelines for paediatric intensive care units in Spain].

    Science.gov (United States)

    de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

    2018-05-01

    A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Admission, discharge and triage guidelines for paediatric intensive care units in Spain.

    Science.gov (United States)

    de la Oliva, Pedro; Cambra-Lasaosa, Francisco José; Quintana-Díaz, Manuel; Rey-Galán, Corsino; Sánchez-Díaz, Juan Ignacio; Martín-Delgado, María Cruz; de Carlos-Vicente, Juan Carlos; Hernández-Rastrollo, Ramón; Holanda-Peña, María Soledad; Pilar-Orive, Francisco Javier; Ocete-Hita, Esther; Rodríguez-Núñez, Antonio; Serrano-González, Ana; Blanch, Luis

    2018-05-01

    A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  20. Adrenal incidentaloma triage with single source (fast kVp switch) dual energy CT

    Science.gov (United States)

    Glazer, Daniel I; Keshavarzi, Nahid R; Parker, Robert A; Kaza, Ravi K; Platt, Joel F; Francis, Isaac R

    2015-01-01

    Purpose To evaluate single source dual energy CT (DECT) for distinguishing benign and indeterminate adrenal nodules, with attention to effects of phase of intravenous contrast enhancement. Materials and methods An IRB-approved, HIPAA-compliant retrospective review revealed 273 contrast-enhanced abdominal DECTs from November 2009–March 2012. 50 adrenal nodules ≥ 0.8 cm were identified in 41 patients: 22 female, 19 male, average age 66 (range 36–88 years). CT post-processing and measurements were independently performed by two radiologists (R1 and R2) for each nodule: (1) HU on true non-contrast images; (2) post-contrast HU on monochromatic spectral images at 40, 75, and 140 keV; (3) post-contrast material density (mg/cc) on virtual non-contrast (VNC) images. Nodules were separated into benign (VNC images, benign nodules had significantly lower material density (R1: 992.4 mg/cc ± 9.9; R2: 992.7 mg/cc ±9.6) than indeterminate nodules (R1: 1001.1mg/cc ±20.5 (p .038); R2: 1007.6 HU ±13.4 (p <.0001). Conclusion DECT tools can mathematically subtract iodine or minimize its effects in high energy reconstructions, approximating non-contrast imaging and potentially reducing the need for additional studies to triage adrenal nodules detected on post-contrast DECT exams. PMID:25055267

  1. Triage of means: options for conserving tiger corridors beyond designated protected lands in India

    Directory of Open Access Journals (Sweden)

    Indranil Mondal

    2016-11-01

    Full Text Available The latest tiger census conducted in India during the year 2014 shows that it harbours 57% of the global tiger population in 7% of their historic global range. At the same time, India has 1.25 billion people growing at a rate of 1.7% per year. Protected tiger habitats in India are geographically isolated and collectively holds this tiger population under tremendous anthropogenic pressure. These protected lands are in itself not enough to sustain the growing tiger population, intensifying human-tiger conflict as dispersing individuals enter human occupied areas. These factors – isolation and inadequate size of the protected lands harbouring tiger meta-populations, highlight the need to connect tiger habitats and the importance of corridors beyond protected lands. It is imperative to conserve such corridors passing through private lands to safeguard the long-term survival of the tigers in India. The goal of long-term tiger conservation in India lies in smartly integrating tiger conservation concerns in various sectors where tiger conservation is not the priority. To effectively tap into all these resources, we propose a Triage of Means strategy. Here we do not prioritize species, populations or sites due to the non-availability of conservation resources. Instead, we aim to prioritize from available resources (means to achieve conservation from other sectors where tiger conservation is not the focus. We outline how to prioritise resources available from various sectors into conservation by prioritizing issues hampering tiger conservation beyond protected habitats.

  2. Triage and management of accidental laboratory exposures to biosafety level-3 and -4 agents.

    Science.gov (United States)

    Jahrling, Peter; Rodak, Colleen; Bray, Mike; Davey, Richard T

    2009-06-01

    The recent expansion of biocontainment laboratory capacity in the United States has drawn attention to the possibility of occupational exposures to BSL-3 and -4 agents and has prompted a reassessment of medical management procedures and facilities to deal with these contingencies. A workshop hosted by the National Interagency Biodefense Campus was held in October 2007 and was attended by representatives of all existing and planned BSL-4 research facilities in the U.S. and Canada. This report summarizes important points of discussion and recommendations for future coordinated action, including guidelines for the engineering and operational controls appropriate for a hospital care and isolation unit. Recommendations pertained to initial management of exposures (ie, immediate treatment of penetrating injuries, reporting of exposures, initial evaluation, and triage). Isolation and medical care in a referral hospital (including minimum standards for isolation units), staff recruitment and training, and community outreach also were addressed. Workshop participants agreed that any unit designated for the isolation and treatment of laboratory employees accidentally infected with a BSL-3 or -4 pathogen should be designed to maximize the efficacy of patient care while minimizing the risk of transmission of infection. Further, participants concurred that there is no medically based rationale for building care and isolation units to standards approximating a BSL-4 laboratory. Instead, laboratory workers accidentally exposed to pathogens should be cared for in hospital isolation suites staffed by highly trained professionals following strict infection control procedures.

  3. The reliability of the Manchester Triage System (MTS): a meta-analysis.

    Science.gov (United States)

    Mirhaghi, Amir; Mazlom, Reza; Heydari, Abbas; Ebrahimi, Mohsen

    2017-05-01

    Although the Manchester Triage System (MTS) was first developed two decades ago, the reliability of the MTS has not been questioned through comparison with a moderating variable; therefore, the aim of this study is to determine the extent of the reliability of MTS using a meta-analytic review. Electronic databases were searched up to 1 March 2014. Studies were only included if they had reported sample sizes, reliability coefficients, and adequate description of the reliability assessment. The Guidelines for Reporting Reliability and Agreement Studies was used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was performed based on the method-of-moments estimator. Seven studies were included. The pooled coefficient for the MTS was substantial at 0.751 (CI 95%: 0.677 to 0.810); the incidence of mistriage is greater than 50%. Agreement is higher for the latest version of MTS (for adults) among nurse-experts and in countries in closer proximity to the country of MTS origin (the UK, in Manchester) than for the oldest (pediatric) version, nurse-nurse raters, and countries at a greater distance from the UK. The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  4. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

  5. Playing Moderately Hard to Get

    Directory of Open Access Journals (Sweden)

    Stephen Reysen

    2013-12-01

    Full Text Available In two studies, we examined the effect of different degrees of attraction reciprocation on ratings of attraction toward a potential romantic partner. Undergraduate college student participants imagined a potential romantic partner who reciprocated a low (reciprocating attraction one day a week, moderate (reciprocating attraction three days a week, high (reciprocating attraction five days a week, or unspecified degree of attraction (no mention of reciprocation. Participants then rated their degree of attraction toward the potential partner. The results of Study 1 provided only partial support for Brehm’s emotion intensity theory. However, after revising the high reciprocation condition vignette in Study 2, supporting Brehm’s emotion intensity theory, results show that a potential partners’ display of reciprocation of attraction acted as a deterrent to participants’ intensity of experienced attraction to the potential partner. The results support the notion that playing moderately hard to get elicits more intense feelings of attraction from potential suitors than playing too easy or too hard to get. Discussion of previous research examining playing hard to get is also re-examined through an emotion intensity theory theoretical lens.

  6. CMOS optimization for radiation hardness

    International Nuclear Information System (INIS)

    Derbenwick, G.F.; Fossum, J.G.

    1975-01-01

    Several approaches to the attainment of radiation-hardened MOS circuits have been investigated in the last few years. These have included implanting the SiO 2 gate insulator with aluminum, using chrome-aluminum layered gate metallization, using Al 2 O 3 as the gate insulator, and optimizing the MOS fabrication process. Earlier process optimization studies were restricted primarily to p-channel devices operating with negative gate biases. Since knowledge of the hardness dependence upon processing and design parameters is essential in producing hardened integrated circuits, a comprehensive investigation of the effects of both process and design optimization on radiation-hardened CMOS integrated circuits was undertaken. The goals are to define and establish a radiation-hardened processing sequence for CMOS integrated circuits and to formulate quantitative relationships between process and design parameters and the radiation hardness. Using these equations, the basic CMOS design can then be optimized for radiation hardness and some understanding of the basic physics responsible for the radiation damage can be gained. Results are presented

  7. Triage of Women with Low-Grade Cervical Lesions - HPV mRNA Testing versus Repeat Cytology

    Science.gov (United States)

    Sørbye, Sveinung Wergeland; Arbyn, Marc; Fismen, Silje; Gutteberg, Tore Jarl; Mortensen, Elin Synnøve

    2011-01-01

    Background In Norway, women with low-grade squamous intraepithelial lesions (LSIL) are followed up after six months in order to decide whether they should undergo further follow-up or be referred back to the screening interval of three years. A high specificity and positive predictive value (PPV) of the triage test is important to avoid unnecessary diagnostic and therapeutic procedures. Materials and Methods At the University Hospital of North Norway, repeat cytology and the HPV mRNA test PreTect HPV-Proofer, detecting E6/E7 mRNA from HPV types 16, 18, 31, 33 and 45, are used in triage of women with ASC-US and LSIL. In this study, women with LSIL cytology in the period 2005–2008 were included (n = 522). Two triage methods were evaluated in two separate groups: repeat cytology only (n = 225) and HPV mRNA testing in addition to repeat cytology (n = 297). Histologically confirmed cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) was used as the study endpoint. Results Of 522 women with LSIL, 207 had biopsies and 125 of them had CIN2+. The sensitivity and specificity of repeat cytology (ASC-US or worse) were 85.7% (95% confidence interval (CI): 72.1, 92.2) and 54.4 % (95% CI: 46.9, 61.9), respectively. The sensitivity and specificity of the HPV mRNA test were 94.2% (95% CI: 88.7, 99.7) and 86.0% (95% CI: 81.5, 90.5), respectively. The PPV of repeat cytology was 38.4% (95% CI: 29.9, 46.9) compared to 67.0% (95% CI: 57.7, 76.4) of the HPV mRNA test. Conclusion HPV mRNA testing was more sensitive and specific than repeat cytology in triage of women with LSIL cytology. In addition, the HPV mRNA test showed higher PPV. These data indicate that the HPV mRNA test is a better triage test for women with LSIL than repeat cytology. PMID:21918682

  8. The design and implementation of an obstetric triage system for unscheduled pregnancy related attendances: a mixed methods evaluation.

    Science.gov (United States)

    Kenyon, Sara; Hewison, Alistair; Dann, Sophie-Anna; Easterbrook, Jolene; Hamilton-Giachritsis, Catherine; Beckmann, April; Johns, Nina

    2017-09-18

    No standardised system of triage exists in Maternity Care and local audit identified this to be problematic. We designed, implemented and evaluated an Obstetric Triage System in a large UK maternity unit. This includes a standard clinical triage assessment by a midwife, within 15 min of attendance, leading to assignment to a category of clinical urgency (on a 4-category scale). This guides timing of subsequent standardised immediate care for the eight most common reasons for attendance. A training programme was integral to the introduction. A mixed methods evaluation was conducted. A structured audit of 994 sets of maternity notes before and after implementation identified the number of women seen within 15 min of attendance. Secondary measures reviewed included time to subsequent care and attendance. An inter-operator reliability study using scenarios was completed by midwives. A focus group and two questionnaire studies were undertaken to explore midwives' views of the system and to evaluate the training. In addition a national postal survey of practice in UK maternity units was undertaken in 2015. The structured audit of 974/992 (98%) of notes demonstrated an increase in the number of women seen within 15 min of attendance from 39% before implementation to 54% afterwards (RR (95% CI) 1.4 (1.2, 1.7) p = reliability (ICC 0.961 (95% CI 0.91-0.99)) was demonstrated with breakdown showing consistently good rates. Thematic analysis of focus group data (n = 12) informed the development of the questionnaire which was sent to all appropriate midwives. The response rate was 53/79 (67%) and the midwives reported that the new system helped them manage the department and improved safety. The National Survey (response rate 85/135 [63%]) demonstrated wide variation in where women are seen and staffing models in place. The majority of units 69/85 (81%) did not use a triage system based on clinical assessment to prioritise care. This obstetric triage system has excellent

  9. Comparing Expert and Novice Driving Behavior in a Driving Simulator

    Directory of Open Access Journals (Sweden)

    Hiran B. Ekanayake

    2014-02-01

    Full Text Available This paper presents a study focused on comparing driving behavior of expert and novice drivers in a mid-range driving simulator with the intention of evaluating the validity of driving simulators for driver training. For the investigation, measurements of performance, psychophysiological measurements, and self-reported user experience under different conditions of driving tracks and driving sessions were analyzed. We calculated correlations between quantitative and qualitative measures to enhance the reliability of the findings. The experiment was conducted involving 14 experienced drivers and 17 novice drivers. The results indicate that driving behaviors of expert and novice drivers differ from each other in several ways but it heavily depends on the characteristics of the task. Moreover, our belief is that the analytical framework proposed in this paper can be used as a tool for selecting appropriate driving tasks as well as for evaluating driving performance in driving simulators.

