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Sample records for reliable bedside sign

  1. Bedside ultrasound reliability in locating catheter and detecting complications

    Directory of Open Access Journals (Sweden)

    Payman Moharamzadeh

    2016-10-01

    Full Text Available Introduction: Central venous catheterization is one of the most common medical procedures and is associated with such complications as misplacement and pneumothorax. Chest X-ray is among good ways for evaluation of these complications. However, due to patient’s excessive exposure to radiation, time consumption and low diagnostic value in detecting pneumothorax in the supine patient, the present study intends to examine bedside ultrasound diagnostic value in locating tip of the catheter and pneumothorax. Materials and methods: In the present cross-sectional study, all referred patients requiring central venous catheterization were examined. Central venous catheterization was performed by a trained emergency medicine specialist, and the location of catheter and the presence of pneumothorax were examined and compared using two modalities of ultrasound and x-ray (as the reference standard. Sensitivity, specificity, and positive and negative predicting values were reported. Results: A total of 200 non-trauma patients were included in the study (58% men. Cohen’s Kappa consistency coefficients for catheterization and diagnosis of pneumothorax were found as 0.49 (95% CI: 0.43-0.55, 0.89 (P<0.001, (95% CI: 97.8-100, respectively. Also, ultrasound sensitivity and specificity in diagnosing pneumothorax were 75% (95% CI: 35.6-95.5, and 100% (95% CI: 97.6-100, respectively. Conclusion: The present study results showed low diagnostic value of ultrasound in determining catheter location and in detecting pneumothorax. With knowledge of previous studies, the search still on this field.   Keywords: Central venous catheterization; complications; bedside ultrasound; radiography;

  2. Memorial Hermann: high reliability from board to bedside.

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    Shabot, M Michael; Monroe, Douglas; Inurria, Juan; Garbade, Debbi; France, Anne-Claire

    2013-06-01

    In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.

  3. Reliability and Validity of Bedside Version of Persian WAB (P-WAB-1).

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    Nilipour, Reza; Pourshahbaz, Abbas; Ghoreyshi, Zahra Sadat

    2014-10-01

    In this study, we reported the reliability and validity of Bedside version of Persian WAB (P-WAB-1) adapted from Western Aphasia Battery (WAB-R) (1,2). P-WAB-1 is a clinical linguistic measuring tool to determine severity and type of aphasia in brain damaged patients based on Aphasia Quotient (AQ) as a functional measure. For the purposes of a quick clinical screening of aphasia in Persian, we adapted the bedside version of WAB-R to assess the performance of Persian aphasic patients. The data we reported on adaptation, validity and reliability of P-WAB-1 are based on faithful translation and criterion validity ratio (CVR) taken from the expert panel and the performance of 60 consecutive brain damaged patients referred to different university clinics for rehabilitation and 30 healthy subjects as norms and 40 age-matched epileptic patients as the control group. Based on the results of this study, P-WAB-1 has internal consistency (a=0.71) and test-retest reliability (r=.65 PPersian speaking brain damaged patients. This study is the initial step on adaptation of different versions of WAB-R to measure the severity of aphasia using AQ, LQ and CQ as operational measures and to classify Persian speaking aphasic patients into different types.

  4. Quantifying cognition at the bedside: a novel approach combining cognitive symptoms and signs in HIV.

    Science.gov (United States)

    Brouillette, Marie-Josée; Fellows, Lesley K; Palladini, Lisa; Finch, Lois; Thomas, Réjean; Mayo, Nancy E

    2015-11-13

    Up to half of all people with HIV infection have some degree of cognitive impairment. This impairment is typically mild, but nonetheless often disabling. Although early detection of cognitive impairment offers the greatest hope of effective intervention, there are important barriers to this goal in most clinical settings. These include uncertainty about how self-reported cognitive symptoms relate to objective impairments, and the paucity of bedside measurement tools suitable for mild deficits. Clinicians need guidance in interpreting cognitive symptoms in this population, and a brief cognitive measurement tool targeted to mild impairment. We addressed these two problems together here. The objective of this study was to determine the extent to which performance on cognitive tests and self-reported cognitive symptoms form a unidimensional construct. Two hundred three HIV+ individuals completed the Montreal Cognitive Assessment, computerized cognitive tasks and a questionnaire eliciting cognitive symptoms. Rasch measurement theory was applied to determine whether patient-reported and performance items could be combined to measure cognition as a unidimensional latent construct. Performance-based items and cognitive symptoms are arranged hierarchically along the same continuum of cognitive ability, forming a measure with thresholds covering a broad spectrum of ability that has good internal reliability. The cognitive symptoms that fit the measurement model relate to important aspects of everyday life, providing evidence that the identified construct is meaningful. This finding lays the foundation for a rapid measure of cognitive ability in people with HIV infection that is feasible for routine clinical use, and shows that some cognitive symptoms are systematically related to performance in this population.

  5. Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment.

    Science.gov (United States)

    Vogel, Adam P; Rommel, Natalie; Sauer, Carina; Horger, Marius; Krumm, Patrick; Himmelbach, Marc; Synofzik, Matthis

    2017-06-01

    Screening assessments for dysphagia are essential in neurodegenerative disease. Yet there are no purpose-built tools to quantify swallowing deficits at bedside or in clinical trials. A quantifiable, brief, easy to administer assessment that measures the impact of dysphagia and predicts the presence or absence of aspiration is needed. The Clinical Assessment of Dysphagia in Neurodegeneration (CADN) was designed by a multidisciplinary team (neurology, neuropsychology, speech pathology) validated against strict methodological criteria in two neurodegenerative diseases, Parkinson's disease (PD) and degenerative ataxia (DA). CADN comprises two parts, an anamnesis (part one) and consumption (part two). Two-thirds of patients were assessed using reference tests, the SWAL-QOL symptoms subscale (part one) and videofluoroscopic assessment of swallowing (part two). CADN has 11 items and can be administered and scored in an average of 7 min. Test-retest reliability was established using correlation and Bland-Altman plots. 125 patients with a neurodegenerative disease were recruited; 60 PD and 65 DA. Validity was established using ROC graphs and correlations. CADN has sensitivity of 79 and 84% and specificity 71 and 69% for parts one and two, respectively. Significant correlations with disease severity were also observed (p dysphagia symptomatology and risk of aspiration. The CADN is a reliable, valid, brief, quantifiable, and easily deployed assessment of swallowing in neurodegenerative disease. It is thus ideally suited for both clinical bedside assessment and future multicentre clinical trials in neurodegenerative disease.

  6. Validity and Inter-Rater Reliability of a Novel Bedside Referral Tool for Spasticity

    Science.gov (United States)

    2018-02-20

    Spasticity, Muscle; Muscular Diseases; Musculoskeletal Disease; Muscle Hypertonia; Muscle Spasticity; Neuromuscular Manifestations; Signs and Symptoms; Nervous System Diseases; Neurologic Manifestations

  7. [Reliability and validity of warning signs checklist for screening psychological, behavioral and developmental problems of children].

    Science.gov (United States)

    Huang, X N; Zhang, Y; Feng, W W; Wang, H S; Cao, B; Zhang, B; Yang, Y F; Wang, H M; Zheng, Y; Jin, X M; Jia, M X; Zou, X B; Zhao, C X; Robert, J; Jing, Jin

    2017-06-02

    Objective: To evaluate the reliability and validity of warning signs checklist developed by the National Health and Family Planning Commission of the People's Republic of China (NHFPC), so as to determine the screening effectiveness of warning signs on developmental problems of early childhood. Method: Stratified random sampling method was used to assess the reliability and validity of checklist of warning sign and 2 110 children 0 to 6 years of age(1 513 low-risk subjects and 597 high-risk subjects) were recruited from 11 provinces of China. The reliability evaluation for the warning signs included the test-retest reliability and interrater reliability. With the use of Age and Stage Questionnaire (ASQ) and Gesell Development Diagnosis Scale (GESELL) as the criterion scales, criterion validity was assessed by determining the correlation and consistency between the screening results of warning signs and the criterion scales. Result: In terms of the warning signs, the screening positive rates at different ages ranged from 10.8%(21/141) to 26.2%(51/137). The median (interquartile) testing time for each subject was 1(0.6) minute. Both the test-retest reliability and interrater reliability of warning signs reached 0.7 or above, indicating that the stability was good. In terms of validity assessment, there was remarkable consistency between ASQ and warning signs, with the Kappa value of 0.63. With the use of GESELL as criterion, it was determined that the sensitivity of warning signs in children with suspected developmental delay was 82.2%, and the specificity was 77.7%. The overall Youden index was 0.6. Conclusion: The reliability and validity of warning signs checklist for screening early childhood developmental problems have met the basic requirements of psychological screening scales, with the characteristics of short testing time and easy operation. Thus, this warning signs checklist can be used for screening psychological and behavioral problems of early childhood

  8. Analysis of Parking Reliability Guidance of Urban Parking Variable Message Sign System

    OpenAIRE

    Zhenyu Mei; Ye Tian; Dongping Li

    2012-01-01

    Operators of parking guidance and information systems (PGIS) often encounter difficulty in determining when and how to provide reliable car park availability information to drivers. Reliability has become a key factor to ensure the benefits of urban PGIS. The present paper is the first to define the guiding parking reliability of urban parking variable message signs (VMSs). By analyzing the parking choice under guiding and optional parking lots, a guiding parking reliability model was constru...

  9. Analysis of Parking Reliability Guidance of Urban Parking Variable Message Sign System

    Directory of Open Access Journals (Sweden)

    Zhenyu Mei

    2012-01-01

    Full Text Available Operators of parking guidance and information systems (PGIS often encounter difficulty in determining when and how to provide reliable car park availability information to drivers. Reliability has become a key factor to ensure the benefits of urban PGIS. The present paper is the first to define the guiding parking reliability of urban parking variable message signs (VMSs. By analyzing the parking choice under guiding and optional parking lots, a guiding parking reliability model was constructed. A mathematical program was formulated to determine the guiding parking reliability of VMS. The procedures were applied to a numerical example, and the factors that affect guiding reliability were analyzed. The quantitative changes of the parking berths and the display conditions of VMS were found to be the most important factors influencing guiding reliability. The parking guiding VMS achieved the best benefit when the parking supply was close to or was less than the demand. The combination of a guiding parking reliability model and parking choice behavior offers potential for PGIS operators to reduce traffic congestion in central city areas.

  10. The reliability of identifying the Omega sign using axial T2-weighted magnetic resonance imaging.

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    Zakaria, Hesham Mostafa; Massa, Peter Joseph; Smith, Richard L; Moharram, Tarek Hazem; Corrigan, John; Lee, Ian; Schultz, Lonni; Hu, Jianhui; Patel, Suresh; Griffith, Brent

    2018-01-01

    Preoperative identification of the eloquent brain is important for neurosurgical planning. One common method of finding the motor cortex is by localizing "the Omega sign." No studies have tested the reliability of imaging to identify the Omega sign. We identified 40 recent and consecutive patients who had undergone preoperative functional magnetic resonance imaging for identification of the hand motor area prior to tumor resection. We recruited 11 neurosurgical residents of various levels of training and one board-certified neurosurgeon to identify the hand motor cortex Omega. Testees were given axial images of T2-weighted MRI and placed marks where they expected to find the Omega. Two board-certified radiologists graded and quantified the localization attempts. Inter-rater reliability was assessed using the kappa statistic, and Rao-Scott chi-square tests were used to examine the relationship between clinical factors and testees' experience with correct identification of the Omega sign. The overall correct identification rate was 69.9% (95% CI = 63.4-75.7), ranging from 36.6% to 92.7% among all raters for the tumor side and from 46.2% to 97.4% for the non-tumor side. Anatomic distortion greatly affected correct identification ( p Omega than junior residents ( p Omega sign is poor, with a Fleiss kappa of 0.23. We concluded that correct identification of the Omega sign is affected by tumor distortion and experience but overall is not reliable. This underscores the limitations of anatomic landmarks and the importance of utilizing multiple scanning planes and preoperative fMRI for appropriate localization.

  11. Content validation: clarity/relevance, reliability and internal consistency of enunciative signs of language acquisition.