  10. Driving skills after whiplash.

    Science.gov (United States)

    Gimse, R; Bjørgen, I A; Straume, A

    1997-09-01

    Previous studies have shown that some persons with longlasting problems after whiplash have changed eye movements. These changes have been related to disturbance of the posture control system. The question raised in the present study is whether such disturbances can influence daily life functions connected with balance, position and external movements, such as car driving. A group of 23 persons with disturbed eye movements due to whiplash injury, was tested in a driving simulator, together with a closely matched control group. The results revealed significant differences between the two groups with respect to response times to the traffic signs presented, identification of type of sign, as well as steering precision while the subjects' attention was directed to the process of identifying the signs. Alternative explanations such as driving experience, pain, medication or malingering are at least partly controlled for, but cannot completely be ruled out. A distorted posture control system leading to disturbance of eye movements seems to be the most likely primary causative factor, but these disturbances are most certainly complexly determined. Reduced attention capacity is considered to be a mediating secondary factor. Registration of eye movements may be a useful diagnostic tool to evaluate driving skill after whiplash.

  11. Gaze-controlled Driving

    DEFF Research Database (Denmark)

    Tall, Martin; Alapetite, Alexandre; San Agustin, Javier

    2009-01-01

    We investigate if the gaze (point of regard) can control a remote vehicle driving on a racing track. Five different input devices (on-screen buttons, mouse-pointing low-cost webcam eye tracker and two commercial eye tracking systems) provide heading and speed control on the scene view transmitted...

  12. Gas turbine drives

    Energy Technology Data Exchange (ETDEWEB)

    1981-01-01

    Developments in gas turbine drives are reviewed, e.g., low weight per unit power and thrust-weight ratio, fast availability of the maximum speed, absolute resistance to cold and to droplet formation vibrationeless run, and low exhaust gas temperatures. Applications in aeronautic engineering (turbofan), power stations, marine propulsion systems, railways and road transportation vehicles are mentioned.

  13. Chaos in drive systems

    Directory of Open Access Journals (Sweden)

    Kratochvíl C.

    2007-10-01

    Full Text Available The purpose of this article is to provide an elementary introduction to the subject of chaos in the electromechanical drive systems. In this article, we explore chaotic solutions of maps and continuous time systems. These solutions are also bounded like equilibrium, periodic and quasiperiodic solutions.

  14. Electric Drive Study

    Science.gov (United States)

    1987-03-01

    compound promises to reduce weight of future permanent magnet motors by 20 to 30 percent; a similar reduction is expected in size (approximately 20...drive systems. The AC permanent magnet (brushless DC motor) is rapidly evolving and will replace most electrically excited machines. Permanent magnet motors using

  15. Electric-Drive Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Septon, Kendall K [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-11

    Electric-drive vehicles use electricity as their primary fuel or to improve the efficiency of conventional vehicle designs. These vehicles can be divided into three categories: Hybrid electric vehicles (HEVs), Plug-in hybrid electric vehicles (PHEVs), All-electric vehicles (EVs). Together, PHEVs and EVs can also be referred to as plug-in electric vehicles (PEVs).

  16. Electric-Drive Vehicles

    Energy Technology Data Exchange (ETDEWEB)

    None

    2017-09-01

    Electric-drive vehicles use electricity as their primary fuel or to improve the efficiency of conventional vehicle designs. These vehicles can be divided into three categories: Hybrid electric vehicles (HEVs), Plug-in hybrid electric vehicles (PHEVs), All-electric vehicles (EVs). Together, PHEVs and EVs can also be referred to as plug-in electric vehicles (PEVs).

  17. Driving While Intoxicated.

    Science.gov (United States)

    Brick, John

    Alcohol intoxication increases the risk of highway accidents, the relative risk of crash probability increasing as a function of blood alcohol content (BAC). Because alcohol use is more prevalent than use of other drugs, more is known about the relationship between alcohol use and driving. Most states presume a BAC of .10% to be evidence of drunk…

  18. Impact of aging on radiation hardness

    International Nuclear Information System (INIS)

    Shaneyfelt, M.R.; Winokur, P.S.; Fleetwood, D.M.

    1997-01-01

    Burn-in effects are used to demonstrate the potential impact of thermally activated aging effects on functional and parametric radiation hardness. These results have implications on hardness assurance testing. Techniques for characterizing aging effects are proposed

  19. Why Are Drugs So Hard to Quit?

    Medline Plus

    Full Text Available ... Quitting drugs is hard because addiction is a brain disease. Your brain is like a control tower that sends out ... and choices. Addiction changes the signals in your brain and makes it hard to feel OK without ...

  20. The impact of using computer decision-support software in primary care nurse-led telephone triage: interactional dilemmas and conversational consequences.

    Science.gov (United States)

    Murdoch, Jamie; Barnes, Rebecca; Pooler, Jillian; Lattimer, Valerie; Fletcher, Emily; Campbell, John L

    2015-02-01

    Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Rod drive and latching mechanism

    International Nuclear Information System (INIS)

    Veronesi, L.; Sherwood, D.G.

    1982-01-01

    Hydraulic drive and latching mechanisms for driving reactivity control mechanisms in nuclear reactors are described. Preferably, the pressurized reactor coolant is utilized to raise the drive rod into contact with and to pivot the latching mechanism so as to allow the drive rod to pass the latching mechanism. The pressure in the housing may then be equalized which allows the drive rod to move downwardly into contact with the latching mechanism but to hold the shaft in a raised position with respect to the reactor core. Once again, the reactor coolant pressure may be utilized to raise the drive rod and thus pivot the latching mechanism so that the drive rod passes above the latching mechanism. Again, the mechanism pressure can be equalized which allows the drive rod to fall and pass by the latching mechanism so that the drive rod approaches the reactor core. (author)

  2. Predicting psychopharmacological drug effects on actual driving performance (SDLP) from psychometric tests measuring driving-related skills.

    Science.gov (United States)

    Verster, Joris C; Roth, Thomas

    2012-03-01

    There are various methods to examine driving ability. Comparisons between these methods and their relationship with actual on-road driving is often not determined. The objective of this study was to determine whether laboratory tests measuring driving-related skills could adequately predict on-the-road driving performance during normal traffic. Ninety-six healthy volunteers performed a standardized on-the-road driving test. Subjects were instructed to drive with a constant speed and steady lateral position within the right traffic lane. Standard deviation of lateral position (SDLP), i.e., the weaving of the car, was determined. The subjects also performed a psychometric test battery including the DSST, Sternberg memory scanning test, a tracking test, and a divided attention test. Difference scores from placebo for parameters of the psychometric tests and SDLP were computed and correlated with each other. A stepwise linear regression analysis determined the predictive validity of the laboratory test battery to SDLP. Stepwise regression analyses revealed that the combination of five parameters, hard tracking, tracking and reaction time of the divided attention test, and reaction time and percentage of errors of the Sternberg memory scanning test, together had a predictive validity of 33.4%. The psychometric tests in this test battery showed insufficient predictive validity to replace the on-the-road driving test during normal traffic.

  3. The hard problem of cooperation.

    Directory of Open Access Journals (Sweden)

    Kimmo Eriksson

    Full Text Available Based on individual variation in cooperative inclinations, we define the "hard problem of cooperation" as that of achieving high levels of cooperation in a group of non-cooperative types. Can the hard problem be solved by institutions with monitoring and sanctions? In a laboratory experiment we find that the answer is affirmative if the institution is imposed on the group but negative if development of the institution is left to the group to vote on. In the experiment, participants were divided into groups of either cooperative types or non-cooperative types depending on their behavior in a public goods game. In these homogeneous groups they repeatedly played a public goods game regulated by an institution that incorporated several of the key properties identified by Ostrom: operational rules, monitoring, rewards, punishments, and (in one condition change of rules. When change of rules was not possible and punishments were set to be high, groups of both types generally abided by operational rules demanding high contributions to the common good, and thereby achieved high levels of payoffs. Under less severe rules, both types of groups did worse but non-cooperative types did worst. Thus, non-cooperative groups profited the most from being governed by an institution demanding high contributions and employing high punishments. Nevertheless, in a condition where change of rules through voting was made possible, development of the institution in this direction was more often voted down in groups of non-cooperative types. We discuss the relevance of the hard problem and fit our results into a bigger picture of institutional and individual determinants of cooperative behavior.

  4. The hard problem of cooperation.

    Science.gov (United States)

    Eriksson, Kimmo; Strimling, Pontus

    2012-01-01

    Based on individual variation in cooperative inclinations, we define the "hard problem of cooperation" as that of achieving high levels of cooperation in a group of non-cooperative types. Can the hard problem be solved by institutions with monitoring and sanctions? In a laboratory experiment we find that the answer is affirmative if the institution is imposed on the group but negative if development of the institution is left to the group to vote on. In the experiment, participants were divided into groups of either cooperative types or non-cooperative types depending on their behavior in a public goods game. In these homogeneous groups they repeatedly played a public goods game regulated by an institution that incorporated several of the key properties identified by Ostrom: operational rules, monitoring, rewards, punishments, and (in one condition) change of rules. When change of rules was not possible and punishments were set to be high, groups of both types generally abided by operational rules demanding high contributions to the common good, and thereby achieved high levels of payoffs. Under less severe rules, both types of groups did worse but non-cooperative types did worst. Thus, non-cooperative groups profited the most from being governed by an institution demanding high contributions and employing high punishments. Nevertheless, in a condition where change of rules through voting was made possible, development of the institution in this direction was more often voted down in groups of non-cooperative types. We discuss the relevance of the hard problem and fit our results into a bigger picture of institutional and individual determinants of cooperative behavior.

  5. Electrical drives for direct drive renewable energy systems

    CERN Document Server

    Mueller, Markus

    2013-01-01

    Wind turbine gearboxes present major reliability issues, leading to great interest in the current development of gearless direct-drive wind energy systems. Offering high reliability, high efficiency and low maintenance, developments in these direct-drive systems point the way to the next generation of wind power, and Electrical drives for direct drive renewable energy systems is an authoritative guide to their design, development and operation. Part one outlines electrical drive technology, beginning with an overview of electrical generators for direct drive systems. Principles of electrical design for permanent magnet generators are discussed, followed by electrical, thermal and structural generator design and systems integration. A review of power electronic converter technology and power electronic converter systems for direct drive renewable energy applications is then conducted. Part two then focuses on wind and marine applications, beginning with a commercial overview of wind turbine drive systems and a...

  6. Hard electroproduction of hybrid mesons

    International Nuclear Information System (INIS)

    Anikin, I.V.; LPT Universite Paris-Sud, Orsay; Szymanowski, L.; Teryaev, O.V.; ); Wallon, S.

    2005-01-01

    We estimate the sizeable cross section for deep exclusive electroproduction of an exotic J PC = 1 -+ hybrid meson in the Bjorken regime. The production amplitude scales like the one for usual meson electroproduction, i.e. as 1/Q 2 . This is due to the non-vanishing leading twist distribution amplitude for the hybrid meson, which may be normalized thanks to its relation to the energy momentum tensor and to the QCD sum rules technique. The hard amplitude is considered up to next-to-leading order in as and we explore the consequences of fixing the renormalization scale ambiguity through the BLM procedure. (author)

  7. Hard Identity and Soft Identity

    Directory of Open Access Journals (Sweden)

    Hassan Rachik

    2006-04-01

    Full Text Available Often collective identities are classified depending on their contents and rarely depending on their forms. Differentiation between soft identity and hard identity is applied to diverse collective identities: religious, political, national, tribal ones, etc. This classification is made following the principal dimensions of collective identities: type of classification (univocal and exclusive or relative and contextual, the absence or presence of conflictsof loyalty, selective or totalitarian, objective or subjective conception, among others. The different characteristics analysed contribute to outlining an increasingly frequent type of identity: the authoritarian identity.

  8. Driving towards ecotechnologies.

    Science.gov (United States)

    Najjar, Devora A; Normandin, Avery M; Strait, Elizabeth A; Esvelt, Kevin M

    2017-12-01

    The prospect of using genetic methods to target vector, parasite, and reservoir species offers tremendous potential benefits to public health, but the use of genome editing to alter the shared environment will require special attention to public perception and community governance in order to benefit the world. Public skepticism combined with the media scrutiny of gene drive systems could easily derail unpopular projects entirely, especially given the potential for trade barriers to be raised against countries that employ self-propagating gene drives. Hence, open and community-guided development of thoughtfully chosen applications is not only the most ethical approach, but also the most likely to overcome the economic, social, and diplomatic barriers. Here we review current and past attempts to alter ecosystems using biological methods, identify key determinants of social acceptance, and chart a stepwise path for developers towards safe and widely supported use.

  9. Control rod drives

    International Nuclear Information System (INIS)

    Asano, Hiromitsu.

    1979-01-01

    Purpose: To drive control rods at an optimum safety speed corresponding to the reactor core output. Constitution: The reactor power is detected by a neutron detector and the output signal is applied to a process computer. The process computer issues a signal representing the reactor core output, which is converted through a function generator into a signal representing the safety speed of control rods. The converted signal is further supplied to a V/F converter and converted into a pulse signal. The pulse signal is inputted to a step motor driving circuit, which actuates a step motor to operate the control rods always at a safety speed corresponding to the reactor core power. (Furukawa, Y.)