    Science.gov (United States)

    Crestani, Anelise Henrich; Moraes, Anaelena Bragança de; Souza, Ana Paula Ramos de

    2017-08-10

    To analyze the results of the validation of building enunciative signs of language acquisition for children aged 3 to 12 months. The signs were built based on mechanisms of language acquisition in an enunciative perspective and on clinical experience with language disorders. The signs were submitted to judgment of clarity and relevance by a sample of six experts, doctors in linguistic in with knowledge of psycholinguistics and language clinic. In the validation of reliability, two judges/evaluators helped to implement the instruments in videos of 20% of the total sample of mother-infant dyads using the inter-evaluator method. The method known as internal consistency was applied to the total sample, which consisted of 94 mother-infant dyads to the contents of the Phase 1 (3-6 months) and 61 mother-infant dyads to the contents of Phase 2 (7 to 12 months). The data were collected through the analysis of mother-infant interaction based on filming of dyads and application of the parameters to be validated according to the child's age. Data were organized in a spreadsheet and then converted to computer applications for statistical analysis. The judgments of clarity/relevance indicated no modifications to be made in the instruments. The reliability test showed an almost perfect agreement between judges (0.8 ≤ Kappa ≥ 1.0); only the item 2 of Phase 1 showed substantial agreement (0.6 ≤ Kappa ≥ 0.79). The internal consistency for Phase 1 had alpha = 0.84, and Phase 2, alpha = 0.74. This demonstrates the reliability of the instruments. The results suggest adequacy as to content validity of the instruments created for both age groups, demonstrating the relevance of the content of enunciative signs of language acquisition.

  12. Early warning signs checklists for relapse in bipolar depression and mania: utility, reliability and validity.

    Science.gov (United States)

    Lobban, Fiona; Solis-Trapala, Ivonne; Symes, Wendy; Morriss, Richard

    2011-10-01

    Recognising early warning signs (EWS) of mood changes is a key part of many effective interventions for people with Bipolar Disorder (BD). This study describes the development of valid and reliable checklists required to assess these signs of depression and mania. Checklists of EWS based on previous research and participant feedback were designed for depression and mania and compared with spontaneous reporting of EWS. Psychometric properties and utility were examined in 96 participants with BD. The majority of participants did not spontaneously monitor EWS regularly prior to use of the checklists. The checklists identified most spontaneously generated EWS and led to a ten fold increase in the identification of EWS for depression and an eight fold increase for mania. The scales were generally reliable over time and responses were not associated with current mood. Frequency of monitoring for EWS correlated positively with social and occupational functioning for depression (beta=3.80, p=0.015) and mania (beta=3.92, p=0.008). The study is limited by a small sample size and the fact that raters were not blind to measures of mood and function. EWS checklists are useful and reliable clinical and research tools helping to generate enough EWS for an effective EWS intervention. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. New definitions of 6 clinical signs of perceptual disorder in children with cerebral palsy: an observational study through reliability measures.

    Science.gov (United States)

    Ferrari, A; Sghedoni, A; Alboresi, S; Pedroni, E; Lombardi, F

    2014-12-01

    Recently authors have begun to emphasize the non-motor aspects of Cerebral Palsy and their influence on motor control and recovery prognosis. Much has been written about single clinical signs (i.e., startle reaction) but so far no definitions of the six perceptual signs presented in this study have appeared in literature. This study defines 6 signs (startle reaction, upper limbs in startle position, frequent eye blinking, posture freezing, averted eye gaze, grimacing) suggestive of perceptual disorders in children with cerebral palsy and measures agreement on sign recognition among independent observers and consistency of opinions over time. Observational study with both cross-sectional and prospective components. Fifty-six videos presented to observers in random order. Videos were taken from 19 children with a bilateral form of cerebral palsy referred to the Children Rehabilitation Unit in Reggio Emilia. Thirty-five rehabilitation professionals from all over Italy: 9 doctors and 26 physiotherapists. Measure of agreement among 35 independent observers was compiled from a sample of 56 videos. Interobserver reliability was determined using the K index of Fleiss and reliability intra-observer was calculated by the Spearman correlation index between ranks (rho - ρ). Percentage of agreement between observers and Gold Standard was used as criterion validity. Interobserver reliability was moderate for startle reaction, upper limb in startle position, adverted eye gaze and eye-blinking and fair for posture freezing and grimacing. Intraobserver reliability remained consistent over time. Criterion validity revealed very high agreement between independent observer evaluation and gold standard. Semiotics of perceptual disorders can be used as a specific and sensitive instrument in order to identify a new class of patients within existing heterogeneous clinical types of bilateral cerebral palsy forms and could help clinicians in identifying functional prognosis. To provide

  14. The reliability and validity of video analysis for the assessment of the clinical signs of concussion in Australian football.

    Science.gov (United States)

    Makdissi, Michael; Davis, Gavin

    2016-10-01

    The objective of this study was to determine the reliability and validity of identifying clinical signs of concussion using video analysis in Australian football. Prospective cohort study. All impacts and collisions potentially resulting in a concussion were identified during 2012 and 2013 Australian Football League seasons. Consensus definitions were developed for clinical signs associated with concussion. For intra- and inter-rater reliability analysis, two experienced clinicians independently assessed 102 randomly selected videos on two occasions. Sensitivity, specificity, positive and negative predictive values were calculated based on the diagnosis provided by team medical staff. 212 incidents resulting in possible concussion were identified in 414 Australian Football League games. The intra-rater reliability of the video-based identification of signs associated with concussion was good to excellent. Inter-rater reliability was good to excellent for impact seizure, slow to get up, motor incoordination, ragdoll appearance (2 of 4 analyses), clutching at head and facial injury. Inter-rater reliability for loss of responsiveness and blank and vacant look was only fair and did not reach statistical significance. The feature with the highest sensitivity was slow to get up (87%), but this sign had a low specificity (19%). Other video signs had a high specificity but low sensitivity. Blank and vacant look (100%) and motor incoordination (81%) had the highest positive predictive value. Video analysis may be a useful adjunct to the side-line assessment of a possible concussion. Video analysis however should not replace the need for a thorough multimodal clinical assessment. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  15. Bedside teaching with unwell patients: Can it ever be appropriate?

    Science.gov (United States)

    Jayakumar, Nithish

    2017-03-01

    Bedside teaching has seen a decline in its popularity since the heady days of Boerhaave and Osler; a number of hurdles have been noted in the literature including time constraints on senior clinicians. While organizing a bedside teaching course for final-year medical students, it was apparent that the availability of suitable patients was also a limiting factor. Often, we would be turned away from patients with physical signs because they were deemed to be too unwell for an examination. However, the benefits to medical students of examining unwell patients with physical signs cannot be underestimated. Identifying the unwell patient, and the associated physical signs relevant to the underlying diagnosis, should be a priority; although simulation is increasingly being used in teaching, it cannot fully replicate the learning experience gained in bedside teaching. As long as the patient is not under duress, bedside teaching with unwell patients should be encouraged.

  16. Neurology at the bedside

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Waldemar, Gunhild

    This updated and expanded new edition takes neurology trainees by the hand and guides them through the whole patient encounter - from an efficient neurological history and bedside examination through to differential diagnosis, diagnostic procedures and treatment. At each step the expert authors......, as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training....... Medical students, general practitioners and others with an interest in neurology will also find invaluable information here....

  17. Neurology at the bedside

    DEFF Research Database (Denmark)

    Kondziella, Daniel; Waldemar, Gunhild

    , as have new chapters including neurogenetics, neurorehabilitation, neurocritical care and heuristic neurological reasoning. In addition, this second edition now includes more than 100 unique case histories. Neurology at the Bedside, Second Edition is written for neurologists in all stages of training...

  18. Between Bedside and Budget

    NARCIS (Netherlands)

    J.L.T. Blank; E. Eggink

    1998-01-01

    Original title: Tussen bed en budget. The report Between bedside and budget (Tussen bed en budget) describes an extensive empirical study of the efficiency of general and university hospitals in the Netherlands. A policy summary recaps the main findings of the study. Those findings

  19. Migraine patients consistently show abnormal vestibular bedside tests

    Directory of Open Access Journals (Sweden)

    Eliana Teixeira Maranhão

    2015-01-01

    Full Text Available Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs.Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls.Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls.Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity.Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

  20. Migraine patients consistently show abnormal vestibular bedside tests.

    Science.gov (United States)

    Maranhão, Eliana Teixeira; Maranhão-Filho, Péricles; Luiz, Ronir Raggio; Vincent, Maurice Borges

    2016-01-01

    Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Cross-sectional study including sixty individuals - thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

  1. The bedside Sherlock Holmes.

    Science.gov (United States)

    Fitzgerald, F T; Tierney, L M

    1982-08-01

    There are a multitude of diagnostic clues contained in clothing, jewelry, possessions and other extracorporeal attachments that each patient brings with him or her to a physician. Because of the emphasis of classic physical diagnosis on the body of a patient solely, and because of modern practices that may have patients stripped of these articles before the first encounter with their physician, these interesting and enlightening findings are often ignored or unavailable. Incorporation of these observations into the panoply of data obtained from the history and physical examination will enhance both the accuracy and adventure of differential diagnosis. Such exercises in observation, moreover, may increase general physical diagnostic skills as well as enliven bedside rounds.

  2. Reliability and Validity of the Assessment of Neurological Soft-Signs in Children with and without Attention-Deficit-Hyperactivity Disorder

    Science.gov (United States)

    Gustafsson, Peik; Svedin, Carl Goran; Ericsson, Ingegerd; Linden, Christian; Karlsson, Magnus K.; Thernlund, Gunilla

    2010-01-01

    Aim: To study the value and reliability of an examination of neurological soft-signs, often used in Sweden, in the assessment of children with attention-deficit-hyperactivity disorder (ADHD), by examining children with and without ADHD, as diagnosed by an experienced clinician using the DSM-III-R. Method: We have examined interrater reliability…

  3. Reliability

    OpenAIRE

    Condon, David; Revelle, William

    2017-01-01

    Separating the signal in a test from the irrelevant noise is a challenge for all measurement. Low test reliability limits test validity, attenuates important relationships, and can lead to regression artifacts. Multiple approaches to the assessment and improvement of reliability are discussed. The advantages and disadvantages of several different approaches to reliability are considered. Practical advice on how to assess reliability using open source software is provided.

  4. Evaluating the validity and reliability of the V-scale instrument (Turkish version) used to determine nurses' attitudes towards vital sign monitoring.

    Science.gov (United States)

    Ertuğ, Nurcan

    2018-06-01

    The aim of this study was to determine the validity and reliability of the Turkish version of the V-scale, which measures nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration. This validity and reliability study was conducted at a tertiary hospital in Ankara, Turkey, in 2016. A total of 169 ward nurses participated in the study. Exploratory factor analysis, Cronbach's alpha coefficient, and the intraclass correlation coefficient were used to determine the validity and reliability of the scale. A 5-factor, 16-item scale explained 60.823% of the total variance according to the validity analysis. Our version matched the original scale in terms of the number of items and factor structure. Cronbach's alpha coefficient of the Turkish version of the V-scale was 0.764. The test-retest reliability results were 0.855 for the overall intraclass correlation coefficient, and the t-test result was P > 0.05. The V-scale is a reliable and valid instrument to measure Turkish nurses' attitudes towards vital signs monitoring in the detection of clinical deterioration. © 2018 John Wiley & Sons Australia, Ltd.

  5. Validity and reliability of haemoglobin colour scale and its comparison with clinical signs in diagnosing anaemia in pregnancy in Ahmedabad, India.

    Science.gov (United States)

    Bala, D V; Vyas, S; Shukla, A; Tiwari, H; Bhatt, G; Gupta, K

    2012-07-01

    This study compared the validity of the haemoglobin colour scale (HCS) and clinical signs in diagnosing anaemia against Sahli's haemoglobinometer method as the gold standard, and assessed the reliability of HCS. The sample comprised 129 pregnant women recruited from 6 urban health centres in Ahmedabad. The prevalence of anaemia was 69.8% by Sahli's method, 78.3% by HCS and 89.9% by clinical signs; there was no statistically significant difference between Sahli's method and HCS whereas there was between Sahlis method and clinical signs. The mean haemoglobin level by Sahli's method and HCS differed significantly. The sensitivity, specificity, positive predictive value and negative predictive value of HCS was 83.3%, 33.3%, 74.3% and 46.4% respectively and that of clinical signs was 91.1%, 12.8%, 70.7% and 38.5% respectively. Interobserver agreement for HCS was moderate (K = 0.43). Clinical signs are better than HCS for diagnosing anaemia. HCS can be used in the field provided assessors are adequately trained.