  10. Drive-by-Downloads

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, Julia; Endicott-Popovsky, Barbara E.; Seifert, Christian; Aval, Chiraag U.; Frincke, Deborah A.

    2010-02-01

    Abstract: Drive-by-downloads are malware that push, and then execute, malicious code on a client system without the user's consent. The purpose of this paper is to introduce a discussion of the usefulness of antivirus software for detecting the installation of such malware, providing groundwork for future studies. Client honeypots collected drive-by malware which was then evaluated using common antivirus products. Initial analysis showed that most of such antivirus products identified less than 70% of these highly polymorphic malware programs. Also, it was observed that the antivirus products tested, even when successfully detecting this malware, often failed to classify it, leading to the conclusion that further work could involve not only developing new behavioral detection technologies, but also empirical studies that improve general understanding of these threats. Toward that end, one example of malicious code was analyzed behaviorally to provide insight into next steps for the future direction of this research.

  11. Safety rod driving device

    International Nuclear Information System (INIS)

    Murakami, Kiyonobu; Kurosaki, Akira.

    1988-01-01

    Purpose: To rapidly insert safety rods for a criticality experiment device into a reactor core container to stop the criticality reaction thereby prevent reactivity accidents. Constitution: A cylinder device having a safety rod as a cylinder rod attached with a piston at one end is constituted. The piston is elevated by pressurized air and attracted and fixed by an electromagnet which is a stationary device disposed at the upper portion of the cylinder. If the current supply to the electromagnet is disconnected, the safety rod constituting the cylinder rod is fallen together with the piston to the lower portion of the cylinder. Since the cylinder rod driving device has neither electrical motor nor driving screw as in the conventional device, necessary space can be reduced and the weight is decreased. In addition, since the inside of the nuclear reactor can easily be shielded completely from the external atmosphere, leakage of radioactive materials can be prevented. (Horiuchi, T.)

  12. Control rod drive mechanism

    International Nuclear Information System (INIS)

    Futatsugi, Masao; Goto, Mikihiko.

    1976-01-01

    Purpose: To provide a control rod drive mechanism using water as an operating source, which prevents a phenomenon for forming two-layers of water in the neighbourhood of a return nozzle in a reactor to limit formation of excessive thermal stress to improve a safety. Constitution: In the control rod drive mechanism of the present invention, a heating device is installed in the neighbourhood of a pressure container for a reactor. This heating device is provided to heat return water in the reactor to a level equal to the temperature of reactor water thereby preventing a phenomenon for forming two-layers of water in the reactor. This limits formation of thermal stress in the return nozzle in the reactor. Accordingly, it is possible to minimize damages in the return nozzle portion and yet a possibility of failure in reactor water. (Kawakami, Y.)

  13. A rotary drive

    International Nuclear Information System (INIS)

    Causer, R.

    1983-01-01

    A rotary drive for a manipulator or teleoperator comprises a ring member freely rotatable about an eccentric boss extending from an input driver shaft. The ring member has a tapered rim portion wedged between two resiliently biassed friction rings of larger diameter than the ring member and coaxial with the driver shaft, and the ring member is rotatably connected to an output driven shaft. The rotary drive provides a considerable velocity ratio, and also provides a safety feature in that friction between the rim portion and the friction rings only causes rotation of the driven shaft if the load on the driven shaft is less than a certain limiting value. This limiting value may be varied by adjusting the resilient bias on the friction rings. (author)

  14. Driving and engine cycles

    CERN Document Server

    Giakoumis, Evangelos G

    2017-01-01

    This book presents in detail the most important driving and engine cycles used for the certification and testing of new vehicles and engines around the world. It covers chassis and engine-dynamometer cycles for passenger cars, light-duty vans, heavy-duty engines, non-road engines and motorcycles, offering detailed historical information and critical review. The book also provides detailed examples from SI and diesel engines and vehicles operating during various cycles, with a focus on how the engine behaves during transients and how this is reflected in emitted pollutants, CO2 and after-treatment systems operation. It describes the measurement methods for the testing of new vehicles and essential information on the procedure for creating a driving cycle. Lastly, it presents detailed technical specifications on the most important chassis-dynamometer cycles around the world, together with a direct comparison of those cycles.

  15. Driving electrostatic transducers

    DEFF Research Database (Denmark)

    Nielsen, Dennis; Knott, Arnold; Andersen, Michael A. E.

    2013-01-01

    Electrostatic transducers represent a very interesting alternative to the traditional inefficient electrodynamic transducers. In order to establish the full potential of these transducers, power amplifiers which fulfill the strict requirements imposed by such loads (high impedance, frequency...... depended, nonlinear and high bias voltage for linearization) must be developed. This paper analyzes power stages and bias configurations suitable for driving an electrostatic transducer. Measurement results of a 300 V prototype amplifier are shown. Measuring THD across a high impedance source is discussed...

  16. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses

    International Nuclear Information System (INIS)

    Lakkaraju, A.; Sinha, R.; Garikipati, R.; Edward, S.; Robinson, P.

    2009-01-01

    Aim: To evaluate the efficacy of ultrasound as a first-line investigation in patients with a clinical soft-tissue mass. Methods: Three hundred and fifty-eight consecutive patients (155 male, 203 female, mean age 48 years) referred from primary and secondary care with soft-tissue masses underwent ultrasound evaluation. Five radiologists performed ultrasound using a 10-15 MHz linear transducer and recorded the referrer diagnosis, history, lesion size, anatomical location and depth, internal echogenicity, external margins (well-defined rim or infiltrative), and vascularity on power Doppler (absent or present, if present the pattern was listed as either linear or disorganized). A provisional ultrasound diagnosis was made using one of eight categories. Benign categories (categories 1-5) were referred back to a non-sarcoma specialist or original referrer for observation. Indeterminate or possible sarcomas (categories 6-8) were referred for magnetic resonance imaging (MRI) within 14 days. Additionally category 8 lesions were referred to the regional sarcoma service. Institutional and regional database follow-up was performed. Results: Two hundred and eighty-four of the 358 (79%) lesions were classified as benign (categories 1-5). On follow-up 15 of the 284 patients were re-referred but none (284/284) had a malignancy on follow-up (24-30 months). Overall at ultrasound 33 lesions were larger than 5 cm, 42 lesions were deep to deep fascia with 20 showing both features. In this subgroup of 95 patients there were six malignant tumours with the rest benign. Seventy-three of the 358 patients underwent MRI; the results of which indicated that there were 60 benign or non-tumours, 10 possible sarcomas, and three indeterminate lesions. Overall six of 12 (6/358, 1.68% of total patients) lesions deemed to represent possible sarcomas on imaging were sarcomas. Conclusion: Ultrasound is an effective diagnostic triage tool for the evaluation of soft-tissue masses referred from primary

  17. Health assessment of raptors in triage in Belo Horizonte, MG, Brazil

    Directory of Open Access Journals (Sweden)

    D de A Andery

    2013-09-01

    Full Text Available Falconiformes (n=82, Strigiformes (n=84 and Cathartiformes (n=14 at a triage center (CETAS-Belo Horizonte, IBAMA, Brazil were examined between 2008 and 2010 . No bird was reactive at hemagglutination-inhibition (HI for antibodies against Mycoplasma gallisepticum (Mg. Two Caracara plancus (2/68 had HI titers (16-32 against Newcastle disease virus. No Chlamydophila psittaci DNA was detected in the liver (PCR; n=95. Blood smears (Giemsa; n=89 and spleen fragments (PCR; n=82 were 13.5% and 8.5% positive, respectively, for Haemoproteus only. Necropsy of Cathartiformes (n=10, Falconiformes (n=42 and Strigiformes (n=57 showed that trauma injuries were the main cause (63.3% of admission and death, being fractures (38.5% of the thoracic limbs (57.1% the most frequent. Nematode (12.8%, cestode (1.8%, trematode (0.9%, and acanthocephalan (2.7% parasite infections were relevant. Mites (Acari were the most frequent (17.4% external parasites, particularly Ornithonyssus sylviarum in Asio clamator and Amblyomma cajennense in Tyto alba. Chewing lice (10.1% and Pseudolynchia spp. (9.2% were also found. Histomonas spp. (6.4% was found in the ceca of Bubo virginianus, Athene cunicularia, Tyto alba, and Asio clamator, but not in Falconiformes or Cathartiformes. Trichomonas spp. (oral cavity, pharynx and upper esophagus; 9.1% was detected in Falconiformes and Strigiformes, but not in Cathartiformes. Trichomonas spp. were found in A. cunicularia, Asio clamator, Glaucidium brasilianum and Tyto alba (Strigiformes, and in Rupornis magnirostris, Milvago chimachima, Falco femoralis, Falco sparverius and Caracara plancus (Falconiformes. Coccidia (9.1% (Sarcocystis spp., 6.4% and mycosis were observed in most Tyto alba (70%. The evaluated Orders may not pose risks for commercial poultry production. Habitat loss and urban adaptation may be increasingly affecting raptors.

  18. A deployable in vivo EPR tooth dosimeter for triage after a radiation event involving large populations

    International Nuclear Information System (INIS)

    Williams, Benjamin B.; Dong, Ruhong; Flood, Ann Barry; Grinberg, Oleg; Kmiec, Maciej; Lesniewski, Piotr N.; Matthews, Thomas P.; Nicolalde, Roberto J.; Raynolds, Tim; Salikhov, Ildar K.; Swartz, Harold M.

    2011-01-01

    In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators. Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately 5 min, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care. -- Highlights: → Advances in radiation biodosimetry are needed for large-scale emergency response. → Radiation-induced radicals in tooth enamel can be measured using in vivo EPR. → A novel transportable spectrometer was applied in the laboratory and at remote sites. → The current

  19. Violence against nurses in the triage area: An Italian qualitative study.

    Science.gov (United States)

    Ramacciati, Nicola; Ceccagnoli, Andrea; Addey, Beniamino

    2015-10-01

    This qualitative study aims to investigate the feelings experienced by nurses following episodes of violence in the workplace. Numerous studies show that healthcare professionals are increasingly finding themselves victims of violence; of all professionals, nurses in the Emergency Department and especially those performing triage are one of the staff categories which most frequently experience these episodes during their work. In Italy, this phenomenon has been studied very little in comparison to other countries but has recently been gaining increasing attention. Few studies have investigated the feelings experienced by nurses following episodes of violence in the workplace. For this study a phenomenological approach was used. Assumptions and previous findings were set aside (bracketing). A purposive sample of 9 nurses coming from 7 different Emergency Department in the region of Tuscany, Italy was interviewed during a focus group meeting. The data analysis was carried out using the Colaizzi method. Data analysis revealed 10 significant themes/responses. The quality of reporting was guaranteed by adopting the COREQ criteria. Data analysis revealed that nurses feel that violent episodes are "inevitable" and that they feel they have grown accustomed to high levels of violence, that they suffer feelings of "inadequacy" but also that they are aware that they themselves can trigger conflict with patients, and again suffer the feeling of "being alone" in facing these problems and a sense of "being left on their own" by the institution and feeling "hurt", "scared", "angry" and have a sense that "it is not fair". Last but not least, "the gender difference" appears to play an important role in the emotional response. To suffer episodes of violence has serious and severe "hidden costs" which are just as important as the direct, tangible costs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Monitor Soil Degradation or Triage for Soil Security? An Australian Challenge

    Directory of Open Access Journals (Sweden)

    Andrea Koch

    2015-04-01

    Full Text Available The Australian National Soil Research, Development and Extension Strategy identifies soil security as a foundation for the current and future productivity and profitability of Australian agriculture. Current agricultural production is attenuated by soil degradation. Future production is highly dependent on the condition of Australian soils. Soil degradation in Australia is dominated in its areal extent by soil erosion. We reiterate the use of soil erosion as a reliable indicator of soil condition/quality and a practical measure of soil degradation. We describe three key phases of soil degradation since European settlement, and show a clear link between inappropriate agricultural practices and the resultant soil degradation. We demonstrate that modern agricultural practices have had a marked effect on reducing erosion. Current advances in agricultural soil management could lead to further stabilization and slowing of soil degradation in addition to improving productivity. However, policy complacency towards soil degradation, combined with future climate projections of increased rainfall intensity but decreased volumes, warmer temperatures and increased time in drought may once again accelerate soil degradation and susceptibility to erosion and thus limit the ability of agriculture to advance without further improving soil management practices. Monitoring soil degradation may indicate land degradation, but we contend that monitoring will not lead to soil security. We propose the adoption of a triaging approach to soil degradation using the soil security framework, to prioritise treatment plans that engage science and agriculture to develop practices that simultaneously increase productivity and improve soil condition. This will provide a public policy platform for efficient allocation of public and private resources to secure Australia’s soil resource.

  1. Elderly fall patients triaged to the trauma bay: age, injury patterns, and mortality risk.

    Science.gov (United States)

    Evans, Daniel; Pester, Jonathan; Vera, Luis; Jeanmonod, Donald; Jeanmonod, Rebecca

    2015-11-01

    Falls in the elderly are a significant cause of morbidity and mortality. We sought to better categorize this patient population and describe factors contributing to their falls. This is a retrospective review of geriatric patients presenting to a level 1 community trauma center. We queried our trauma database for all patients 65 years and older presenting with fall and triaged to the trauma bay from 2008 to 2013. Researchers reviewed the patients' trauma intake paperwork to assess mechanism, injury, and location of fall, whereas discharge summaries were reviewed to determine disposition, morbidity, and mortality. A total of 650 encounters were analyzed. Five hundred thirty-nine resided at home (82.9%), 110 presented from nursing homes or assisted living (16.9%), and 1 came from hospice (0.15%). Ninety-five patients died or were placed on hospice as a result of their falls (14.7%), of which 88 came from home. Controlling for Injury Severity Score, living at home was an independent risk factor for fall-related mortality (odds ratio, 3.0). Comparing the elderly (age 65-79 years; n = 274) and the very elderly (age ≥80 years; n = 376), there were no differences in Injury Severity Score (P = .33), likelihood of death (P = .49), likelihood of C-spine injury (P = 1.0), or likelihood of other axial or long bone skeletal injury (P = .23-1.0). There was a trend for increased likelihood of head injury in very elderly patients (P = 0.06). Prevention measures to limit morbidity and mortality in elderly fall patients should be aimed at the home setting, where most severe injuries occur. Very elderly patients may be at increased risk for intracranial fall-related injuries. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Natural immune responses against eight oncogenic human papillomaviruses in the ASCUS-LSIL triage study

    Science.gov (United States)

    Wilson, Lauren E.; Pawlita, Michael; Castle, Phillip E.; Waterboer, Tim; Sahasrabuddhe, Vikrant; Gravitt, Patti E.; Schiffman, Mark; Wentzensen, Nicolas

    2014-01-01

    Only a subset of women with human papillomavirus (HPV) infections will become seropositive, and the factors influencing seroconversion are not well-understood. We used a multiplex serology assay in women with mildly abnormal cytology results to examine seroreactivity to oncogenic HPV genotypes. An unbiased subset of women in the atypical squamous cell of undetermined significance /low-grade squamous intraepithelial lesion Triage Study (ALTS) provided blood samples at trial enrollment for serological testing. A Luminex assay based on GST-L1 fusion proteins as antigens was used to test seroreactivity against eight carcinogenic HPV genotypes (16, 18, 31, 33, 35, 45, 52, 58). We analyzed the relationship between seroprevalence in women free of precancer (N=2464) and HPV DNA status, age, sexual behavior, and other HPV-related risk factors. The overall seroprevalence was 24.5% for HPV16 L1 and ~ 20% for 18L1 and 31L1. Among women free of precancer, seroprevalence peaked in women less than 29 years and decreased with age. Type-specific seroprevalence was associated with baseline DNA detection for HPV16 (OR= 1.36, 95%CI: 1.04–1.79) and HPV18 (OR= 2.31, 95%CI: 1.61–3.32), as well as for HPV52 and HPV58. Correlates of sexual exposure were associated with increased seroprevalence across most genotypes. Women who were current or former smokers were less likely to be seropositive for all eight of the tested oncogenic genotypes. The multiplex assay showed associations between seroprevalence and known risk factors for HPV infection across nearly all tested HPV genotypes but associations between DNA- and serostatus were weak, suggesting possible misclassification of the participants’ HPV serostatus. PMID:23588935

  3. Hierarchical clustering of HPV genotype patterns in the ASCUS-LSIL triage study

    Science.gov (United States)

    Wentzensen, Nicolas; Wilson, Lauren E.; Wheeler, Cosette M.; Carreon, Joseph D.; Gravitt, Patti E.; Schiffman, Mark; Castle, Philip E.

    2010-01-01

    Anogenital cancers are associated with about 13 carcinogenic HPV types in a broader group that cause cervical intraepithelial neoplasia (CIN). Multiple concurrent cervical HPV infections are common which complicate the attribution of HPV types to different grades of CIN. Here we report the analysis of HPV genotype patterns in the ASCUS-LSIL triage study using unsupervised hierarchical clustering. Women who underwent colposcopy at baseline (n = 2780) were grouped into 20 disease categories based on histology and cytology. Disease groups and HPV genotypes were clustered using complete linkage. Risk of 2-year cumulative CIN3+, viral load, colposcopic impression, and age were compared between disease groups and major clusters. Hierarchical clustering yielded four major disease clusters: Cluster 1 included all CIN3 histology with abnormal cytology; Cluster 2 included CIN3 histology with normal cytology and combinations with either CIN2 or high-grade squamous intraepithelial lesion (HSIL) cytology; Cluster 3 included older women with normal or low grade histology/cytology and low viral load; Cluster 4 included younger women with low grade histology/cytology, multiple infections, and the highest viral load. Three major groups of HPV genotypes were identified: Group 1 included only HPV16; Group 2 included nine carcinogenic types plus non-carcinogenic HPV53 and HPV66; and Group 3 included non-carcinogenic types plus carcinogenic HPV33 and HPV45. Clustering results suggested that colposcopy missed a prevalent precancer in many women with no biopsy/normal histology and HSIL. This result was confirmed by an elevated 2-year risk of CIN3+ in these groups. Our novel approach to study multiple genotype infections in cervical disease using unsupervised hierarchical clustering can address complex genotype distributions on a population level. PMID:20959485

  4. A deployable in vivo EPR tooth dosimeter for triage after a radiation event involving large populations

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Benjamin B., E-mail: Benjamin.B.Williams@dartmouth.edu [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Section of Radiation Oncology, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH (United States); Dong, Ruhong [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Flood, Ann Barry [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Clin-EPR, LLC, Lyme, NH (United States); Grinberg, Oleg [Clin-EPR, LLC, Lyme, NH (United States); Kmiec, Maciej; Lesniewski, Piotr N.; Matthews, Thomas P.; Nicolalde, Roberto J.; Raynolds, Tim [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Salikhov, Ildar K. [Clin-EPR, LLC, Lyme, NH (United States); Swartz, Harold M. [Dartmouth Physically Based Biodosimetry Center for Medical Countermeasures Against Radiation (Dart-Dose CMCR), Dartmouth Medical School, Hanover, NH 03768 (United States); Clin-EPR, LLC, Lyme, NH (United States)

    2011-09-15

    In order to meet the potential need for emergency large-scale retrospective radiation biodosimetry following an accident or attack, we have developed instrumentation and methodology for in vivo electron paramagnetic resonance spectroscopy to quantify concentrations of radiation-induced radicals within intact teeth. This technique has several very desirable characteristics for triage, including independence from confounding biologic factors, a non-invasive measurement procedure, the capability to make measurements at any time after the event, suitability for use by non-expert operators at the site of an event, and the ability to provide immediate estimates of individual doses. Throughout development there has been a particular focus on the need for a deployable system, including instrumental requirements for transport and field use, the need for high throughput, and use by minimally trained operators. Numerous measurements have been performed using this system in clinical and other non-laboratory settings, including in vivo measurements with unexposed populations as well as patients undergoing radiation therapies. The collection and analyses of sets of three serially-acquired spectra with independent placements of the resonator, in a data collection process lasting approximately 5 min, provides dose estimates with standard errors of prediction of approximately 1 Gy. As an example, measurements were performed on incisor teeth of subjects who had either received no irradiation or 2 Gy total body irradiation for prior bone marrow transplantation; this exercise provided a direct and challenging test of our capability to identify subjects who would be in need of acute medical care. -- Highlights: > Advances in radiation biodosimetry are needed for large-scale emergency response. > Radiation-induced radicals in tooth enamel can be measured using in vivo EPR. > A novel transportable spectrometer was applied in the laboratory and at remote sites. > The current instrument

  5. Effectiveness of Resident Physicians as Triage Liaison Providers in an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Victoria Weston

    2017-04-01

    Full Text Available Introduction: Emergency department (ED crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. Methods: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods. The primary outcome was defined as cost-effectiveness based upon return on investment (ROI. Secondary outcomes were defined as differences in median ED length of stay (LOS, median door-to-provider (DTP time, proportion of left without being seen (LWBS, and proportion of “very good” overall patient satisfaction scores. Results: Annual profit generated for physician-based collections through LWBS capture (after deducting respective salary costs equated to a gain (ROI: 54% for resident TLPs and a loss (ROI: −31% for attending TLPs. Accounting for hospital-based collections made both profitable, with gains for resident TLPs (ROI: 317% and for attending TLPs (ROI: 86%. Median DTP time for resident TLPs was significantly lower (p<0.0001 than attending or historical control. Proportion of “very good” patient satisfaction scores and LWBS was improved for both resident and attending TLPs over historical control. Overall median LOS was not significantly different. Conclusion: Resident and attending TLPs improved DTP time, patient satisfaction, and LWBS rates. Both resident and attending TLPs are cost effective, with residents having a more favorable financial profile.

  6. CT triage for lung malignancy: coronal multiplanar reformation versus images in three orthogonal planes.

    Science.gov (United States)

    Kusk, Martin Weber; Karstoft, Jens; Mussmann, Bo Redder

    2015-11-01

    Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks. To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers. Retrospective study of 63 patients with suspicion of lung cancer, scanned on 64-slice multidetector computed tomography (MDCT) with images reconstructed in three planes. Coronal images were presented to four readers, two novice and two experienced. Readers decided whether the patients were suspicious for malignant disease, and indicated their confidence on a five-point scale. Sensitivity and specificity on per-patient basis was calculated with regards to a reference standard of histological diagnosis, and compared with the original report using McNemar's test. Receiver operating characteristic (ROC) curves were plotted to compare the performance of the four readers, using the area under the curve (AUC) as figure of merit. No statistically significant difference of sensitivity and specificity was found for any of the readers when compared to the original reports. ROC analysis yielded AUCs in the range of 0.92-0.93 for all readers with no significant difference. Inter-rater agreement was substantial (kappa = 0.72). Sensitivity and specificity were comparable to diagnosis using images in three planes. No significant difference was found between experienced and novice readers. © The Foundation Acta Radiologica 2014.

  7. Endovascular treatment outcomes using the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program.

    Science.gov (United States)

    Hassan, Ameer E; Sanchez, Christina; Johnson, Angela N

    2018-02-01

    Background "Door to treatment" time affects outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, the correlation between staff education and accessible technology with stroke outcomes has not been demonstrated. Objective The objective of this paper is to demonstrate the five-year impact of the Stroke Triage Education, Procedure Standardization, and Technology (STEPS-T) program on time-to-treat and clinical outcomes. Methods The study analyzed a prospectively maintained database of AIS patients who benefited from EVT through implementation of STEPS-T. Demographics, clinical characteristics, and modified Rankin Score at three months were analyzed. Thrombolysis in Cerebral Infarction (TICI) scale was used to grade pre- and post-procedure angiographic recanalization. Using electronic hemodynamic recording, stepwise workflow times were collected for door time (T D ), entering angiography suite (T A ), groin puncture (T G ), first DSA (T DSA ), microcatheter placement (T M ), and final recanalization (T R ). Median intervention time (T A to T R ) and recanalization time (T G to T R ) were compared through Year 1 to Year 5. Results A total of 230 individuals (age 74 ± 12, between 30 to 95) were enrolled. Median intervention and recanalization times were significantly reduced, from 121 minutes to 52 minutes and from 83 minutes to 36 minutes respectively from Year 1 to Year 5, ( p < 0.001). Across the study period, annual recruitment went up from 12 to 66 patients, and modified Rankin Score between 0 and 2 increased from 36% to 59% ( p = 0.024). Conclusions STEPS-T improved time-to-treat in patients undergoing mechanical thrombectomy for AIS. During the observation period, clinical outcomes significantly improved.

  8. Advanced practice physiotherapy-led triage in Irish orthopaedic and rheumatology services: national data audit.

    Science.gov (United States)

    Fennelly, Orna; Blake, Catherine; FitzGerald, Oliver; Breen, Roisin; Ashton, Jennifer; Brennan, Aisling; Caffrey, Aoife; Desmeules, François; Cunningham, Caitriona

    2018-06-01

    Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. Throughout 2014, APPs (n = 22) entered clinical data on a national database. Analysis of these data using descriptive statistics determined patient wait times, Consultant Doctor involvement in clinical decisions, and patient clinical outcomes. Chi square tests were used to compare patient clinical outcomes across orthopaedic and rheumatology clinics. A pilot study at one site identified re-referral rates to orthopaedic/rheumatology services of patients managed by the APPs. In one year, 13,981 new patients accessed specialist orthopaedic and rheumatology consultations via the APP. Median wait time for an appointment was 5.6 months. Patients most commonly presented with knee (23%), lower back (22%) and shoulder (15%) disorders. APPs made autonomous clinical decisions regarding patient management at 77% of appointments, and managed patient care pathways without onward referral to Consultant Doctors in more than 80% of cases. Other onward clinical pathways recommended by APPs were: physiotherapy referrals (42%); clinical investigations (29%); injections administered (4%); and surgical listing (2%). Of those managed by the APP, the pilot study identified that only 6.5% of patients were re-referred within one year. This national evaluation of APP services demonstrated that the majority of patients assessed by an APP did not require onward referral for a Consultant Doctor appointment. Therefore, patients gained earlier access to orthopaedic and rheumatology consultations in secondary care, with most patients conservatively managed.