  6. Diabetic Cardiomyopathy: Bench to Bedside

    Science.gov (United States)

    Schilling, Joel D.; Mann, Douglas L.

    2012-01-01

    The study of diabetic cardiomyopathy (diabetic CM) is an area of significant interest given the strong association between diabetes and the risk of heart failure. Many unanswered questions remain regarding the clinical definition and pathogenesis of this metabolic cardiomyopathy. This article reviews the current understanding of diabetic CM with a particular emphasis on the unresolved issues that have limited translation of scientific discovery to patient bedside. PMID:22999244

  7. Is the omega sign a reliable landmark for the neurosurgical team? An anatomical study about the central sulcus region

    Directory of Open Access Journals (Sweden)

    Thiago Rodrigues

    2015-11-01

    Full Text Available ABSTRACTThe central sulcus region is an eloquent area situated between the frontal and parietal lobes. During neurosurgical procedures, it is sometimes difficult to understand the cortical anatomy of this region.Objective Find alternative ways to anatomically navigate in this region during neurosurgical procedures.Method We analyzed eighty two human hemispheres using a surgical microscope and completed a review of the literature about central sulcus region.Results In 68/82 hemispheres, the central sulcus did not reach the posterior ramus of the lateral sulcus. A knob on the second curve of the precentral gyrus was reliably identified in only 64/82 hemispheres.Conclusion The morphometric data presented in this article can be useful as supplementary method to identify the central sulcus region landmarks.

  8. The evaluation of bedside teaching – an instrument for staff ...

    African Journals Online (AJOL)

    teaching during their undergraduate training, while 100% thought that bedside ... or no attention has been given to the evaluation of bedside teaching. Problem ... of this pilot study was to determine the quality of bedside teaching in one group ...

  9. Validity and reliability of the Spanish-language version of the self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) pain scale.

    Science.gov (United States)

    López-de-Uralde-Villanueva, I; Gil-Martínez, A; Candelas-Fernández, P; de Andrés-Ares, J; Beltrán-Alacreu, H; La Touche, R

    2016-12-08

    The self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) scale is a tool designed to identify patients with pain with neuropathic features. To assess the validity and reliability of the Spanish-language version of the S-LANSS scale. Our study included a total of 182 patients with chronic pain to assess the convergent and discriminant validity of the S-LANSS; the sample was increased to 321 patients to evaluate construct validity and reliability. The validated Spanish-language version of the ID-Pain questionnaire was used as the criterion variable. All participants completed the ID-Pain, the S-LANSS, and the Numerical Rating Scale for pain. Discriminant validity was evaluated by analysing sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Construct validity was assessed with factor analysis and by comparing the odds ratio of each S-LANSS item to the total score. Convergent validity and reliability were evaluated with Pearson's r and Cronbach's alpha, respectively. The optimal cut-off point for S-LANSS was ≥12 points (AUC=.89; sensitivity=88.7; specificity=76.6). Factor analysis yielded one factor; furthermore, all items contributed significantly to the positive total score on the S-LANSS (P<.05). The S-LANSS showed a significant correlation with ID-Pain (r=.734, α=.71). The Spanish-language version of the S-LANSS is valid and reliable for identifying patients with chronic pain with neuropathic features. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Bedside Teaching in Australian Clinical Schools: A National Study

    Directory of Open Access Journals (Sweden)

    Praveen L. Indraratna

    2013-01-01

    Full Text Available Purpose. Bedside teaching (BST of medical students has become less common in recent years; however, there have been strong recommendations made in the literature to continue this teaching modality for the valued benefits it provides. The purpose of the present study is to explore the perceptions and opinions of bedside teaching among senior Australian medical students. Methods. Medical students at Australian universities were surveyed by means of an electronic questionnaire. The results were collected and analysed. Results. A total of 517 responses were received from students at 15 universities and 94 different clinical sites. The percentage of students who identified BST as very important ranged from 62.5% in psychiatry to 90.4% in internal medicine. The optimal class size was nominated as 3-4 students, and students favoured a style where one individual performs a complete examination, with the remainder allowed to elicit the key sign afterwards. Students felt 3-4 hours of BST per week to be ideal. Advantages identified to BST included provision of feedback and elicitation of clinical signs. Disadvantages included time constraints and excessive class sizes. Conclusions. The unique benefits of BST result in its high demand by students, regardless of the discipline being taught.

  11. Pneumococcusuria: From bench to bedside.

    Science.gov (United States)

    Krishna, S; Sanjeevan, K V; Sudheer, A; Dinesh, K R; Kumar, A; Karim, S

    2012-01-01

    The present study highlights six cases of pneumococcusuria during the time period of May 2008 to May 2010. All the patients had a co-existing predisposing factor with the isolation of Streptococcus pneumoniae in urine. Five of the six patients having signs and symptoms of urinary tract infections (UTI) were treated and cured of the same. It becomes essential to consider pneumococcal UTI in the presence of clinical signs and symptoms associated with urinary tract abnormalities like hydronephrosis and renal stones. S. pneumoniae may be regarded as an emerging pathogen in UTI. Precise microbiological diagnosis must correlate with the clinical signs and symptoms for the administration of appropriate antibiotic therapy.

  12. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department.

    Science.gov (United States)

    Testa, Americo; Francesconi, Andrea; Giannuzzi, Rosangela; Berardi, Silvia; Sbraccia, Paolo

    2015-12-01

    The economic crisis, the growing healthcare demand, and Defensive Medicine wastefulness, strongly recommend the restructuring of the entire medical network. New health technology, such as bedside ultrasonography, might successfully integrate the clinical approach optimizing the use of limited resources, especially in a person-oriented vision of medicine. Bedside ultrasonography is a safe and reliable technique, with worldwide expanding employment in various clinical settings, being considered as "the stethoscope of the 21st century". However, at present, bedside ultrasonography lacks economic analysis. We performed a Cost-Benefit Analysis "ex ante", with a break-even point computing, of bedside ultrasonography implementation in an Internal Medicine department in the mid-term. Number and kind estimation of bedside ultrasonographic studies were obtained by a retrospective study, whose data results were applied to the next 3-year period (foresight study). All 1980 foreseen bedside examinations, with prevailing multiorgan ultrasonographic studies, were considered to calculate direct and indirect costs, while specific and generic revenues were considered only after the first semester. Physician professional training, equipment purchase and working time represented the main fixed and variable cost items. DRG increase/appropriateness, hospitalization stay shortening and reduction of traditional ultrasonography examination requests mainly impacted on calculated revenues. The break-even point, i.e. the volume of activity at which revenues exactly equal total incurred costs, was calculated to be 734 US examinations, corresponding to € 81,998 and the time considered necessary to reach it resulting 406 days. Our economic analysis clearly shows that bedside ultrasonography implementation in clinical daily management of an Internal Medicine department can produce consistent savings, or economic profit according to managerial choices (i.e., considering public or private targets

  13. SIGNS The sandwich sign

    African Journals Online (AJOL)

    The sandwich sign is demonstrated on cross-sectional imaging, commonly on CT or ultrasound. It refers to homogeneous soft- tissue masses representing mesenteric lymphadenopathy as the two halves of a sandwich bun, encasing the mesenteric fat and tubular mesenteric vessels that constitute the 'sandwich filling' (Figs ...

  14. Medical students' perceptions of bedside teaching.

    Science.gov (United States)

    Gray, David; Cozar, Octavian; Lefroy, Janet

    2017-06-01

    Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students' satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants. We aimed to identify how students perceived bedside teaching delivered by junior doctors compared with consultants METHODS: A questionnaire was distributed to all third-year medical students at Keele University via e-mail. Responses were submitted anonymously. Forty-six students responded (37.4%), 73.3 per cent of whom said that they felt more comfortable having bedside teaching delivered by junior doctors than by consultants. Consultants were perceived as more challenging by 60 per cent of respondents. Students appeared to value feedback on their performance, trust the validity of taught information, and to value the overall educational experience equally, regardless of the clinical grade of the teacher. Student preference does not equate to the value that they place on their bedside teaching. Junior doctors are perceived as being more in touch with students and the curriculum, whereas consultants are perceived as having higher expectations and as being both stricter and more knowledgeable. The clinical teacher's approachable manner and enthusiasm for teaching are more important than clinical grade, as is the ability to deliver well-structured constructive feedback. © 2016 John Wiley & Sons Ltd.

  15. Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea

    Directory of Open Access Journals (Sweden)

    Keihan Golshani

    2016-04-01

    Full Text Available Acute dyspnea is a common cause of hospitalization in emergency departments (ED.Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP in this regard. Methods: This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex, vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20. Results: 48 patients with acute respiratory distress were evaluated (50% female. The mean age of participants was 66.94 ± 16.33 (28-94 years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6% cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive and BNP in 44 cases (24 false positives. The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3 and 66.3 (95% CI: 49.8-89.2, respectively (p = 0.0021. Conclusion: It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.

  16. The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review.

    Science.gov (United States)

    Daum, Corinna; Hubschmid, Monica; Aybek, Selma

    2014-02-01

    Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and identifying 'positive' signs suggestive of a functional disorder. These positive signs are well known to all trained neurologists but their validity is still not established. The aim of this study is to provide current evidence regarding their sensitivity and specificity. We conducted a systematic search on motor, sensory and gait functional signs in Embase, Medline, PsycINfo from 1965 to June 2012. Studies in English, German or French reporting objective data on more than 10 participants in a controlled design were included in a systematic review. Other relevant signs are discussed in a narrative review. Eleven controlled studies (out of 147 eligible articles) describing 14 signs (7 motor, 5 sensory, 2 gait) reported low sensitivity of 8-100% but high specificity of 92-100%. Studies were evidence class III, only two had a blinded design and none reported on inter-rater reliability of the signs. Clinical signs for functional neurological symptoms are numerous but only 14 have been validated; overall they have low sensitivity but high specificity and their use should thus be recommended, especially with the introduction of the new DSM-V criteria.

  17. Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination.

    Science.gov (United States)

    Kimura, Bruce J; Shaw, David J; Amundson, Stan A; Phan, James N; Blanchard, Daniel G; DeMaria, Anthony N

    2015-09-01

    The current practice of physical diagnosis is dependent on physician skills and biases, inductive reasoning, and time efficiency. Although the clinical utility of echocardiography is well known, few data exist on how to integrate 2-dimensional screening "quick-look" ultrasound applications into a novel, modernized cardiac physical examination. We discuss the evidence basis behind ultrasound "signs" pertinent to the cardiovascular system and elemental in synthesis of bedside diagnoses and propose the application of a brief cardiac limited ultrasound examination based on these signs. An ultrasound-augmented cardiac physical examination can be taught in traditional medical education and has the potential to improve bedside diagnosis and patient care. © 2015 by the American Institute of Ultrasound in Medicine.

  18. reliability reliability

    African Journals Online (AJOL)

    eobe

    Corresponding author, Tel: +234-703. RELIABILITY .... V , , given by the code of practice. However, checks must .... an optimization procedure over the failure domain F corresponding .... of Concrete Members based on Utility Theory,. Technical ...

  19. Stem Cell Transplantation from Bench to Bedside

    Indian Academy of Sciences (India)

    Table of contents. Stem Cell Transplantation from Bench to Bedside · Slide 2 · Slide 3 · Slide 4 · Principles of an allogeneic stem cell transplant · Principle of an allogeneic stem cell transplant · Principle of an autologous Stem Cell Transplant · Slide 8 · Conditioning · Slide 10 · Slide 11 · Stem Cell Transplantation · Slide 13.

  20. Has Bedside Teaching Had Its Day?

    Science.gov (United States)

    Qureshi, Zeshan; Maxwell, Simon

    2012-01-01

    Though a diverse array of teaching methods is now available, bedside teaching is arguably the most favoured. Students like it because it is patient-centred, and it includes a high proportion of relevant skills. It is on the decline, coinciding with declining clinical skills of junior doctors. Several factors might account for this: busier…

  1. Satisfactory reliability among nursing students using the instrument PVC ASSESS to evaluate management of peripheral venous catheters.