  9. Control rod drive mechanism

    International Nuclear Information System (INIS)

    Mizuno, Katsuyuki.

    1976-01-01

    Object: To restrict the reduction in performance due to stress corrosion cracks by making use of condensate produced in a turbine steam condenser. Structure: Water produced in a turbine steam condenser is forced into a condensed water desalting unit by low pressure condensate pump. The condensate is purified and then forced by a high pressure condensate pump into a feedwater heater for heating before it is returned to the reactor by a feedwater pump. Part of the condensate issuing from the condensate desalting unit is branched from the remaining portion at a point upstream the pump and is withdrawn into a control rod drive water pump after passing through a motordriven bypass valve, an orifice and a condenser water level control valve, is pressurized in the control rod drive water desalting unit and supplied to a control rod drive water pressure system. The control rod is vertically moved by the valve operation of the water pressure system. Since water of high oxygen concentration does not enter during normal operation, it is possible to prevent the stress cracking of the stainless steel apparatus. (Nakamura, S.)

  10. Motor car driving; Kraftfahrzeugfuehrung

    Energy Technology Data Exchange (ETDEWEB)

    Juergensohn, T. [Technische Univ. Berlin (Germany). ISS-Fahrzeugtechnik; Timpe, K.P. (eds.) [Technische Univ. Berlin (DE). Zentrum Mensch-Maschine-Systeme (ZMMS)

    2001-07-01

    This is the first comprehensive book on motor car driving, i.e. all aspects of motor car technology that cannot be looked at separately from the needs, characteristics and limitations of the human driver. This includes ergonomics as well as the design of the driver interface in consideration of the findings of cognitive science, problems of driving simulation in the context of simulation of technical systems, problems relating to optimal car automation up to traffic psychology. The book is in honour of Prof. Dr. Willumeit who died in summer 2000. Prof. Willumeit was one of the few scientists in Germany who had been an expert on all aspects of motor car driving for many years. [German] Erstmalig wird das Thema der Fahrzeugfuehrung geschlossen dargestellt. Die Thematik der 'Kraftfahrzeugfuehrung' umfasst in diesem Zusammenhang alle Aspekte der Kraftfahrzeugtechnik, die nicht isoliert von den Erfordernissen, Eigenschaften und Grenzen des menschlichen Fahrers betrachtet werden koennen. Dies beinhaltet u.a. Probleme der Ergonomie, aber auch Fragen nach einer kognitionswissenschaftlich unterstuetzten Schnittstellengestaltung, Fragen der Simulation des Fahrverhalten im Kontext der Simulation technischer Systeme oder Fragen einer optimalen Fahrzeugautomatisierung bis hin zu verkehrspsychologischen Aspekten. Das Buch ist als Gedenkband fuer Prof. Dr. Willumeit konzipiert, der im Sommer 2000 verstarb. Prof. Willumeit war einer der wenigen Wissenschaftler in Deutschland, der ueber viele Jahre diese Thematik der Kraftfahrzeugfuehrung in ihrer vollen Breite verfolgte. (orig.)

  11. Control rod drive

    International Nuclear Information System (INIS)

    Watando, Kosaku; Tanaka, Yuzo; Mizumura, Yasuhiro; Hosono, Kazuya.

    1975-01-01

    Object: To provide a simple and compact construction of an apparatus for driving a drive shaft inside with a magnetic force from the outside of the primary system water side. Structure: The weight of a plunger provided with an attraction plate is supported by a plunger lift spring means so as to provide a buffer action at the time of momentary movement while also permitting the load on lift coil to be constituted solely by the load on the drive shaft. In addition, by arranging the attraction plate and lift coil so that they face each other with a small gap there-between, it is made possible to reduce the size and permit efficient utilization of the attracting force. Because of the small size, cooling can be simply carried out. Further, since there is no mechanical penetration portion, there is no possibility of leakage of the primary system water. Furthermore, concentration of load on a latch pin is prevented by arranging so that with a structure the load of the control rod to be directly beared through the scrum latch. (Kamimura, M.)

  12. A NICER Look at the Aql X-1 Hard State

    Science.gov (United States)

    Bult, Peter; Arzoumanian, Zaven; Cackett, Edward M.; Chakrabarty, Deepto; Gendreau, Keith C.; Guillot, Sebastien; Homan, Jeroen; Jaisawal, Gaurava K.; Keek, Laurens; Kenyon, Steve; Lamb, Frederick K.; Ludlam, Renee; Mahmoodifar, Simin; Markwardt, Craig; Miller, Jon M.; Prigozhin, Gregory; Soong, Yang; Strohmayer, Tod E.; Uttley, Phil

    2018-05-01

    We report on a spectral-timing analysis of the neutron star low-mass X-ray binary (LMXB) Aql X-1 with the Neutron Star Interior Composition Explorer (NICER) on the International Space Station (ISS). Aql X-1 was observed with NICER during a dim outburst in 2017 July, collecting approximately 50 ks of good exposure. The spectral and timing properties of the source correspond to that of a (hard) extreme island state in the atoll classification. We find that the fractional amplitude of the low-frequency (soft thermal emission and the power-law emission. Additionally, we measure hard time lags, indicating the thermal emission at 0.5 keV leads the power-law emission at 10 keV on a timescale of ∼100 ms at 0.3 Hz to ∼10 ms at 3 Hz. Our results demonstrate that the thermal emission in the hard state is intrinsically variable, and is driving the modulation of the higher energy power-law. Interpreting the thermal spectrum as disk emission, we find that our results are consistent with the disk propagation model proposed for accretion onto black holes.

  13. Self-rated driving and driving safety in older adults.

    Science.gov (United States)

    Ross, Lesley A; Dodson, Joan E; Edwards, Jerri D; Ackerman, Michelle L; Ball, Karlene

    2012-09-01

    Many U.S. states rely on older adults to self-regulate their driving and determine when driving is no longer a safe option. However, the relationship of older adults' self-rated driving in terms of actual driving competency outcomes is unclear. The current study investigates self-rated driving in terms of (1) systematic differences between older adults with high (good/excellent) versus low (poor/fair/average) self-ratings, and (2) the predictive nature of self-rated driving to adverse driving outcomes in older adults (n=350; mean age 73.9, SD=5.25, range 65-91). Adverse driving outcomes included self-reported incidences of (1) being pulled over by the police, (2) receiving a citation, (3) receiving a recommendation to cease or limit driving, (4) crashes, and (5) state-reported crashes. Results found that older drivers with low self-ratings reported more medical conditions, less driving frequency, and had been given more suggestions to stop/limit their driving; there were no other significant differences between low and high self-raters. Logistic regression revealed older drivers were more likely to have a state-reported crash and receive a suggestion to stop or limit driving. Men were more likely to report all adverse driving outcomes except for receiving a suggestion to stop or limit driving. Regarding self-rated driving, older adults with high ratings were 66% less likely (OR=0.34, 95% CI=0.14-0.85) to have received suggestions to limit or stop driving after accounting for demographics, health and driving frequency. Self-ratings were not predictive of other driving outcomes (being pulled over by the police, receiving a citation, self-reported crashes, or state-reported crashes, ps>0.05). Most older drivers (85.14%) rated themselves as either good or excellent drivers regardless of their actual previous citation or crash rates. Self-rated driving is likely not related to actual driving proficiency as indicated by previous crash involvement in older adults

  14. Aespoe hard rock laboratory Sweden

    International Nuclear Information System (INIS)

    1992-01-01

    The aim of the new Aespoe hard rock laboratory is to demonstrate state of the art of technology and evaluation methods before the start of actual construction work on the planned deep repository for spent nuclear fuel. The nine country OECD/NEA project in the Stripa mine in Sweden has been an excellent example of high quality international research co-operation. In Sweden the new Aespoe hard rock laboratory will gradually take over and finalize this work. SKB very much appreciates the continued international participation in Aespoe which is of great value for the quality efficiency, and confidence in this kind of work. We have invited a number of leading experts to this first international seminar to summarize the current state of a number of key questions. The contributions show the great progress that has taken place during the years. The results show that there is a solid scientific basis for using this knowledge on site specific preparation and work on actual repositories. (au)

  15. Future Hard Disk Storage: Limits & Potential Solutions

    Science.gov (United States)

    Lambeth, David N.

    2000-03-01

    For several years the hard disk drive technology pace has raced along at 60-100products this year and laboratory demonstrations approaching what has been estimated as a physical thermal stability limit of around 40 Gbit/in2. For sometime now the data storage industry has recogniz d that doing business as usually will not be viable for long and so both incremental evolutionary and revolutionary technologies are being explored. While new recording head materials or thermal recording techniques may allow higher coercivity materials to be recorded upon, and while high sensitivity spin transport transducer technology may provide sufficient signals to extend beyond the 100 Gigabit/in2 regime, conventional isotropic longitudinal media will show large data retention problems at less than 1/2 of this value. We have recently developed a simple model which indicates that while thermal instability issues may appear at different areal densities, they are non-discriminatory as to the magnetic recording modality: longitudinal, perpendicular, magnetooptic, near field, etc. The model indicates that a strong orientation of the media tends to abate the onset of the thermal limit. Hence, for the past few years we have taken an approach of controlled growth of the microstructure of thin film media. This knowledge has lead us to believe that epitaxial growth of multiple thin film layers on single crystalline Si may provide a pathway to nearly perfect crystallites of various, highly oriented, thin film textures. Here we provide an overview of the recording system media challenges, which are useful for the development of a future media design philosophy and then discuss materials issues and processing techniques for multi-layered thin film material structures which may be used to achieve media structures which can easy exceed the limits predicted for isotropic media.

  16. Low Sex Drive in Women

    Science.gov (United States)

    Low sex drive in women Overview Women's sexual desires naturally fluctuate over the years. Highs and lows commonly coincide ... used for mood disorders also can cause low sex drive in women. If your lack of interest ...

  17. Marijuana and actual driving performance

    Science.gov (United States)

    1993-11-01

    This report concerns the effects of marijuana smoking on actual driving performance. It presents the results of one pilot and three actual driving studies. The pilot study's major purpose was to establish the THC dose current marijuana users smoke to...

  18. Distracted Driving Raises Crash Risk

    Science.gov (United States)

    ... this issue Health Capsule Distracted Driving Raises Crash Risk En español Send us your comments Video technology ... distracted driving, especially among new drivers, raises the risk for car crashes and near crashes. The study ...

  19. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.

    Science.gov (United States)

    Mohan, Deepika; Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Angus, Derek C; Yealy, Donald M; Wallace, David J; Barnato, Amber E

    2017-12-12

    To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Randomized clinical trial. Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively

  20. Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90.

    Science.gov (United States)

    Brown, Joshua B; Gestring, Mark L; Forsythe, Raquel M; Stassen, Nicole A; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

    2015-02-01

    Undertriage is a concern in geriatric patients. The National Trauma Triage Protocol (NTTP) recognized that systolic blood pressure (SBP) less than 110 mm Hg may represent shock in those older than 65 years. The objective was to evaluate the impact of substituting an SBP of less than 110 mm Hg for the current SBP of less than 90 mm Hg criterion within the NTTP on triage performance and mortality. Subjects undergoing scene transport in the National Trauma Data Bank (2010-2012) were included. The outcome of trauma center need was defined as Injury Severity Score (ISS) greater than 15, intensive care unit admission, urgent operation, or emergency department death. Geriatric (age > 65 years) and adult (age, 16-65 years) cohorts were compared. Triage characteristics and area under the curve (AUC) were compared between SBP of less than 110 mm Hg and SBP of less than 90 mm Hg. Hierarchical logistic regression was used to determine whether geriatric patients newly triaged positive under this change (SBP, 90-109 mm Hg) have a risk of mortality similar to those triaged positive with SBP of less than 90 mm Hg. There were 1,555,944 subjects included. SBP of less than 110 mm Hg had higher sensitivity but lower specificity in geriatric (13% vs. 5%, 93% vs. 99%) and adult (23% vs. 10%, 90% vs. 98%) cohorts. AUC was higher for SBP of less than 110 mm Hg individually in both geriatric and adult (p AUC was similar for SBP of less than 110 mm Hg and SBP of less than 90 mm Hg in geriatric subjects but was higher for SBP of less than 90 mm Hg in adult subjects (p < 0.01). Substituting SBP of less than 110 mm Hg resulted in an undertriage reduction of 4.4% with overtriage increase of 4.3% in the geriatric cohort. Geriatric subjects with SBP of 90 mm Hg to 109 mm Hg had an odds of mortality similar to those of geriatric patients with SBP of less than 90 mm Hg (adjusted odds ratio, 1.03; 95% confidence interval, 0.88-1.20; p = 0.71). SBP of less than 110 mm Hg increases sensitivity. SBP of

  1. Information technology systems for critical care triage and medical response during an influenza pandemic: a review of current systems.

    Science.gov (United States)

    Bandayrel, Kristofer; Lapinsky, Stephen; Christian, Michael

    2013-06-01

    To assess local, state, federal, and global pandemic influenza preparedness by identifying pandemic plans at the local, state, federal, and global levels, and to identify any information technology (IT) systems in these plans to support critical care triage during an influenza pandemic in the Canadian province of Ontario. The authors used advanced MEDLINE and Google search strategies and conducted a comprehensive review of key pandemic influenza Web sites. Descriptive data extraction and analysis for IT systems were conducted on all of the included pandemic plans. A total of 155 pandemic influenza plans were reviewed: 29 local, 62 state, 63 federal, and 1 global. We found 70 plans that examined IT systems (10 local, 33 state, 26 federal, 1 global), and 85 that did not (19 local, 29 state, 37 federal). Of the 70 plans, 64 described surveillance systems (10 local, 32 state, 21 federal, 1 global), 2 described patient data collection systems (1 state, 1 federal); 4 described other types of IT systems (4 federal), and none were intended for triage. Although several pandemic plans have been drafted, the majority are high-level general documents that do not describe IT systems. The plans that discuss IT systems focus strongly on surveillance, which fails to recognize the needs of a health care system responding to an influenza pandemic. The best examples of the types of IT systems to guide decision making during a pandemic were found in the Kansas and the Czech Republic pandemic plans, because these systems were designed to collect both patient and surveillance data. Although Ontario has yet to develop such an IT system, several IT systems are in place that could be leveraged to support critical care triage and medical response during an influenza pandemic.

  2. Nuclear refueling platform drive system

    International Nuclear Information System (INIS)

    Busch, F.R.; Faulstich, D.L.

    1992-01-01

    This patent describes a drive system. It comprises: a gantry including a bridge having longitudinal and transverse axes and supported by spaced first and second end frames joined to fist and second end frames joined to first and second drive trucks for moving the bridge along the transverse axis; first means for driving the first drive truck; second means for driving the second drive truck being independent from the first driving means; and means for controlling the first and second driving means for reducing differential transverse travel between the first and second drive trucks, due to a skewing torque acting on the bridge, to less than a predetermined maximum, the controlling means being in the form of an electrical central processing unit and including: a closed-loop first velocity control means for controlling velocity of the first drive truck by providing a first command signal to the first driver means; a close loop second velocity control means for controlling velocity of the second drive truck by providing a second command signal to the second driving means; and an auxiliary closed-loop travel control means

  3. The Effect of Education on the Knowledge and Practice of Emergency Department’s Nurses Regarding the Patients’ Triage

    Directory of Open Access Journals (Sweden)

    Mohammad Kalantarimeibidi

    2014-09-01

    Full Text Available Introduction: Emergency department as one of the most important wards of the hospital confronts with lots of referring patients. Timely service presentation in this ward depends on efficient and effective functions of its personnel. Thus, this study was aimed to evaluate the effect of education on the knowledge and practice of emergency department’s nurses in the patients’ triage field. Methods: In this cross-sectional study, the knowledge and practice of 50 nurses was evaluated before and after of 9 hours educational workshop regarding patients’ triage based on the emergency severity index (ESI. Persons who had at least six months work experience in the emergency department and did not participate in any triage workshop during the six years before starting the project were entered to the study. Data gathering was performed through preparing three questionnaires separately included demographic information as well as assessment of knowledge and practice. Evaluated demographic characteristics were age, gender, marital status, work history, academic degree, type of employment, work shift, and average of work shift weekly. To assess the knowledge and practice, two separate questionnaires were used that their reliability and validity were confirmed before. Data was analyzed using SPSS 16 and appropriate analytic tests. P<0.05 was considered as statistically significant. Results: The average knowledge scores of nurses reached from 7.5±2.1 to 14±1.6 (p= 0.001, r=0.49 after education. Also the average scores of participants increased from 31.8±9.9 to 69.7±8.1 (p= 0.001, r=0.87.  There was no significant relationship between characteristics of nurses and their knowledge scores in six weeks after education (p>0.05. While it was seen between the work history of nursing (p=0.038, working in emergency department (p=0.001, as well as type of employment (p=0.019 and average scores of practice within six weeks after education. No significant

  4. Creating a driving profile for older adults using GPS devices and naturalistic driving methodology.

    Science.gov (United States)

    Babulal, Ganesh M; Traub, Cindy M; Webb, Mollie; Stout, Sarah H; Addison, Aaron; Carr, David B; Ott, Brian R; Morris, John C; Roe, Catherine M

    2016-01-01

    Background/Objectives : Road tests and driving simulators are most commonly used in research studies and clinical evaluations of older drivers. Our objective was to describe the process and associated challenges in adapting an existing, commercial, off-the-shelf (COTS), in-vehicle device for naturalistic, longitudinal research to better understand daily driving behavior in older drivers. Design : The Azuga G2 Tracking Device TM was installed in each participant's vehicle, and we collected data over 5 months (speed, latitude/longitude) every 30-seconds when the vehicle was driven.  Setting : The Knight Alzheimer's Disease Research Center at Washington University School of Medicine. Participants : Five individuals enrolled in a larger, longitudinal study assessing preclinical Alzheimer disease and driving performance.  Participants were aged 65+ years and had normal cognition. Measurements :  Spatial components included Primary Location(s), Driving Areas, Mean Centers and Unique Destinations.  Temporal components included number of trips taken during different times of the day.  Behavioral components included number of hard braking, speeding and sudden acceleration events. Methods :  Individual 30-second observations, each comprising one breadcrumb, and trip-level data were collected and analyzed in R and ArcGIS.  Results : Primary locations were confirmed to be 100% accurate when compared to known addresses.  Based on the locations of the breadcrumbs, we were able to successfully identify frequently visited locations and general travel patterns.  Based on the reported time from the breadcrumbs, we could assess number of trips driven in daylight vs. night.  Data on additional events while driving allowed us to compute the number of adverse driving alerts over the course of the 5-month period. Conclusions : Compared to cameras and highly instrumented vehicle in other naturalistic studies, the compact COTS device was quickly installed and transmitted high

  5. Offset Compound Gear Drive

    Science.gov (United States)

    Stevens, Mark A.; Handschuh, Robert F.; Lewicki, David G.

    2010-01-01

    The Offset Compound Gear Drive is an in-line, discrete, two-speed device utilizing a special offset compound gear that has both an internal tooth configuration on the input end and external tooth configuration on the output end, thus allowing it to mesh in series, simultaneously, with both a smaller external tooth input gear and a larger internal tooth output gear. This unique geometry and offset axis permits the compound gear to mesh with the smaller diameter input gear and the larger diameter output gear, both of which are on the same central, or primary, centerline. This configuration results in a compact in-line reduction gear set consisting of fewer gears and bearings than a conventional planetary gear train. Switching between the two output ratios is accomplished through a main control clutch and sprag. Power flow to the above is transmitted through concentric power paths. Low-speed operation is accomplished in two meshes. For the purpose of illustrating the low-speed output operation, the following example pitch diameters are given. A 5.0 pitch diameter (PD) input gear to 7.50 PD (internal tooth) intermediate gear (0.667 reduction mesh), and a 7.50 PD (external tooth) intermediate gear to a 10.00 PD output gear (0.750 reduction mesh). Note that it is not required that the intermediate gears on the offset axis be of the same diameter. For this example, the resultant low-speed ratio is 2:1 (output speed = 0.500; product of stage one 0.667 reduction and stage two 0.750 stage reduction). The design is not restricted to the example pitch diameters, or output ratio. From the output gear, power is transmitted through a hollow drive shaft, which, in turn, drives a sprag during which time the main clutch is disengaged.

  6. Development of radiation hard scintillators

    International Nuclear Information System (INIS)

    Markley, F.; Woods, D.; Pla-Dalmau, A.; Foster, G.; Blackburn, R.

    1992-05-01

    Substantial improvements have been made in the radiation hardness of plastic scintillators. Cylinders of scintillating materials 2.2 cm in diameter and 1 cm thick have been exposed to 10 Mrads of gamma rays at a dose rate of 1 Mrad/h in a nitrogen atmosphere. One of the formulations tested showed an immediate decrease in pulse height of only 4% and has remained stable for 12 days while annealing in air. By comparison a commercial PVT scintillator showed an immediate decrease of 58% and after 43 days of annealing in air it improved to a 14% loss. The formulated sample consisted of 70 parts by weight of Dow polystyrene, 30 pbw of pentaphenyltrimethyltrisiloxane (Dow Corning DC 705 oil), 2 pbw of p-terphenyl, 0.2 pbw of tetraphenylbutadiene, and 0.5 pbw of UVASIL299LM from Ferro

  7. Electrical machines and drives

    CERN Document Server

    Hindmarsh, John

    2002-01-01

    Recent years have brought substantial developments in electrical drive technology, with the appearance of highly rated, very-high-speed power-electronic switches, combined with microcomputer control systems.This popular textbook has been thoroughly revised and updated in the light of these changes. It retains its successful formula of teaching through worked examples, which are put in context with concise explanations of theory, revision of equations and discussion of the engineering implications. Numerous problems are also provided, with answers supplied.The third edition in

  8. Electrical machines & drives

    CERN Document Server

    Hammond, P

    1985-01-01

    Containing approximately 200 problems (100 worked), the text covers a wide range of topics concerning electrical machines, placing particular emphasis upon electrical-machine drive applications. The theory is concisely reviewed and focuses on features common to all machine types. The problems are arranged in order of increasing levels of complexity and discussions of the solutions are included where appropriate to illustrate the engineering implications. This second edition includes an important new chapter on mathematical and computer simulation of machine systems and revised discussions o

  9. Measurement of Driving Terms

    CERN Document Server

    Schmidt, F; Faus-Golfe, A

    2001-01-01

    In 2000 a series of MDs has been performed at the SPS to measure resonance driving terms. Theory predicts that these terms can be determined by harmonic analysis of BPM data recorded after applying single kicks at various amplitudes. Strong sextupoles were introduced to create a sizeable amount of nonlinearities. Experiments at injection energy (26 GeV) with single bunch as well as one experiment at 120 GeV with 84 bunches were carried out. The expected nonlinear content is compared to the experimenteal observation.

  10. Geriatric-specific triage criteria are more sensitive than standard adult criteria in identifying need for trauma center care in injured older adults.

    Science.gov (United States)

    Ichwan, Brian; Darbha, Subrahmanyam; Shah, Manish N; Thompson, Laura; Evans, David C; Boulger, Creagh T; Caterino, Jeffrey M

    2015-01-01

    We evaluate the sensitivity of Ohio's 2009 emergency medical services (EMS) geriatric trauma triage criteria compared with the previous adult triage criteria in identifying need for trauma center care among older adults. We studied a retrospective cohort of injured patients aged 16 years or older in the 2006 to 2011 Ohio Trauma Registry. Patients aged 70 years or older were considered geriatric. We identified whether each patient met the geriatric and the adult triage criteria. The outcome measure was need for trauma center care, defined by surrogate markers: Injury Severity Score greater than 15, operating room in fewer than 48 hours, any ICU stay, and inhospital mortality. We calculated sensitivity and specificity of both triage criteria for both age groups. We included 101,577 patients; 33,379 (33%) were geriatric. Overall, 57% of patients met adult criteria and 68% met geriatric criteria. Using Injury Severity Score, for older adults geriatric criteria were more sensitive for need for trauma center care (93%; 95% confidence interval [CI] 92% to 93%) than adult criteria (61%; 95% CI 60% to 62%). Geriatric criteria decreased specificity in older adults from 61% (95% CI 61% to 62%) to 49% (95% CI 48% to 49%). Geriatric criteria in older adults (93% sensitivity, 49% specificity) performed similarly to the adult criteria in younger adults (sensitivity 87% and specificity 44%). Similar patterns were observed for other outcomes. Standard adult EMS triage guidelines provide poor sensitivity in older adults. Ohio's geriatric trauma triage guidelines significantly improve sensitivity in identifying Injury Severity Score and other surrogate markers of the need for trauma center care, with modest decreases in specificity for older adults. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  11. Cognitive impairment and driving safety.

    Science.gov (United States)

    Eby, David W; Molnar, Lisa J

    2012-11-01

    As the populations of many countries continue to age, cognitive impairment will likely become more common. Individuals with cognitive impairment pose special challenges for families, health professionals, driving safety professionals, and the larger community, particularly if these older adults depend on driving as their primary means of community mobility. It is vital that we continue to extend our knowledge about the driving behavior of individuals' with cognitive impairment, as well as try to develop effective means of screening and assessing these individuals for fitness to drive and help facilitate their transition to non-driving when appropriate. This special issue is intended to provide researchers and practitioners an opportunity to present the most recent research findings on driving-related issues among older adults with cognitive impairment. The issue contains 11 original contributions from seven countries. The topics covered by these papers are: crash risks; screening, assessment, and fitness to drive; driving performance using a driving simulator; and driving behaviors and driving-related decisions of people with cognitive impairments. Copyright © 2012. Published by Elsevier Ltd.