    Science.gov (United States)

    Ahlqvist, Margary; Berglund, Britta; Nordström, Gun; Klang, Birgitta; Johansson, Eva

    2014-01-01

    Nursing students should be given opportunities to participate in clinical audits during their education. However, audit tools are seldom tested for reliability among nursing students. The aim of this study was to present reliability among nursing students using the instrument PVC assess to assess management of peripheral venous catheters (PVCs) and PVC-related signs of thrombophlebitis. PVC assess was used to assess 67 inserted PVCs in 60 patients at ten wards at a university hospital. One group of nursing students (n=4) assessed PVCs at the bedside (inter-rater reliability) and photographs of these PVCs were taken. Another group of students (n=3) assessed the PVCs in the photographs after 4 weeks (test-retest reliability). To determine reliability, proportion of agreement [P(A)] and Cohen's kappa coefficient (κ) were calculated. For bedside assessment of PVCs, P(A) ranged from good to excellent (0.80-1.0) in 55% of the 26 PVC assess items that were tested. P(A) was poor (satisfactory reliability among nursing students. However, students need training in how to use the instrument before assessing PVCs.

  2. Bedside Ultrasound in the Emergency Department to Detect Hydronephrosis for the Evaluation of Suspected Ureteric Colic.

    Science.gov (United States)

    Shrestha, R; Shakya, R M; Khan A, A

    2016-01-01

    Background Renal colic is a common emergency department presentation. Hydronephrosis is indirect sign of urinary obstruction which may be due to obstructing ureteric calculus and can be detected easily by bedside ultrasound with minimal training. Objective To compare the accuracy of detection of hydronephrosis performed by the emergency physician with that of radiologist's in suspected renal colic cases. Method This was a prospective observational study performed over a period of 6 months. Patients >8 years with provisional diagnosis of renal colic with both the bedside ultrasound and the formal ultrasound performed were included. Presence of hydronephrosis in both ultrasounds and size and location of ureteric stone if present in formal ultrasound was recorded. The accuracy of the emergency physician detection of hydronephrosis was determined using the scan reported by the radiologists as the "gold standard" as computed tomography was unavailable. Statistical analysis was executed using SPSS 17.0. Result Among the 111 included patients, 56.7% had ureteric stone detected in formal ultrasound. The overall sensitivity, specificity, positive predictive value and negative predictive value of bedside ultrasound performed by emergency physician for detection of hydronephrosis with that of formal ultrasound performed by radiologist was 90.8%., 78.3%, 85.5% and 85.7% respectively. Bedside ultrasound and formal ultrasound both detected hydronephrosis more often in patients with larger stones and the difference was statistically significant (p=.000). Conclusion Bedside ultrasound can be potentially used as an important tool in detecting clinically significant hydronephrosis in emergency to evaluate suspected ureteric colic. Focused training in ultrasound could greatly improve the emergency management of these patients.

  3. Bedside immunochromatographic test for enterovirus 71 infection in children.

    Science.gov (United States)

    Huang, Kuan-Ying Arthur; Yang, Shuan; Tsao, Kuo-Chien; Chen, Chih-Jung; Hsieh, Yu-Chia; Chiu, Cheng-Hsun; Hsieh, Juo-Yu; Yang, Jyh-Yuan; Huang, Yhu-Chering

    2013-11-01

    Enterovirus 71 (EV71) causes frequent outbreaks worldwide, particularly in the Asia-Pacific area. Its quick spread is a critical challenge for public health and timely preventive measures and clinical management therefore rely on early detection. There is a need for a rapid, easy-to-use, and reliable method for detecting EV71 infections. The study aimed to evaluate a bedside immunochromatography (ICT) kit for diagnosing acute EV71 infection in children. Pediatric patients with herpangina or hand-foot-mouth disease were randomly and prospectively enrolled from hospitals across Taiwan. Throat or rectal swabs were collected for viral culture and reverse-transcriptase polymerase chain reaction (RTPCR). For the ICT kit, whole blood was obtained by ear piercing, finger-sticking, or venipuncture. The results of ICT, virus isolation and RTPCR in clinical samples were compared. Of the 156 patients enrolled, 91 (58%), 64 (41%) and 72 (46%) had positive results of the ICT kit, viral culture and RTPCR, respectively. Laboratory-confirmed infection with either positive EV71 culture or RTPCR was used as the diagnostic standard. The sensitivity and specificity of the ICT kit was 84% and 77%, respectively. The viral culture and RTPCR had relatively lower sensitivity but higher specificity. The patient's age did not affect the performance of the ICT, viral culture and RTPCR. However, a low sensitivity of ICT kit was noted before the second day of disease onset. The ICT kit may serve as a simple, quick and reliable method for the bedside diagnosis of acute EV71 infection in children. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Bedside intravascular ultrasound-guided inferior vena cava filter placement in medical-surgical intensive care critically-ill patients

    Directory of Open Access Journals (Sweden)

    Mohammad A. Abusedera

    2015-09-01

    Conclusions: Bedside IVUS-guided filter placement in medical-surgical critically ill patient in intensive care unit is a feasible, safe and reliable technique for IVC interruption. IVUS may be the most appropriate tool to guide filter insertion in obese patient.

  5. Bench-to-bedside review

    DEFF Research Database (Denmark)

    Janum, Susanne; Zingg, Walter; Classen, Volker

    2013-01-01

    Central venous catheters (CVCs) are indispensable in modern pediatric medicine. CVCs provide secure vascular access, but are associated with a risk of severe complications, in particular bloodstream infection. We provide a review of the recent literature about the diagnostic and therapeutic...... challenges of catheter-related bloodstream infection (CRBSI) in children and its prevention. Variations in blood sampling and limitations in blood culturing interfere with accurate and timely diagnosis of CRBSI. Although novel molecular testing methods appear promising in overcoming some of the present...... diagnostic limitations of conventional blood sampling in children, they still need to solidly prove their accuracy and reliability in clinical practice. Standardized practices of catheter insertion and care remain the cornerstone of CRBSI prevention although their implementation in daily practice may...

  6. Peer-assisted bedside teaching rounds.

    Science.gov (United States)

    Doumouras, Aristithes; Rush, Raphael; Campbell, Anthony; Taylor, David

    2015-06-01

    Although postgraduate trainees play a well-accepted role in medical education, little consideration has traditionally been given to senior undergraduate trainees as teachers. Recently, research has shown senior medical students (SMS) can play an effective teaching role for junior medical students (JMS) in non-clinical medical settings. The purpose of our study was to understand the perceptions of SMSs as teachers in a clinical environment for JMS. All students who participated in our peer-led bedside teaching programme from September 2010 to May 2012 were invited to complete a questionnaire following their teaching session. Fifty-six of 70 JMS (80%) and 15 of 15 SMS (100%) participated. Survey questions addressed learning, bedside experiences, teacher effectiveness and the overall usefulness of these sessions. The data collected were analysed for significance of the perceptions reported. We found students reported positive and statistically significant results in all domains examined. JMS reported that sessions were highly valuable learning, improved confidence and comfort at the bedside, had excellent teaching and were a valuable addition to their clinical skills training. SMS reported getting highly valuable learning through preparation and developing improved comfort in a teaching role. Little consideration has traditionally been given to senior undergraduate trainees as teachers Our findings demonstrate that peer-directed learning in undergraduate medical education can be effectively implemented in the clinical arena. © 2015 John Wiley & Sons Ltd.

  7. Metacarpal sign

    Directory of Open Access Journals (Sweden)

    Barbara Nieradko-Iwanicka

    2018-02-01

    Full Text Available Background Archibald's sign, or metacarpal sign is defined as shortening of the IV and V metacarpal bones, is a rare phenomenon found in the Turner syndrome, homocystinuria and in Albright's osteodystrophy. Objectives The aim of the article was to show a rare case of metacarpal sign with atypical shortening of the III and IV metacarpal bones not connected with gonadal dysgenesia, genetic disorders nor osteodystrophy. Material and methods Case report of a 60-year-old female patient. Results Artchibald's metacarpal sign in the described case was accompanied by erosive arthritis in the left lower extremity. No features of genetic disorders nor gonadal disgenesia were found in the patient. Undifferentiated seronegative asymmetric erosive arthritis developed in the patient. The level of parathormon was within the normal range. No signs of tumor were seen in bone scintigraphy. Conclusions Archibald's metacarpal sign may be present in patients without genetic disorders.

  8. Bedside ketone determination in diabetic children with hyperglycemia and ketosis in the acute care setting.

    Science.gov (United States)

    Ham, Melissa R; Okada, Pamela; White, Perrin C

    2004-03-01

    Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus marked by characteristic biochemical derangements. Diagnosis and management involve frequent evaluation of these biochemical parameters. Reliable bedside equivalents for these laboratory studies may help reduce the time to treatment and reduce costs. We evaluated the precision and bias of a bedside serum ketone meter in the acute care setting. Serum ketone results using the Precision Xtra glucometer/ketone meter (Abbott Laboratories, MediSense Products Inc., Bedford, MA, USA) correlated strongly with the Children's Medical Center of Dallas' laboratory values within the meter's value range. Meter ketone values steadily decreased during the treatment of DKA as pH and CO(2) levels increased and acidosis resolved. Therefore, the meter may be useful in monitoring therapy for DKA. This meter may also prove useful in identifying patients at risk for DKA in physicians' offices or at home.

  9. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside.

    Science.gov (United States)

    Kimura, Bruce J

    2017-07-01

    The development of hand-carried, battery-powered ultrasound devices has created a new practice in ultrasound diagnostic imaging, called 'point-of-care' ultrasound (POCUS). Capitalising on device portability, POCUS is marked by brief and limited ultrasound imaging performed by the physician at the bedside to increase diagnostic accuracy and expediency. The natural evolution of POCUS techniques in general medicine, particularly with pocket-sized devices, may be in the development of a basic ultrasound examination similar to the use of the binaural stethoscope. This paper will specifically review how POCUS improves the limited sensitivity of the current practice of traditional cardiac physical examination by both cardiologists and non-cardiologists. Signs of left ventricular systolic dysfunction, left atrial enlargement, lung congestion and elevated central venous pressures are often missed by physical techniques but can be easily detected by POCUS and have prognostic and treatment implications. Creating a general set of repetitive imaging skills for these entities for application on all patients during routine examination will standardise and reduce heterogeneity in cardiac bedside ultrasound applications, simplify teaching curricula, enhance learning and recollection, and unify competency thresholds and practice. The addition of POCUS to standard physical examination techniques in cardiovascular medicine will result in an ultrasound-augmented cardiac physical examination that reaffirms the value of bedside diagnosis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Medical Education: Entrusting Faith in Bedside Teaching

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2014-05-01

    Full Text Available Globally, patient safety and quality of health care services are the predominant challenges faced by the health care industry. To produce competent doctors it is essential to inculcate skills such as clinical reasoning, critical thinking, and self-directed learning among the medical students. Bedside teaching is a common teaching format in medical education where students are taught in an interactive manner with real patients in hospital wards which help them in acquiring the medical skills and interpersonal behavior necessary for their daily practice as doctors.

  11. Comparison of bedside inoculation of culture media with ...

    African Journals Online (AJOL)

    Background: The yield of bacterial cultures from cerebrospinal fluid (CSF) at Kenyatta National Hospital (KNH) is very low. Bedside inoculation of culture media with CSF may improve yields. Objective: To compare the culture yield of CSF inoculated onto culture medium at the bedside to that of CSF inoculated onto culture ...

  12. Bedside teaching in medical education: a literature review.

    Science.gov (United States)

    Peters, Max; Ten Cate, Olle

    2014-04-01

    Bedside teaching is seen as one of the most important modalities in teaching a variety of skills important for the medical profession, but its use is declining. A literature review was conducted to reveal its strengths, the causes of its decline and future perspectives, the evidence with regard to learning clinical skills and patient/student/teacher satisfaction. PubMed, Embase and the Cochrane library were systematically searched with regard to terms related to bedside teaching. Articles regarding the above-mentioned subjects were included. Bedside teaching has shown to improve certain clinical diagnostic skills in medical students and residents. Patients, students/residents and teachers all seem to favour bedside teaching, for varying reasons. Despite this, the practice of bedside teaching is declining. Reasons to explain this decline include the increased patient turnover in hospitals, the assumed violation of patients' privacy and an increased reliance on technology in the diagnostic process. Solutions vary from increasingly using residents and interns as bedside teachers to actively educating staff members regarding the importance of bedside teaching and providing them with practical essentials. Impediments to bedside teaching need to be overcome if this teaching modality is to remain a valuable educational method for durable clinical skills.