  12. Parkinson's disease and driving ability

    Science.gov (United States)

    Singh, Rajiv; Pentland, Brian; Hunter, John; Provan, Frances

    2007-01-01

    Objectives To explore the driving problems associated with Parkinson's disease (PD) and to ascertain whether any clinical features or tests predict driver safety. Methods The driving ability of 154 individuals with PD referred to a driving assessment centre was determined by a combination of clinical tests, reaction times on a test rig and an in‐car driving test. Results The majority of cases (104, 66%) were able to continue driving although 46 individuals required an automatic transmission and 10 others needed car modifications. Ability to drive was predicted by the severity of physical disease, age, presence of other associated medical conditions, particularly dementia, duration of disease, brake reaction, time on a test rig and score on a driving test (all pautomatic transmission. A combination of clinical tests and in‐car driving assessment will establish safety to drive, and a number of clinical correlates can be shown to predict the likely outcome and may assist in the decision process. This is the largest series of consecutive patients seen at a driving assessment centre reported to date, and the first to devise a scoring system for on‐road driving assessment. PMID:17178820

  13. Magnetic hard disks for audio-visual use; AV yo jiki disk baitai

    Energy Technology Data Exchange (ETDEWEB)

    Tei, Y.; Sakaguchi, S.; Uwazumi, H. [Fuji Electric Co. Ltd., Tokyo (Japan)

    1999-11-10

    Computers, consumer, and communications are converging and fusing. The key device in homes in the near future will be an audiovisual hard disk drive (AV-HDD). The reason is that there is no other AV cash memory with high capacity, high speed, and a low price than the HDD. Fuji Electric has early started developing an AV magnetic hard disk, a core-functional element of the AV-HDD, to take the initiative in the market. This paper describes the state of plastic medium development, which is regarded as a next-generation strategic commodity. (author)

  14. Glaucoma and Driving: On-Road Driving Characteristics

    Science.gov (United States)

    Wood, Joanne M.; Black, Alex A.; Mallon, Kerry; Thomas, Ravi; Owsley, Cynthia

    2016-01-01

    Purpose To comprehensively investigate the types of driving errors and locations that are most problematic for older drivers with glaucoma compared to those without glaucoma using a standardized on-road assessment. Methods Participants included 75 drivers with glaucoma (mean = 73.2±6.0 years) with mild to moderate field loss (better-eye MD = -1.21 dB; worse-eye MD = -7.75 dB) and 70 age-matched controls without glaucoma (mean = 72.6 ± 5.0 years). On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist using a standardized scoring system which assessed the types of driving errors and the locations where they were made and the number of critical errors that required an instructor intervention. Driving safety was rated on a 10-point scale. Self-reported driving ability and difficulties were recorded using the Driving Habits Questionnaire. Results Drivers with glaucoma were rated as significantly less safe, made more driving errors, and had almost double the rate of critical errors than those without glaucoma. Driving errors involved lane positioning and planning/approach, and were significantly more likely to occur at traffic lights and yield/give-way intersections. There were few between group differences in self-reported driving ability. Conclusions Older drivers with glaucoma with even mild to moderate field loss exhibit impairments in driving ability, particularly during complex driving situations that involve tactical problems with lane-position, planning ahead and observation. These results, together with the fact that these drivers self-report their driving to be relatively good, reinforce the need for evidence-based on-road assessments for evaluating driving fitness. PMID:27472221

  15. A qualitative exploration of driving stress and driving discourtesy.

    Science.gov (United States)

    Scott-Parker, B; Jones, C M; Rune, K; Tucker, J

    2018-05-31

    Driving courtesy, and conversely driving discourtesy, recently has been of great interest in the public domain. In addition, there has been increasing recognition of the negative impact of stress upon the individual's health and wellbeing, with a plethora of interventions aimed at minimising stress more generally. The research literature regarding driving dis/courtesy, in comparison, is scant, with a handful of studies examining the dis/courteous driving behaviour of road users, and the relationship between driving discourtesy and driving stress. To examine courteous and discourteous driving experiences, and to explore the impact of stress associated with such driving experiences. Thirty-eight drivers (20 females) from the Sunshine Coast region volunteered to participate in one of four 1-1.5 h focus groups. Content analysis used the verbatim utterances captured via an Mp3 device. Three themes pertaining to stressful and discourteous interactions were identified. Theme one pertained to the driving context: road infrastructure (eg, roundabouts, roadwork), vehicles (eg, features), location (eg, country vs city, unfamiliar areas), and temporal aspects (eg, holidays). Theme two pertained to other road users: their behaviour (eg, tailgating, merging), and unknown factors (eg, illicit and licit drug use). Theme three pertained to the self as road user: their own behaviours (eg, deliberate intimidation), and their emotions (eg, angry reaction to other drivers, being in control). Driving dis/courtesy and driving stress is a complex phenomenon, suggesting complex intervention efforts are required. Driving discourtesy was reported as being highly stressful, therefore intervention efforts which encourage driving courtesy and which foster emotional capacity to cope with stressful circumstances appear warranted. Copyright © 2018. Published by Elsevier Ltd.

  16. Glaucoma and Driving: On-Road Driving Characteristics.

    Directory of Open Access Journals (Sweden)

    Joanne M Wood

    Full Text Available To comprehensively investigate the types of driving errors and locations that are most problematic for older drivers with glaucoma compared to those without glaucoma using a standardized on-road assessment.Participants included 75 drivers with glaucoma (mean = 73.2±6.0 years with mild to moderate field loss (better-eye MD = -1.21 dB; worse-eye MD = -7.75 dB and 70 age-matched controls without glaucoma (mean = 72.6 ± 5.0 years. On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist using a standardized scoring system which assessed the types of driving errors and the locations where they were made and the number of critical errors that required an instructor intervention. Driving safety was rated on a 10-point scale. Self-reported driving ability and difficulties were recorded using the Driving Habits Questionnaire.Drivers with glaucoma were rated as significantly less safe, made more driving errors, and had almost double the rate of critical errors than those without glaucoma. Driving errors involved lane positioning and planning/approach, and were significantly more likely to occur at traffic lights and yield/give-way intersections. There were few between group differences in self-reported driving ability.Older drivers with glaucoma with even mild to moderate field loss exhibit impairments in driving ability, particularly during complex driving situations that involve tactical problems with lane-position, planning ahead and observation. These results, together with the fact that these drivers self-report their driving to be relatively good, reinforce the need for evidence-based on-road assessments for evaluating driving fitness.

  17. Glaucoma and Driving: On-Road Driving Characteristics.

    Science.gov (United States)

    Wood, Joanne M; Black, Alex A; Mallon, Kerry; Thomas, Ravi; Owsley, Cynthia

    2016-01-01

    To comprehensively investigate the types of driving errors and locations that are most problematic for older drivers with glaucoma compared to those without glaucoma using a standardized on-road assessment. Participants included 75 drivers with glaucoma (mean = 73.2±6.0 years) with mild to moderate field loss (better-eye MD = -1.21 dB; worse-eye MD = -7.75 dB) and 70 age-matched controls without glaucoma (mean = 72.6 ± 5.0 years). On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist using a standardized scoring system which assessed the types of driving errors and the locations where they were made and the number of critical errors that required an instructor intervention. Driving safety was rated on a 10-point scale. Self-reported driving ability and difficulties were recorded using the Driving Habits Questionnaire. Drivers with glaucoma were rated as significantly less safe, made more driving errors, and had almost double the rate of critical errors than those without glaucoma. Driving errors involved lane positioning and planning/approach, and were significantly more likely to occur at traffic lights and yield/give-way intersections. There were few between group differences in self-reported driving ability. Older drivers with glaucoma with even mild to moderate field loss exhibit impairments in driving ability, particularly during complex driving situations that involve tactical problems with lane-position, planning ahead and observation. These results, together with the fact that these drivers self-report their driving to be relatively good, reinforce the need for evidence-based on-road assessments for evaluating driving fitness.

  18. Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France

    Directory of Open Access Journals (Sweden)

    Olivier Philippe

    2011-10-01

    Full Text Available Abstract Background For several decades, emergency departments (EDs utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. Methods We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. Results Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43. The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61, gynaecological (kappa = 0.66 and toxicology complaints (kappa = 1.00. The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09 and hospitalization (kappa = 0.20. When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%. Conclusions The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used

  19. Control rod drives

    International Nuclear Information System (INIS)

    Hayakawa, Hiroyasu; Kawamura, Atsuo.

    1979-01-01

    Purpose: To reduce pellet-clad mechanical interactions, as well as improve the fuel safety. Constitution: In the rod drive of a bwr type reactor, an electric motor operated upon intermittent input such as of pulse signals is connected to a control rod. A resolver for converting the rotational angle of the motor to electric signals is connected to the rotational shaft of the motor and the phase difference between the output signal from the resolver and a reference signal is adapted to detect by a comparator. Based on the detection result, the controller is actuated to control a motor for control rod drive so that fine control for the movement of the control rod is made possible. This can reduce the moving distance of the control rod, decrease the thermal stress applied to the control rod and decrease the pellet clad mechanical interaction failures due to thermal expansion between the cladding tube and the pellets caused by abrupt changes in the generated power. (Furukawa, Y.)

  20. Control rod drives

    International Nuclear Information System (INIS)

    Oonuki, Koji.

    1981-01-01

    Purpose: To increase the driving speed of control rods at rapid insertion with an elongate control rod and an extension pipe while ensuring sufficient buffering performance in a short buffering distance, by providing a plurality of buffers to an extension pipe between a control rod drive source and a control rod in LMFBR type reactor. Constitution: First, second and third buffers are respectively provided to an acceleration piston, an extension pipe and a control rod respectively and the insertion positions for each of the buffers are displaced orderly from above to below. Upon disconnection of energizing current for an electromagnet, the acceleration piston, the extension pipe and the control rod are rapidly inserted in one body. The first, second and third buffers are respectively actuated at each of their falling strokes upon rapid insertion respectively, and the acceleration piston, the extension pipe and the control rod receive the deceleration effect in the order correspondingly. Although the compression force is applied to the control rod only near the stroke end, it does not cause deformation. (Kawakami, Y.)

  1. Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

    Directory of Open Access Journals (Sweden)

    Kantonen Jarmo

    2012-01-01

    Full Text Available Abstract Background Many Finnish emergency departments (ED serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland. Methods The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital. A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care, B (to be examined within 10 min, C (to be examined within 1 h, D (to be examined within 2 h and E (no need for immediate treatment for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. Results After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month as compared to the three previous years in the EDs

  2. Soft And Hard Skills of Social Worker

    OpenAIRE

    HANTOVÁ, Libuše

    2011-01-01

    The work deals with soft and hard skills relevant to the profession of social worker. The theoretical part at first evaluates and analyzes important soft and hard skills necessary for people working in the field of social work. Then these skills are compared. The practical part illustrates the use of soft and hard skills in practice by means of model scenes and deals with the preferences in three groups of people ? students of social work, social workers and people outside the sphere, namely ...

  3. Theory of hard diffraction and rapidity gaps

    International Nuclear Information System (INIS)

    Del Duca, V.

    1995-06-01

    In this talk we review the models describing the hard diffractive production of jets or more generally high-mass states in presence of rapidity gaps in hadron-hadron and lepton-hadron collisions. By rapidity gaps we mean regions on the lego plot in (pseudo)-rapidity and azimuthal angle where no hadrons are produced, between the jet(s) and an elastically scattered hadron (single hard diffraction) or between two jets (double hard diffraction). (orig.)

  4. Theory of hard diffraction and rapidity gaps

    International Nuclear Information System (INIS)

    Del Duca, V.

    1996-01-01

    In this talk we review the models describing the hard diffractive production of jets or more generally high-mass states in presence of rapidity gaps in hadron-hadron and lepton-hadron collisions. By rapidity gaps we mean regions on the lego plot in (pseudo)-rapidity and azimuthal angle where no hadrons are produced, between the jet(s) and an elastically scattered hadron (single hard diffraction) or between two jets (double hard diffraction). copyright 1996 American Institute of Physics

  5. Advances in hard nucleus cataract surgery

    Directory of Open Access Journals (Sweden)

    Wei Cui

    2013-11-01

    Full Text Available Security and perfect vision and fewer complications are our goals in cataract surgery, and hard-nucleus cataract surgery is always a difficulty one. Many new studies indicate that micro-incision phacoemulsification in treating hard nucleus cataract is obviously effective. This article reviews the evolution process of hard nuclear cataract surgery, the new progress in the research of artificial intraocular lens for microincision, and analyse advantages and disadvantages of various surgical methods.