  13. Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

    Directory of Open Access Journals (Sweden)

    Melody Ni

    2014-12-01

    Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

  14. Shared decision making: empowering the bedside nurse.

    Science.gov (United States)

    Slack, Stephanie M; Boguslawski, Jean M; Eickhoff, Rachel M; Klein, Kristi A; Pepin, Teresa M; Schrandt, Kevin; Wise, Carrie A; Zylstra, Jody A

    2005-12-01

    Shared decision making is a process that has empowered specialty nurses at the Mayo Clinic in Rochester, MN, to solve a practice concern. Staff nurses recognized a lack of concise, collated information available that described what nurses need to know when caring for patients receiving chemotherapy. Many aspects of the administration process were knowledge and experience based and not easily retrievable. The Hematology/Oncology/Blood and Marrow Transplant Clinical Practice Committee identified this as a significant practice issue. Ideas were brainstormed regarding how to make the information available to nursing colleagues. The Chemotherapy Yellow Pages is a resource that was developed to facilitate the rapid retrieval of pertinent information for bedside nurses. The content of this article outlines a'model of shared decision making and the processes used to address and resolve the practice concern.

  15. Evaluation of the Diagnostic Role of Bedside Lung Ultrasonography in Patients with Suspected Pulmonary Embolism in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hüseyin Acar

    2017-08-01

    Full Text Available Background: Despite the existence of detailed consensus guidelines, challenges remain regarding efficient, appropriate, and safe imaging methods for the diagnosis of suspected pulmonary embolism. Aims: To investigate the role of the wedge sign, B-lines, and pleural effusion seen on bedside lung ultrasound in the diagnosis of pulmonary embolism. Study Design: Diagnostic accuracy study. Methods: During the first evaluation of patients with suspected pulmonary embolism, bedside lung ultrasound was performed, and the B-lines, wedge sign, and pleural effusion were investigated. Computed tomography angiography was used as a confirmatory test and was compared with the lung ultrasound findings. Results: Pulmonary embolism was detected in 38 (38% patients. In the comparison of bedside lung ultrasound results, statistically significant differences were found between the groups in terms of the B-lines and wedge sign (p=0.005 and p<0.001, respectively. There were no significant differences in terms of effusion (p=0.234. Comparison of these findings with computed tomography angiography of the chest showed weak negative correlations between the groups in terms of B-lines (r=-0297 and a moderately positive correlation in terms of the wedge sign (r=0.523. The sensitivity, specificity, and positive and negative predictive values of lung ultrasound findings alone were low. In the logistic regression analysis, the wedge sign (p<0.01, OR=69.45, 95% CI=6.94-695.17 and B-line (p=0.033, OR=1.96, 95% CI=0.41-8.40 were found to be effective in the diagnosis of pulmonary embolism. Conclusion: Although the role of lung ultrasound has been increasing in the management of critically ill patients, its value is limited and cannot replace the gold standard tests in the diagnosis of pulmonary embolism

  16. Novel Signs and Their Clinical Utility in Diagnosing Complex Regional Pain Syndrome (CRPS): A Prospective Observational Cohort Study.

    Science.gov (United States)

    Kuttikat, Anoop; Shaikh, Maliha; Oomatia, Amin; Parker, Richard; Shenker, Nicholas

    2017-06-01

    Delays in diagnosis occur with complex regional pain syndrome (CRPS). We define and prospectively demonstrate that novel bedside tests measuring body perception disruption can identify patients with CRPS postfracture. The objectives of our study were to define and validate 4 bedside tests, to identify the prevalence of positive tests in patients with CRPS and other chronic pain conditions, and to assess the clinical utility (sensitivity, specificity, positive predictive value, negative predictive value) for identifying CRPS within a Fracture cohort. This was a single UK teaching hospital prospective cohort study with 313 recruits from pain-free volunteers and patients with chronic pain conditions.Four novel tests were Finger Perception (FP), Hand Laterality identification (HL), Astereognosis (AS), and Body Scheme (BS) report. Five questionnaires (Brief Pain Inventory, Upper Extremity Functional Index, Lower Extremity Functional Index, Neglect-like Symptom Questionnaire, Hospital Anxiety and Depression Score) assessed the multidimensional pain experience. FP and BS were the best performing tests. Prospective monitoring of fracture patients showed that out of 7 fracture patients (total n=47) who had both finger misperception and abnormal BS report at initial testing, 3 developed persistent pain with 1 having a formal diagnosis of CRPS. Novel signs are reliable, easy to perform, and present in chronic pain patients. FP and BS have significant clinical utility in predicting persistent pain in a fracture group thereby allowing targeted early intervention.

  17. Leukocyte esterase reagent strip as a bedside tool to detect peritonitis in patients undergoing acute peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Vinay Rathore

    2017-01-01

    Full Text Available Peritonitis is a common and life-threatening complication of acute peritoneal dialysis (PD. Diagnosis requires the presence of clinical signs of peritonitis which are nonspecific and laboratory investigations [total leukocyte count (TLC, Gram-stain, and culture of PD effluent fluid] which are time-consuming and not available at the bedside. In this study, we evaluated the use of leukocyte esterase reagent strip (LERS as a bedside test to diagnose peritonitis in patients undergoing acute PD. Patients who underwent acute PD were monitored for signs and symptoms of peritonitis. PD effluent fluid analysis included TLC, absolute neutrophil count, Gram-stain, and culture for the diagnosis of peritonitis. LERS (Multistix 10SG was simultaneously dipped in PD effluent fluid and read at two minutes. Reading of + was considered as indicative of peritonitis. Twenty-one out of 166 (12.6% patients undergoing acute PD developed peritonitis. LERS detected peritonitis in 20 patients. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV of LERS were 95.2%, 95.2%, 74.1%, and 99.3%, respectively. LERS has very high sensitivity and NPV and can be used as a rapid bedside tool to exclude peritonitis in patients undergoing acute PD.

  18. Bedside prediction of right subclavian venous catheter insertion length

    Directory of Open Access Journals (Sweden)

    Yoon Ji Choi

    2014-12-01

    Full Text Available Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC, via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively. Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89. The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm = -0.037 + 0.036 × Height (cm + 0.903 × I-T-IC (cm (adjusted r2 =0.64. Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

  19. Bedside paediatric HIV testing in Malawi: Impact on testing rates

    African Journals Online (AJOL)

    2017-05-25

    May 25, 2017 ... and timely ART initiation, one third of infants living with. HIV die before their first ... received reimbursement of their travel costs, but no salary. Bedside ... Study design. The design was a quality improvement process which.

  20. Bedside paediatric HIV testing in Malawi: Impact on testing rates

    African Journals Online (AJOL)

    2017-05-25

    May 25, 2017 ... Malawi Integrated Guidelines on 'Clinical Management of ... referred by nursing staff to attend the HIV counsellor's ... Implementation of a bedside testing service at Queen Elizabeth Central Hospital significantly increased HIV ...

  1. Recognizing Bedside Events Using Thermal and Ultrasonic Readings

    Directory of Open Access Journals (Sweden)

    Danielsen Asbjørn

    2017-06-01

    Full Text Available Falls in homes of the elderly, in residential care facilities and in hospitals commonly occur in close proximity to the bed. Most approaches for recognizing falls use cameras, which challenge privacy, or sensor devices attached to the bed or the body to recognize bedside events and bedside falls. We use data collected from a ceiling mounted 80 × 60 thermal array combined with an ultrasonic sensor device. This approach makes it possible to monitor activity while preserving privacy in a non-intrusive manner. We evaluate three different approaches towards recognizing location and posture of an individual. Bedside events are recognized using a 10-second floating image rule/filter-based approach, recognizing bedside falls with 98.62% accuracy. Bed-entry and exit events are recognized with 98.66% and 96.73% accuracy, respectively.

  2. Contamination of nebulisers and surrounding air at the bedside of ...

    African Journals Online (AJOL)

    An air sampler was used to collect air samples from the surrounding bedside environment. .... individualised resealable plastic bags and stored upside down in a cooler .... conventional and mesh technology nebulisers used at home by adults.

  3. Improving nurse-physician teamwork through interprofessional bedside rounding.

    Science.gov (United States)

    Henkin, Stanislav; Chon, Tony Y; Christopherson, Marie L; Halvorsen, Andrew J; Worden, Lindsey M; Ratelle, John T

    2016-01-01

    Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician-nurse teamwork are often suboptimal. To improve nurse-physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients' bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds. To assess the effect of bedside rounding on nurse-physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician-nurse communication. Participation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 ("In this clinical area, it is not difficult to speak up if I perceive a problem with patient care", 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 ("Nurse input is well received in this area", 62% vs 82%, P=0.01). Increasing face-to-face communication through

  4. Blind bedside insertion of small bowel feeding tubes.

    LENUS (Irish Health Repository)

    Duggan, SN

    2009-12-01

    The use of Naso-Jejunal (NJ) feeding is limited by difficulty in feeding tube placement. Patients have traditionally required transfer to Endoscopy or Radiology for insertion of small bowel feeding tubes, with clear resource implications. We hypothesised that the adoption of a simple bedside procedure would be effective and reduce cost. Clinical nutrition and nurse specialist personnel were trained in the 10\\/10\\/10 method of blind bedside NJ insertion.

  5. sign-by-sign'' correlation

    International Nuclear Information System (INIS)

    Schmidt, Sabine; Lepori, Domenico; Meuwly, Jean-Yves; Duvoisin, Bertrand; Meuli, Reto; Schnyder, Pierre; Denys, Alban; Michetti, Pierre; Felley, Christian; Melle, Guy van

    2003-01-01

    Our objective was a prospective comparison of MR enteroclysis (MRE) with multidetector spiral-CT enteroclysis (MSCTE). Fifty patients with various suspected small bowel diseases were investigated by MSCTE and MRE. The MSCTE was performed using slices of 2.5 mm, immediately followed by MRE, obtaining T1- and T2-weighted sequences, including gadolinium-enhanced acquisition with fat saturation. Three radiologists independently evaluated MSCTE and MRE searching for 12 pathological signs. Interobserver agreement was calculated. Sensitivities and specificities resulted from comparison with pathological results (n=29) and patient's clinical evolution (n=21). Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and lymphadenopathy (ADP), showed better interobserver agreement on MSCTE than on MRE (BWT: 0.65 vs 0.48; BWE: 0.51 vs 0.37; ADP: 0.52 vs 0.15). Sensitivity of MSCTE was higher than that of MRE in detecting BWT (88.9 vs 60%), BWE (78.6 vs 55.5%) and ADP (63.8 vs 14.3%). Wilcoxon signed-rank test revealed significantly better sensitivity of MSCTE than that of MRE for each observer (p=0.028, p=0.046, p=0.028, respectively). Taking the given study design into account, MSCTE provides better sensitivity in detecting lesions of the small bowel than MRE, with higher interobserver agreement. (orig.)

  6. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis.

    Science.gov (United States)

    Chen, Lei; Hsiao, Allen; Langhan, Melissa; Riera, Antonio; Santucci, Karen A

    2010-10-01

    Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by our group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis. Another objective was to investigate the interrater reliability of the IVC/Ao measurements. A prospective observational study was carried out in a pediatric emergency department (PED) between November 2007 and June 2009. Children with acute gastroenteritis were enrolled as subjects. A pair of investigators obtained transverse images of the IVC and Ao using bedside US. The ratio of IVC and Ao diameters (IVC/Ao) was calculated. Subjects were asked to return after resolution of symptoms. The difference between the convalescent weight and ill weight was used to calculate the degree of dehydration. Greater than or equal to 5% difference was judged to be significant. Linear regression was performed with dehydration as the dependent variable and the IVC/Ao as the independent variable. Pearson's correlation coefficient was calculated to assess the degree of agreement between observers. A total of 112 subjects were enrolled. Seventy-one subjects (63%) completed follow-up. Twenty-eight subjects (39%) had significant dehydration. The linear regression model resulted in an R² value of 0.21 (p dehydration. Forty-eight paired measurements of IVC/Ao ratios were made. The Pearson correlation coefficient was 0.76.   In this pilot study the ratio of IVC to Ao diameters, as measured by bedside US, was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis. The technique demonstrated good interrater

  7. Fast Doppler as a novel bedside measure of cerebral perfusion in preterm infants.

    Science.gov (United States)

    Peeples, Eric S; Mehic, Edin; Mourad, Pierre D; Juul, Sandra E

    2016-02-01

    Altered cerebral perfusion from impaired autoregulation may contribute to the morbidity and mortality associated with premature birth. We hypothesized that fast Doppler imaging could provide a reproducible bedside estimation of cerebral perfusion and autoregulation in preterm infants. This is a prospective pilot study using fast Doppler ultrasound to assess blood flow velocity in the basal ganglia of 19 subjects born at 26-32 wk gestation. Intraclass correlation provided a measure of test-retest reliability, and linear regression of cerebral blood flow velocity and heart rate or blood pressure allowed for estimations of autoregulatory ability. The intraclass correlation when imaging in the first 48 h of life was 0.634. We found significant and independent correlations between the systolic blood flow velocity and both systolic blood pressure and heart rate (P = 0.015 and 0.012 respectively) only in the 26-28 wk gestational age infants in the first 48 h of life. Our results suggest that fast Doppler provides reliable bedside measurements of cerebral blood flow velocity at the tissue level in premature infants, acting as a proxy for cerebral tissue perfusion. Additionally, autoregulation appears to be impaired in the extremely preterm infants, even within a normal range of blood pressures.

  8. Bedside teaching-making it an effective instructional tool.

    Science.gov (United States)

    Khan, Ishtiaq Ali

    2014-01-01

    Bedside teaching is defined as any teaching in the presence of patient and is the core teaching strategy during the clinical years of a medical student. Although it is considered the most effective method to teach clinical and communication skills but its quality is deteriorating with the passage of time. The objective of this study is to explore faculty's perceptions about bedside teaching. This study was conducted in clinical disciplines of Ayub Medical College and hospital Abbottabad, Pakistan from January 2012 to July 2012. Pragmatic paradigm was selected to gather both quantitative and qualitative information. Data was collected sequentially to validate findings. Perceptions of all professors of clinical subjects about bed side teaching were recorded on a close-ended structured questionnaire. Then in-depth interviews were taken from 5 professors using an open ended questionnaire. Quantitative data was analysed using, SPSS-16. Qualitative research data was analysed through content analysis. Out of 20 professors of clinical departments 18 agreed to respond to the questionnaire assessing their perceptions about bed side teaching. Non-existence of bedside teaching curriculum, lack of discipline in students and faculty, lack of accountability, poor job satisfaction and low salary were identified as major factors responsible for decline in quality of bedside teaching. Most of them advocated that curriculum development, planning bedside teaching, implementation of discipline and accountability, improved job satisfaction and performance based promotions will improve quality of clinical teaching. Curriculum development for bedside teaching, institutional discipline, application of best planning strategies, performance based appraisal of faculty and good job satisfaction can make bedside teaching an effective instructional tool.

  9. Efficacy of daily bedside chest radiography as visualized by digital luminescence radiography

    International Nuclear Information System (INIS)

    Kirchner, J.; Stueckle, C.A.; Schilling, E.M.; Peters, J.

    2001-01-01

    To determine the diagnostic impact of daily bedside chest radiography in comparison with digital luminescence technique (DLR; storage phosphor radiography) and conventional film screen radiography, a prospective randomized study was completed in 210 mechanically ventilated patients with a total of 420 analysed radiographs. The patients were allocated to two groups: 150 patients underwent DLR, and 60 patients underwent conventional film screen radiography. Radiological analysis was performed consensually and therapeutic efficacy was assessed by the clinicians. There was no statistical significant difference between the frequency of abnormal findings seen on DLR and conventional film screen radiography. In total, 448 abnormal findings were present in 249 of 300 DLR and 97 of 120 conventional film screen radiographs. The most common findings were signs of overhydration (41 %), pleural effusion (31%), partial collapse of the lung (11%) and pneumothorax (2%). One hundred and twenty-three of 448 (27%) of these abnormal findings were thought to have a considerable impact on patient management. The high rate of abnormal findings with significant impact on patient management suggests that the use of daily bedside chest radiography may be reasonable. Copyright (2001) Blackwell Science Pty Ltd

  10. Teaching at the Bedside. Maximal Impact in Minimal Time.

    Science.gov (United States)

    Carlos, William G; Kritek, Patricia A; Clay, Alison S; Luks, Andrew M; Thomson, Carey C

    2016-04-01

    Academic physicians encounter many demands on their time including patient care, quality and performance requirements, research, and education. In an era when patient volume is prioritized and competition for research funding is intense, there is a risk that medical education will become marginalized. Bedside teaching, a responsibility of academic physicians regardless of professional track, is challenged in particular out of concern that it generates inefficiency, and distractions from direct patient care, and can distort physician-patient relationships. At the same time, the bedside is a powerful location for teaching as learners more easily engage with educational content when they can directly see its practical relevance for patient care. Also, bedside teaching enables patients and family members to engage directly in the educational process. Successful bedside teaching can be aided by consideration of four factors: climate, attention, reasoning, and evaluation. Creating a safe environment for learning and patient care is essential. We recommend that educators set expectations about use of medical jargon and engagement of the patient and family before they enter the patient room with trainees. Keep learners focused by asking relevant questions of all members of the team and by maintaining a collective leadership style. Assess and model clinical reasoning through a hypothesis-driven approach that explores the rationale for clinical decisions. Focused, specific, real-time feedback is essential for the learner to modify behaviors for future patient encounters. Together, these strategies may alleviate challenges associated with bedside teaching and ensure it remains a part of physician practice in academic medicine.

  11. Bedside examination for vestibular screening in occupational medicine.

    Science.gov (United States)

    Zamysłowska-Szmytke, Ewa; Szostek-Rogula, Sylwia; Śliwińska-Kowalska, Mariola

    2015-01-01

    The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  12. Bedside examination for vestibular screening in occupational medicine

    Directory of Open Access Journals (Sweden)

    Ewa Zamysłowska-Szmytke

    2015-04-01

    Full Text Available Objectives: The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG oculomotor tests (central group and 43 subjects with normal VNG. Material and Methods: Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT, Dynamic Visual Acuity (DVA and gaze nystagmus assessment. Results: Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73% had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. Conclusions: The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.

  13. Signing off

    Science.gov (United States)

    2001-05-01

    sharp that they cause paper cuts. Stains. If you accidentally spill some food or drink on your clothes, make sure you attempt to remove it as soon as possible and preferably within the same lunar cycle. Some teachers seem to think they should be worn with pride like the stains on a chemistry teacher's white coat. This is a myth. Materials. For scientists continually teaching about the wonder of smart materials, physics teachers are remarkably conservative in their choice of materials for their clothes. Try to break out from the traditional corduroy and tweed and practise what you teach. It is not acceptable to wear the actual tie you wore at school, as this will be at least 20 years old, be rather frayed and will have your name sewn in the back by your mum. Steven Chapman Science Year Manager, British Association for the Advancement of Science Signing Off takes a humorous and irreverent look at physics education. The views expressed here are those of the author and are not endorsed by the Editorial Board for Physics Education. Can you contribute a zany attitude or humorous anecdote? Please send your offering to ped@iop.org marked Signing Off.

  14. Role of bedside-focused ultrasonographic evaluation in the critical patient: a case report

    Directory of Open Access Journals (Sweden)

    Andrea Bruzzone

    2011-09-01

    Full Text Available We present the case report of an 80 years old woman with late posttraumatic (of low intensity without any immediate clinical alteration onset of dysphnoea, chest pain and hypotension, in which bedside ultrasonography has been a very useful tool in immediate diagnostic definition (acute respiratory distress syndrome – ARDS due to multiple pulmonary contusions, considering and excluding all possible alternative diagnosis with the same clinical presentation, but also providing a “real time” evaluation of therapeutic regimen (hypovolemia versus excessive fluid embalance and, last but not least, the chance to perform a close follow up of the ultrasonographic alterations (pleural effusion, signs of alveolar consolidation pointed out at initial diagnosis. Moreworthly, it has been possible to identify the previous mentioned lesion before they had become evident to standard X-Ray chest evaluation.

  15. Bedside Ultrasonography: A Useful Tool For Traumatic Pneumothorax

    International Nuclear Information System (INIS)

    Mumtaz, U.; Zahur, Z.; Chaudhry, M. A.; Warraich, R. A.

    2016-01-01

    Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax. Study Design: Analytical study. Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015. Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard. Result: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33 percentage and 54.76 percentage, respectively and specificity of 100 percentage for both modalities. Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk. (author)

  16. Headaches - danger signs

    Science.gov (United States)

    Migraine headache - danger signs; Tension headache - danger signs; Cluster headache - danger signs; Vascular headache - danger signs ... and other head pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  17. Psoas sign: a reevaluation

    International Nuclear Information System (INIS)

    Kye, Jong Sik; Lim, Jae Hoon; Yoon, Yup; Ahn, Chi Yul

    1987-01-01

    In general, the psoas sign has been known to be a reliabler index of presence of a retroperitoneal pathology. However, obliterated psoas margin may be caused by various other conditions in so far as the amount of fat around the psoas muscle is not enough to be visualized. On the other hand, retroperitoneal pathology does not always obliterates the psoas margin. Authors analyzed obliterated psoas margins in 72 patients by comparing simple radiographs and computed tomography, and attempted to explain the mechanism of obliterated psoas margin, on simple radiograph. The results are as follows : 1. The psoas margin is obliterated by the retroperitoneal pathology and various other conditions such as kidney-psoas contract, scanty extraperitoneal fat, scoliosis, bowel interposition and angled psoas muscle. 2. The psoas margin is preserved as far as the perinephric fat is intact and X-ray beam strikes the lateral margin of the psoas muscle tangentially. 3. The psoas sign is considered not to be a reliable index of a retroperitoneal pathology

  18. Performance of Bedside Lung Ultrasound by a Pediatric Resident

    DEFF Research Database (Denmark)

    Zhan, Chen; Grundtvig, Natalia; Klug, Bent Helmuth

    2017-01-01

    OBJECTIVES: Recent studies suggest that lung ultrasound is a good, radiation-free alternative to chest radiography in children with pneumonia. We investigated how bedside lung ultrasound performed by a pediatric resident compared with chest radiography in children with suspected pneumonia. METHODS......: This was a prospective study comparing bedside lung ultrasound to chest radiography as the reference standard. Children aged 0 to 15 years with suspected pneumonia at a pediatric emergency department were included and underwent chest radiography and lung ultrasound. A pediatric resident with minimal practical ultrasound...

  19. Bedside ultrasound education in Canadian medical schools: A national survey

    Directory of Open Access Journals (Sweden)

    Peter Steinmetz

    2016-04-01

    Results:  Approximately half of the 13 responding medical schools had integrated bedside ultrasound teaching into their undergraduate curriculum. The most common trends in undergraduate ultrasound teaching related to duration (1-5 hours/year in 50% of schools, format (practical and theoretical in 67% of schools, and logistics (1:4 instructor to student ratio in 67% of schools. The majority of responding vice-deans indicated that bedside ultrasound education should be integrated into the medical school curriculum (77%, and cited a lack of ultrasound machines and infrastructure as barriers to integration. Conclusions: This study documents the current characteristics of undergraduate ultrasound education in Canada.

  20. Refuting the lipstick sign.

    Science.gov (United States)

    Grassbaugh, Jason A; Bean, Betsey R; Greenhouse, Alyssa R; Yu, Henry H; Arrington, Edward D; Friedman, Richard J; Eichinger, Josef K

    2017-08-01

    Arthroscopic examination of the tendon has been described as the "gold standard" for diagnosis of tendinitis of the long head of the biceps (LHB). An arthroscopic finding of an inflamed and hyperemic LHB within the bicipital groove has been described as the "lipstick sign." Studies evaluating direct visualization in diagnosis of LHB tendinitis are lacking. During a 1-year period, 363 arthroscopic shoulder procedures were performed, with 16 and 39 patients prospectively selected as positive cases and negative controls, respectively. All positive controls had groove tenderness, positive Speed maneuver, and diagnostic ultrasound-guided bicipital injection. Negative controls had none of these findings. Six surgeons reviewed randomized deidentified arthroscopic pictures of enrolled patients The surgeons were asked whether the images demonstrated LHB tendinitis and if the lipstick sign was present. Overall sensitivity and specificity were 49% and 66%, respectively, for detecting LHB tendinitis and 64% and 31%, respectively, for erythema. The nonweighted κ score for interobserver reliability ranged from 0.042 to 0.419 (mean, 0.215 ± 0.116) for tendinitis and from 0.486 to 0.835 (mean, 0.680 ± 0.102) for erythema. The nonweighted κ score for intraobserver reliability ranged from 0.264 to 0.854 (mean, 0.615) for tendinitis and from 0.641 to 0.951 (mean, 0.783) for erythema. The presence of the lipstick sign performed only moderately well in a rigorously designed level III study to evaluate its sensitivity and specificity. There is only fair agreement among participating surgeons in diagnosing LHB tendinitis arthroscopically. Consequently, LHB tendinitis requiring tenodesis remains a clinical diagnosis that should be made before arthroscopic examination. Published by Elsevier Inc.