  6. A handbook for the triage, monitoring and treatment of people exposed to a malevolent use of radiation

    International Nuclear Information System (INIS)

    Rojas-Palma, Carlos; Meer, Klaas van der; Liland, Astrid; Jaworska, Alicja; Jerstad, Ane; Kruse, Phil; Smith, Karen; Rahola, Tua; Muikku, Maarit; Etherington, George; Perez, Maria del R.; Carr, Zhanat; Smagala, Genowefa

    2008-01-01

    In the aftermath of the Chernobyl accident European national emergency response plans have been tailored to deal with accidents at nuclear power plants. Several terrorist acts (World Trade Center, New York; Atocha train station, Madrid; suicide bombings) carried out by disaffected groups have shifted the focus to malevolent use of radiation. The radiation exposure can range from very low to substantial, possibly combined with conventional injuries. Therefore practicable tools are needed for an adequate response to such acts and more specifically to address European guidelines covering triage to treatment and long term follow up of exposed people. The European Commission through the EURATOM 6th Framework Programme is co-sponsoring the specific targeted research project TMT handbook. The main objective of this project is to produce a practicable handbook for the effective and timely triage, monitoring and treatment of people exposed to radiation following a malevolent act. This paper elaborates on the work being carried out and outlines the progress achieved prior to the deployment of the handbook in European national emergency response organizations, which are in the process of testing and evaluating the material through targeted emergency response exercises. The end of this paper includes some remarks on the challenges that need to be dealt with in order to achieve a sustainable development of what has been achieved through the lifetime of this project. (author)

  7. High-throughput microfluidics automated cytogenetic processing for effectively lowering biological process time and aid triage during radiation accidents

    International Nuclear Information System (INIS)

    Ramakumar, Adarsh

    2016-01-01

    Nuclear or radiation mass casualties require individual, rapid, and accurate dose-based triage of exposed subjects for cytokine therapy and supportive care, to save life. Radiation mass casualties will demand high-throughput individual diagnostic dose assessment for medical management of exposed subjects. Cytogenetic techniques are widely used for triage and definitive radiation biodosimetry. Prototype platform to demonstrate high-throughput microfluidic micro incubation to support the logistics of sample in miniaturized incubators from the site of accident to analytical labs has been developed. Efforts have been made, both at the level of developing concepts and advanced system for higher throughput in processing the samples and also implementing better and efficient methods of logistics leading to performance of lab-on-chip analyses. Automated high-throughput platform with automated feature extraction, storage, cross platform data linkage, cross platform validation and inclusion of multi-parametric biomarker approaches will provide the first generation high-throughput platform systems for effective medical management, particularly during radiation mass casualty events

  8. The sequential organ failure assessment (SOFA) score is an effective triage marker following staggered paracetamol (acetaminophen) overdose.

    Science.gov (United States)

    Craig, D G; Zafar, S; Reid, T W D J; Martin, K G; Davidson, J S; Hayes, P C; Simpson, K J

    2012-06-01

    The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses. To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose. Time-course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated. A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2-95.7), 94.3 (95% CI 82.5-99.1), and 98.4 (95% CI 84.3-100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of paracetamol overdose, is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high-risk staggered paracetamol overdose patients. © 2012 Blackwell Publishing Ltd.

  9. Advances in a framework to compare bio-dosimetry methods for triage in large-scale radiation events

    International Nuclear Information System (INIS)

    Flood, Ann Barry; Boyle, Holly K.; Du, Gaixin; Demidenko, Eugene; Williams, Benjamin B.; Swartz, Harold M.; Nicolalde, Roberto J.

    2014-01-01

    Planning and preparation for a large-scale nuclear event would be advanced by assessing the applicability of potentially available bio-dosimetry methods. Using an updated comparative framework the performance of six bio-dosimetry methods was compared for five different population sizes (100-1 000 000) and two rates for initiating processing of the marker (15 or 15 000 people per hour) with four additional time windows. These updated factors are extrinsic to the bio-dosimetry methods themselves but have direct effects on each method's ability to begin processing individuals and the size of the population that can be accommodated. The results indicate that increased population size, along with severely compromised infrastructure, increases the time needed to triage, which decreases the usefulness of many time intensive dosimetry methods. This framework and model for evaluating bio-dosimetry provides important information for policy-makers and response planners to facilitate evaluation of each method and should advance coordination of these methods into effective triage plans. (authors)

  10. Soft Dielectric Elastomer Oscillators Driving Bioinspired Robots.

    Science.gov (United States)

    Henke, E-F Markus; Schlatter, Samuel; Anderson, Iain A

    2017-12-01

    Entirely soft robots with animal-like behavior and integrated artificial nervous systems will open up totally new perspectives and applications. To produce them, we must integrate control and actuation in the same soft structure. Soft actuators (e.g., pneumatic and hydraulic) exist but electronics are hard and stiff and remotely located. We present novel soft, electronics-free dielectric elastomer oscillators, which are able to drive bioinspired robots. As a demonstrator, we present a robot that mimics the crawling motion of the caterpillar, with an integrated artificial nervous system, soft actuators and without any conventional stiff electronic parts. Supplied with an external DC voltage, the robot autonomously generates all signals that are necessary to drive its dielectric elastomer actuators, and it translates an in-plane electromechanical oscillation into a crawling locomotion movement. Therefore, all functional and supporting parts are made of polymer materials and carbon. Besides the basic design of this first electronic-free, biomimetic robot, we present prospects to control the general behavior of such robots. The absence of conventional stiff electronics and the exclusive use of polymeric materials will provide a large step toward real animal-like robots, compliant human machine interfaces, and a new class of distributed, neuron-like internal control for robotic systems.

  11. Phase-matched generation of coherent soft and hard X-rays using IR lasers

    Science.gov (United States)

    Popmintchev, Tenio V.; Chen, Ming-Chang; Bahabad, Alon; Murnane, Margaret M.; Kapteyn, Henry C.

    2013-06-11

    Phase-matched high-order harmonic generation of soft and hard X-rays is accomplished using infrared driving lasers in a high-pressure non-linear medium. The pressure of the non-linear medium is increased to multi-atmospheres and a mid-IR (or higher) laser device provides the driving pulse. Based on this scaling, also a general method for global optimization of the flux of phase-matched high-order harmonic generation at a desired wavelength is designed.

  12. Dimensions of driving anger and their relationships with aberrant driving.

    Science.gov (United States)

    Zhang, Tingru; Chan, Alan H S; Zhang, Wei

    2015-08-01

    The purpose of this study was to investigate the relationship between driving anger and aberrant driving behaviours. An internet-based questionnaire survey was administered to a sample of Chinese drivers, with driving anger measured by a 14-item short Driving Anger Scale (DAS) and the aberrant driving behaviours measured by a 23-item Driver Behaviour Questionnaire (DBQ). The results of Confirmatory Factor Analysis demonstrated that the three-factor model (hostile gesture, arrival-blocking and safety-blocking) of the DAS fitted the driving anger data well. The Exploratory Factor Analysis on DBQ data differentiated four types of aberrant driving, viz. emotional violation, error, deliberate violation and maintaining progress violation. For the anger-aberration relation, it was found that only "arrival-blocking" anger was a significant positive predictor for all four types of aberrant driving behaviours. The "safety-blocking" anger revealed a negative impact on deliberate violations, a finding different from previously established positive anger-aberration relation. These results suggest that drivers with different patterns of driving anger would show different behavioural tendencies and as a result intervention strategies may be differentially effective for drivers of different profiles. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. Control rod drive mechanism

    International Nuclear Information System (INIS)

    Nakamura, Akira.

    1981-01-01

    Purpose: To ensure the scram operation of a control rod by the reliable detection for the position of control rods. Constitution: A permanent magnet is provided to the lower portion of a connecting rod in engagement with a control rod and a tube having a plurality of lead switches arranged axially therein in a predetermined pitch is disposed outside of the control rod drives. When the control rod moves upwardly in the scram operation, the lead switches are closed successively upon passage of the permanent magnet to operate the electrical circuit provided by way of each of the lead switches. Thus, the position for the control rod during the scram can reliably be determined and the scram characteristic of the control rod can be recognized. (Furukawa, Y.)

  14. [Epilepsy and driving].

    Science.gov (United States)

    Matsuura, Masato

    2014-05-01

    In Japan, the Road Traffic Act was amended in June 2013, including new penalty to false statement in a disease condition declaration form, and new voluntary notification system for a doctor who is aware that a person is at high risk for traffic accident and in possession of a driver license. Moreover, New Criminal Law Act was established in November 2013, including a prison sentence of up to 15 years for persons, who under the influence of specific drugs or diseases, causing death or injury to other persons by driving a motor vehicle. Both laws are supposed to be enforced during 2014, after additional resolutions including the review of the laws after five years, considerations so as not to create discrimination due to diseases, etc are examined.

  15. Control rod drives

    International Nuclear Information System (INIS)

    Furumitsu, Yutaka.

    1981-01-01

    Purpose: To improve the reliability of a device for driving an LMFBR type reactor control rod by providing a buffer unit having a stationary electromagnetic coil and a movable electromagnetic coil in the device to thereby avord impact stress at scram time and to simplify the structure of the buffer unit. Constitution: A non-contact type buffer unit is constructed with a stationary electromagnetic coil, a cable for the stationary coil, a movable electromagnetic coil, a spring cable for the movable coil, and a backup coil spring or the like. Force produced at scram time is delivered without impact by the attracting or repelling force between the stationary coil and the movable coil of the buffer unit. Accordingly, since the buffer unit is of a non-contact type, there is no mechanical impact and thus no large impact stress, and as it has simple configuration, the reliability is improved and the maintenance can be conducted more easily. (Yoshihara, H.)

  16. Control rod drives

    International Nuclear Information System (INIS)

    Yamanaka, Toshikatsu.

    1979-01-01

    Purpose: To protect bellows against failures due to negative pressure to prevent the loss of pressure balance caused by the expansion of the bellows upon scram. Constitution: An expansion pipe connected to the control rod drive is driven along a guide pipe to insert a control rod into the reactor core. Expansible bellows are provided at the step between the expansion pipe and the guide pipe. Further, a plurality of bore holes or slits are formed on the side wall of the guide pipe corresponding to the expansion portion of the bellows. In such an arrangement, when the expansion pipe falls rapidly and the bellows are expanded upon scram, the volume between each of the pipes of the bellows and the guide pipe is increased to produce a negative pressure, but the effect of the negative pressure on the bellows can be eliminated by the flowing-in of coolants corresponding to that pressure through the bore holes or the slits. (Furukawa, Y.)

  17. Do emotions drive psychosis?

    Directory of Open Access Journals (Sweden)

    João G. Ribeiro

    2012-12-01

    Full Text Available Introduction: How important is the emotional life of persons who manifest psychotic symptoms? Aims: The aim of this paper is to review evidence on a causal role for emotions in psychotic processes. Methods: Selective review of literature on affective symptoms in psychoses, on emotions in the production of psychotic symptoms and on dopaminergic models of psychosis. Results: Affective symptoms are relevant across psychoses. Persons with schizophrenia have high levels of emotional reactivity and the intensification of negative affects not only is associated with but also precedes the intensification of psychotic symptoms, which is evidence that negative emotions drive the course of psychotic symptoms. Negative self‑representations are central in psychotic processes and can be the link between negative emotions and psychosis. Evidence favours the notion that persecutory delusions are consistent with negative affects and self‑representations, while grandiose delusions are consistent with a defensive amplification of positive affects and self‑representations. Shame has been proposed as the core emotional experience of psychosis, one in which the self becomes vulnerable to the external world, which is consistent with persecutory experiences. Assaults on the self, under the form of hostility in the family environment and society, are strong predictors of relapse and development of schizophrenia. Assaults on the self which induce social defeat are also strong stimulants of mesolimbic dopaminergic pathways, whose hyperactivity is associated with acute psychotic episodes and the experience of “aberrant salience”, put forward as a dopaminergic model of psychosis. Conclusions: The “defeat of the self” emerges as a central link that binds the experience of negative emotions to the expression of psychotic symptoms and its psychological and neurobiological correlates. The hypothesis gains support that the emotions related to that defeat control

  18. 30 CFR 75.1720-1 - Distinctively colored hard hats, or hard caps; identification for newly employed, inexperienced...

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Distinctively colored hard hats, or hard caps... STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1720-1 Distinctively colored hard hats, or hard caps; identification for newly employed, inexperienced miners. Hard hats or hard caps distinctively different in color...

  19. 30 CFR 77.1710-1 - Distinctively colored hard hats or hard caps; identification for newly employed, inexperienced...

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Distinctively colored hard hats or hard caps... Distinctively colored hard hats or hard caps; identification for newly employed, inexperienced miners. Hard hats or hard caps distinctively different in color from those worn by experienced miners shall be worn at...

  20. Hard disks with SCSI interface

    CERN Document Server

    Denisov, O Yu

    1999-01-01

    The testing of 20 models of hard SCSI-disks is carried out: the Fujitsu MAE3091LP; the IBM DDRS-39130, DGHS-318220, DNES-318350, DRHS-36V and DRVS-18V; the Quantum Atlas VI 18.2; the Viking 11 9.1; the Seagate ST118202LW, ST118273LW, ST118273W, ST318203LW, ST318275LW, ST34520W, ST39140LW and ST39173W; and the Western Digital WDE9100-0007, WDE9100-AV0016, WDE9100-AV0030 and WDE9180-0048. All tests ran under the Windows NT 4.0 workstation operating system with Service Pack 4, under video mode with 1024*768 pixel resolution, 32- bit colour depth and V-frequency equal to 85 Hz. The detailed description and characteristics of SCSI stores are presented. Test results (ZD Winstone 99 and ZD WinBench 99 tests) are given in both table and diagram (disk transfer rate) forms. (0 refs).