  1. Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography

    Science.gov (United States)

    2010-05-01

    worldwide. Peer Reviewed Title: Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular Sonography Journal Issue: Western...Preferred Citation: Thompson D, Stanescu C, Pryor P, Laselle B. Retrobulbar Hematoma from Warfarin Toxicity and the Limitations of Bedside Ocular...nontrauamtic retrobulbar hematoma associated with warfarin toxicity. The application and limitations of focused bedside ocular sonography for this

  2. Name signs in Danish Sign Language

    DEFF Research Database (Denmark)

    Bakken Jepsen, Julie

    2018-01-01

    in spoken languages, where a person working as a blacksmith by his friends might be referred to as ‘The Blacksmith’ (‘Here comes the Blacksmith!’) instead of using the person’s first name. Name signs are found not only in Danish Sign Language (DSL) but in most, if not all, sign languages studied to date....... This article provides examples of the creativity of the users of Danish Sign Language, including some of the processes in the use of metaphors, visual motivation and influence from Danish when name signs are created.......A name sign is a personal sign assigned to deaf, hearing impaired and hearing persons who enter the deaf community. The mouth action accompanying the sign reproduces all or part of the formal first name that the person has received by baptism or naming. Name signs can be compared to nicknames...

  3. Comparison of visual analogue and Likert scales in evaluation of an emergency department bedside teaching programme.

    Science.gov (United States)

    Celenza, Antonio; Rogers, Ian R

    2011-02-01

    The present study compares visual analogue scale (VAS) to Likert-type scale (LTS) instruments in evaluating perceptions of an ED bedside clinical teaching programme. A prospective study was conducted in the ED of an urban, adult tertiary hospital. Prospective pairing occurred of a teaching consultant and registrar who were relatively quarantined from normal clinical duties. Registrars received 3 months of the teaching intervention, and 3 months without the intervention in a cross-over fashion. Evaluation questionnaires were completed using both the LTS and 100 mm horizontal VAS for each question. Correlation between VAS and LTS gave a measure of validity, and test-retest stability and internal consistency gave measures of reliability. Registrar perceptions of the teaching programme were positive, but no differences were found between the pre- and post-intervention groups. The test-retest reliabilities (intraclass correlation coefficient) for the questionnaires were 0.51 and 0.54 for the VAS, and 0.58 and 0.58 for the LTS. Cronbach's alpha varied between 0.79 and 0.91 for the VAS, and 0.79 and 0.81 for the LTS. Correlations between the two methods varied from 0.35 to 0.94 for each question. A linear regression equation describing the relationship approximated VAS = 19.5 × LTS-9 with overall r= 0.89. An ED bedside teaching programme is perceived to be a beneficial educational intervention. The VAS is a reliable and valid alternative to the LTS for educational evaluation and might provide advantages in educational measurement. Further research into the significance of extreme values and educationally important changes in scores is required. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. An unanticipated diagnosis with bedside ultrasonography in patients ...

    African Journals Online (AJOL)

    Although abdominal pain is a common presentation in emergency departments, rectus sheath hematoma (RSH) is among the rarest diagnosis. Here we present 2 cases of RSH likely caused by coughing due to upper respiratory tract infection. The two described cases were diagnosed by bedside ultrasonography and ...

  5. Executive cognitive impairment detected by simple bedside testing ...

    African Journals Online (AJOL)

    Aims. Cognitive impairment in people with type 2 diabetes is a barrier to successful disease management. We sought to determine whether impaired executive function as detected by a battery of simple bedside cognitive tests of executive function was associated with inadequate glycaemic control. Methods. People with ...

  6. Comparative study of bedside and laboratory measurements of hemoglobin.

    Science.gov (United States)

    Krenzischek, D A; Tanseco, F V

    1996-11-01

    The purpose of this study was to examine the effects of variations in technique on measurements of hemoglobin level done at the bedside and to compare these results with laboratory measurements of hemoglobin. In accordance with hospital policy, procedure, and protocol, various techniques were used to obtain samples of capillary and venous blood and of blood from arterial and central venous catheters. Levels of hemoglobin were measured at the bedside and in the laboratory, and the results were compared. The Johns Hopkins Hospital adult postanesthesia care unit. A total of 187 blood samples were obtained from 62 adults who had undergone general surgery. Group I comprised 20 subjects with capillary and venous blood samples. Group II comprised 21 subjects with arterial blood samples. Group III comprised 21 subjects with central venous blood samples. The results showed that the amount of blood to be discarded before obtaining samples of arterial and central venous blood need not be any larger than double the dead space of the catheter, and that shaking the blood sample for 10 seconds was sufficient to mix the sample before measurement of hemoglobin levels. Results of bedside and laboratory measurements of hemoglobin level were comparable. Bedside measurement of hemoglobin increases efficiency in patient care, decreases risk of blood-transmitted infection for staff, and decreases cost to the patient. However, the persons who perform the assay must be responsible in adhering to the standard of practice to minimize errors in the measurements.

  7. The evaluation of bedside teaching – an instrument for staff ...

    African Journals Online (AJOL)

    Bedside teaching is the core teaching strategy in the clinical study years of the medical undergraduate degree at the University of the Witwatersrand. ... evaluation questionnaire was developed, based on previously validated peer review questionnaires used in evaluating small group formal classroom-based lectures.

  8. Effect of bedside teaching activities on patients' experiences at an ...

    African Journals Online (AJOL)

    Items where respondents scored less than the median of 67 (interquartile range 21) were categorised as displaying a negative attitude. Results. Patients (60%) did not favour the bedside teaching activities. No significant association was found with age, sex, occupation, literacy level, duration of hospital stay, and ward.

  9. Mixed methods evaluation of a quality improvement and audit tool for nurse-to-nurse bedside clinical handover in ward settings.

    Science.gov (United States)

    Redley, Bernice; Waugh, Rachael

    2018-04-01

    Nurse bedside handover quality is influenced by complex interactions related to the content, processes used and the work environment. Audit tools are seldom tested in 'real' settings. Examine the reliability, validity and usability of a quality improvement tool for audit of nurse bedside handover. Naturalistic, descriptive, mixed-methods. Six inpatient wards at a single large not-for-profit private health service in Victoria, Australia. Five nurse experts and 104 nurses involved in 199 change-of-shift bedside handovers. A focus group with experts and pilot test were used to examine content and face validity, and usability of the handover audit tool. The tool was examined for inter-rater reliability and usability using observation audits of handovers across six wards. Data were collected in 2013-2014. Two independent observers for 72 audits demonstrated acceptable inter-observer agreement for 27 (77%) items. Reliability was weak for items examining the handover environment. Seventeen items were not observed reflecting gaps in practices. Across 199 observation audits, gaps in nurse bedside handover practice most often related to process and environment, rather than content items. Usability was impacted by high observer burden, familiarity and non-specific illustrative behaviours. The reliability and validity of most items to audit handover content was acceptable. Gaps in practices for process and environment items were identified. Context specific exemplars and reducing the items used at each handover audit can enhance usability. Further research is needed to develop context specific exemplars and undertake additional reliability testing using a wide range of handover settings. CONTRIBUTION OF THE PAPER. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Indoor sign recognition for the blind

    CSIR Research Space (South Africa)

    Kunene, D

    2016-09-01

    Full Text Available that is faster and more reliable. We first segment the signs by colour, and then by shape recognition. The sign-type classification is done using a tree search structure that enables the use of iterative contour descriptors like the speeded-up-robust features...

  11. Reliability engineering

    International Nuclear Information System (INIS)

    Lee, Chi Woo; Kim, Sun Jin; Lee, Seung Woo; Jeong, Sang Yeong

    1993-08-01

    This book start what is reliability? such as origin of reliability problems, definition of reliability and reliability and use of reliability. It also deals with probability and calculation of reliability, reliability function and failure rate, probability distribution of reliability, assumption of MTBF, process of probability distribution, down time, maintainability and availability, break down maintenance and preventive maintenance design of reliability, design of reliability for prediction and statistics, reliability test, reliability data and design and management of reliability.

  12. Warning Signs of Bullying

    Science.gov (United States)

    ... of Aggressive Behavior Print Share Warning Signs for Bullying There are many warning signs that may indicate ... Get help right away . Signs a Child is Bullying Others Kids may be bullying others if they: ...

  13. The study on quality control of bedside CR examination

    International Nuclear Information System (INIS)

    Yang Xufeng; Luo Xiaomei; Xu Qiaolan; Wu Tengfang; Wen Xingwei

    2007-01-01

    Objective: To study the quality controll of bedside CR examination and improves the imaging quality. Methods: X-ray examination with CR system were performed on 3,300 patients. All CR cassettes were encoded. The imaging plate and cassettes were cleaned regularly. Results: With and without quality control, the percentage of first-rate film was 58.2% and 51%, the second-rate film was 40% and 45.5%, the third-rate film was 1.3% and 2%, respectively. Corxespondingly, the ratio of re-examination decreased from 1.5% to 0.5% after quality control, and imaging quality was stable. Conclusion: The quality control of bedside CR examination can improve the image quality as well as lighten the labor of radiographers. (authors)

  14. Bedside Teaching: Is it Effective Methods in Clinical Nursing Students Learning?

    Directory of Open Access Journals (Sweden)

    Fatikhu Yatuni Asmara

    2017-01-01

    Full Text Available Introduction: Clinical learning is the centre of medical students education. Students not only learn about practical skills but also communication with patient and other health care givers which both competencies are useful for students when they come into working world (Spencer, 2003. There are variations of methods applied in clinical learning process; one of them is bedside teaching. The aim of this study was to observe the bedside teaching process which is held in group of students, teacher, and patient. Another aim was to know responses of students, teacher, and patients to the bedside teaching process. Method: The method which was applied in this study is observation in which bedside teaching process was observed related to the roles and function of each component of bedside teaching: students, teacher, and patient in each phase: preparation, process, and evaluation. Then it was continued by interview to know the responses of students, teacher, and patient related to bedside teaching process. Result: The result showed that both students and teacher felt that bedside teaching is an effective method since it helped students to achieve their competences in clinical setting and develop their communication skill. Furthermore teacher stated that bedside teaching facilitated her to be a good role model for students. As well as students and teacher, patient got advantage from the bedside teaching process that she got information related to her case; however the time to discuss was limited. During the observation, each component of bedside teaching did their roles and function, such as: during the preparation teacher asked inform consent from patient, and patient gave inform consent as well while students prepared the material. Discussions: Suggestion for next research is conducting a deeper study about perception of students, teacher, and patient about bedside teaching process and the strategies to develop it to be better method. Keywords: bedside

  15. Approaching Sign Language Test Construction: Adaptation of the German Sign Language Receptive Skills Test

    Science.gov (United States)

    Haug, Tobias

    2011-01-01

    There is a current need for reliable and valid test instruments in different countries in order to monitor deaf children's sign language acquisition. However, very few tests are commercially available that offer strong evidence for their psychometric properties. A German Sign Language (DGS) test focusing on linguistic structures that are acquired…

  16. [Implementation of bedside training and advanced objective structured clinical examination (OSCE) trial to learn and confirm about pharmacy clinical skills].

    Science.gov (United States)

    Tokunaga, Jin; Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Sato, Keizo

    2013-01-01

    Bedside training for fourth-year students, as well as seminars in hospital pharmacy (vital sign seminars) for fifth-year students at the Department of Pharmacy of Kyushu University of Health and Welfare have been implemented using patient training models and various patient simulators. The introduction of simulation-based pharmaceutical education, where no patients are present, promotes visually, aurally, and tactilely simulated learning regarding the evaluation of vital signs and implementation of physical assessment when disease symptoms are present or adverse effects occur. A patient simulator also promotes the creation of training programs for emergency and critical care, with which basic as well as advanced life support can be practiced. In addition, an advanced objective structured clinical examination (OSCE) trial has been implemented to evaluate skills regarding vital signs and physical assessments. Pharmacists are required to examine vital signs and conduct physical assessment from a pharmaceutical point of view. The introduction of these pharmacy clinical skills will improve the efficacy of drugs, work for the prevention or early detection of adverse effects, and promote the appropriate use of drugs. It is considered that simulation-based pharmaceutical education is essential to understand physical assessment, and such education will ideally be applied and developed according to on-site practices.

  17. Feasibility of monomodal analgesia with IV alfentanil during burn dressing changes at bedside (in spontaneously breathing non-intubated patients).

    Science.gov (United States)

    Fontaine, Mathieu; Latarjet, Jacques; Payre, Jacqueline; Poupelin, Jean-Charles; Ravat, François

    2017-03-01

    The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. Cohort study began after favorable opinion from local ethic committee has been collected. Patient's informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable). 100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000μg for a median duration of 35min. Pain scores during the procedure were low or moderate (VRS mean=2.0 and maximal VRS=5). Median satisfaction collected 2h after the dressing was 10 on a ten step scale. Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated

  18. 'Felson Signs' revisited

    International Nuclear Information System (INIS)

    George, Phiji P.; Irodi, Aparna; Keshava, Shyamkumar N.; Lamont, Anthony C.

    2014-01-01

    In this article we revisit, with the help of images, those classic signs in chest radiography described by Dr Benjamin Felson himself, or other illustrious radiologists of his time, cited and discussed in 'Chest Roentgenology'. We briefly describe the causes of the signs, their utility and the differential diagnosis to be considered when each sign is seen. Wherever possible, we use CT images to illustrate the basis of some of these classic radiographic signs.

  19. Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED.

    Science.gov (United States)

    Bolandparvaz, Shahram; Moharamzadeh, Payman; Jamali, Kazem; Pouraghaei, Mahboob; Fadaie, Maryam; Sefidbakht, Sepideh; Shahsavari, Kavous

    2013-11-01

    Long bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED). The study assessed 80 injured patients with multiple trauma from February 2011 to July 2012. The patients were older than 18 years and triaged to the cardiopulmonary resuscitation ward of the ED. Bedside ultrasound and radiography were conducted for them. The findings were separately and blindly assessed by 2 radiologists. Sensitivity, specificity, the positive and negative predictive value, and κ coefficient were measured to assess the accuracy and validity of ultrasound as compared with radiography. The sensitivity of ultrasound for diagnosis of limb bone fractures was not high enough and ranged between 55% and 75% depending on the fracture site. The specificity of this diagnostic method had an acceptable range of 62% to 84%. Ultrasound negative prediction value was higher than other indices under study and ranged between 73% and 83%, but its positive prediction value varied between 33.3% and 71%. The κ coefficient for diagnosis of long bone fractures of upper limb (κ = 0.58) and upper limb joints (κ = 0.47) and long bones of lower limb (κ = 0.52) was within the medium range. However, the value for diagnosing fractures of lower limb joints (κ = 0.47) was relatively low. Bedside ultrasound is not a reliable method for diagnosing fractures of upper and lower limb bones compared with radiography. © 2013 Elsevier Inc. All rights reserved.

  20. Signed languages and globalization

    NARCIS (Netherlands)

    Hiddinga, A.; Crasborn, O.

    2011-01-01

    Deaf people who form part of a Deaf community communicate using a shared sign language. When meeting people from another language community, they can fall back on a flexible and highly context-dependent form of communication called international sign, in which shared elements from their own sign

  1. British Sign Name Customs

    Science.gov (United States)

    Day, Linda; Sutton-Spence, Rachel

    2010-01-01

    Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

  2. On the System of Person-Denoting Signs in Estonian Sign Language: Estonian Name Signs

    Science.gov (United States)

    Paales, Liina

    2010-01-01

    This article discusses Estonian personal name signs. According to study there are four personal name sign categories in Estonian Sign Language: (1) arbitrary name signs; (2) descriptive name signs; (3) initialized-descriptive name signs; (4) loan/borrowed name signs. Mostly there are represented descriptive and borrowed personal name signs among…

  3. From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

    Directory of Open Access Journals (Sweden)

    Michael Butterfield

    2014-09-01

    Full Text Available A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm bicornuate interatrial septal aneurysm (IASA projecting into the right atrium (Figure 1, Video 1. There was no evidence of intraatrial thrombus. A formal echocardiogram performed later that day confirmed the diagnosis and also detected a patent foramen ovale (PFO with a left-to-right shunt that reversed with Valsalva maneuver. [West J Emerg Med. 2014;15(6:719–720

  4. Reliability Engineering

    International Nuclear Information System (INIS)

    Lee, Sang Yong

    1992-07-01

    This book is about reliability engineering, which describes definition and importance of reliability, development of reliability engineering, failure rate and failure probability density function about types of it, CFR and index distribution, IFR and normal distribution and Weibull distribution, maintainability and movability, reliability test and reliability assumption in index distribution type, normal distribution type and Weibull distribution type, reliability sampling test, reliability of system, design of reliability and functionality failure analysis by FTA.

  5. Elective open bedside tracheostomy in the neurosurgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Niran Maharjan

    2015-09-01

    Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11

  6. Using a Bedside Video-assisted Test Tube Test to Assess Stoma Viability: A Report of 4 Cases.

    Science.gov (United States)

    Ahmad, Sarwat; Turner, Keli; Shah, Paulesh; Diaz, Jose

    2016-07-01

    Mucosal discoloration of an intestinal stoma may indicate self-limited venous congestion or necrosis necessitating operative revision. A common bedside technique to assess stoma viability is the "test tube test". A clear tube is inserted into the stoma and a hand-held light is used to assess the color of the stoma. A technique (video-assisted test tube test [VATTT]) developed by the authors utilizes a standard video bronchoscope inserted into a clear plastic blood collection tube to visually inspect and assess the mucosa. This technique was evaluated in 4 patients (age range 49-72 years, all critically ill) with a discolored stoma after emergency surgery. In each case, physical exam revealed ischemic mucosa at the surface either immediately after surgery or after worsening hypotension weeks later. Serial test tube test assessments were ambiguous when trying to assess deeper mucosa. The VATTT assessment showed viable pink mucosa beneath the surface and until the fascia was revealed in 3 patients. One (1) patient had mucosal ischemia down to the fascia, which prompted operative revision of the stoma. The new stoma was assessed with a VATTT and was viable for the entire length of the stoma. VATTT provided an enhanced, magnified, and clearer way to visually assess stoma viability in the postoperative period that can be performed at the bedside with no adverse events. It may prevent unnecessary relaparotomy or enable earlier diagnosis of deep ostomy necrosis. Validity and reliability studies are warranted.

  7. Use of Bedside Compression Ultrasonography for Diagnosis of Deep Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Mohamad Moussa

    2017-07-01

    Full Text Available History of present illness: A 70-year-old female with a history of breast cancer and smoking for 50 years presented to the emergency department with left-lower extremity pain and swelling for two days. The patient denied recent long-distance travel, history of hypercoagulable disorder, or recent surgery. Physical examination revealed a warm, erythematous, 3+ edematous left-lower extremity with mild tenderness extending into the proximal thigh. Her D-dimer level was 2307ng/mL and vital signs were significant for a heart rate of 110bpm, oxygen saturation of 90% on 2 liters of oxygen, and blood pressure of 153/102. Significant findings: As shown in the still image of the performed ultrasound, a transverse view of the proximal-thigh revealed a visible thrombus (green shading occluding the lumen of the left common femoral vein (blue ring, which was non-compressible when direct pressure was applied to the probe. Also visible is a patent and compressible branch of the common femoral vein (purple ring and the femoral artery (red ring, highlighted by its thick vessel wall and pulsatile motion. Discussion: Deep venous thrombosis (DVT affects 1 per 1,000 individuals each year and may lead to complications such as recurrent DVT, pulmonary embolism, and death.1 The utilization of bedside compression ultrasonography allows for rapid diagnosis of DVT and has virtually replaced other diagnostic methods due to its non-invasive and inexpensive nature. When performing compression ultrasonography, the patient should be positioned to maximize distention of the leg veins. The extremity in question should be flexed at the knee and externally rotated at the hip (this fully exposes of the common, superficial, and deep femoral veins as well as the popliteal fossa and the head of the bed elevated at a 30-45 degree angle.2 In patients with an elevated D-dimer and low-to-moderate clinical probability, negative compression imaging of a single proximal location of the femoral

  8. New radiation warning sign

    International Nuclear Information System (INIS)

    Mac Kenzie, C.; Mason, C.

    2006-01-01

    Full text: Radiation accidents involving orphan radioactive sources have happened as a result of people not recognizing the radiation trefoil symbol or from being illiterate and not understanding a warning statement on the radiation source. The trefoil symbol has no inherent meaning to people that have not been instructed in its use. A new radiation warning sign, to supplement the existing trefoil symbol, has been developed to address these issues. Human Factors experts, United Nations member states, and members of the international community of radiation protection professionals were consulted for input on the design of a new radiation warning sign that would clearly convey the message of 'Danger- Run Away- Stay Away' when in close proximity to a dangerous source of radiation. Cultural differences of perception on various warning symbols were taken into consideration and arrays of possible signs were developed. The signs were initially tested in international children for identification with the desired message and response. Based on these test results and further input from radiation protection professionals, five warning signs were identified as the most successful in conveying the desired message and response. These five signs were tested internationally in eleven countries by a professional survey company to determine the best sign for this purpose. The conclusion of the international testing is presented. The new radiation warning sign is currently a draft ISO standard under committee review. The design of the propose d radiation warning sign and the proposed implementation strategy outlined in the draft ISO standard is presented. (authors)

  9. Bedside arterial blood gas monitoring system using fluorescent optical sensors

    Science.gov (United States)

    Bartnik, Daniel J.; Rymut, Russell A.

    1995-05-01

    We describe a bedside arterial blood gas (ABG) monitoring system which uses fluorescent optical sensors in the measurement of blood pH, PCO2 and PO2. The Point-of-Care Arterial Blood Gas Monitoring System consists of the SensiCathTM optical sensor unit manufactured by Optical Sensors Incorporated and the TramTM Critical Care Monitoring System with ABG Module manufactured by Marquette Electronics Incorporated. Current blood gas measurement techniques require a blood sample to be removed from the patient and transported to an electrochemical analyzer for analysis. The ABG system does not require removal of blood from the patient or transport of the sample. The sensor is added to the patient's existing arterial line. ABG measurements are made by drawing a small blood sample from the arterial line in sufficient quantity to ensure an undiluted sample at the sensor. Measurements of pH, PCO2 and PO2 are made within 60 seconds. The blood is then returned to the patient, the line flushed and results appear on the bedside monitor. The ABG system offers several advantages over traditional electrochemical analyzers. Since the arterial line remains closed during the blood sampling procedure the patient's risk of infection is reduced and the caregiver's exposure to blood is eliminated. The single-use, disposable sensor can be measure 100 blood samples over 72 hours after a single two-point calibration. Quality Assurance checks are also available and provide the caregiver the ability to assess system performance even after the sensor is patient attached. The ABG module integrates with an existing bedside monitoring system. This allows ABG results to appear on the same display as ECG, respiration, blood pressure, cardiac output, SpO2, and other clinical information. The small module takes up little space in the crowded intensive care unit. Performance studies compare the ABG system with an electrochemical blood gas analyzer. Study results demonstrated accurate and precise blood

  10. Nuclear performance and reliability

    International Nuclear Information System (INIS)

    Rothwell, G.

    1993-01-01

    If fewer forced outages are a sign of improved safety, nuclear power plants have become safer and more productive. There has been a significant improvement in nuclear power plant performance, due largely to a decline in the forced outage rate and a dramatic drop in the average number of forced outages per fuel cycle. If fewer forced outages are a sign of improved safety, nuclear power plants have become safer and more productive over time. To encourage further increases in performance, regulatory incentive schemes should reward reactor operators for improved reliability and safety, as well as for improved performance

  11. Standardization of Sign Languages

    Science.gov (United States)

    Adam, Robert

    2015-01-01

    Over the years attempts have been made to standardize sign languages. This form of language planning has been tackled by a variety of agents, most notably teachers of Deaf students, social workers, government agencies, and occasionally groups of Deaf people themselves. Their efforts have most often involved the development of sign language books…

  12. A novel bedside diagnostic test for methanol poisoning using dry chemistry for formate.

    Science.gov (United States)

    Hovda, Knut Erik; Gadeholt, Gaut; Evtodienko, Vladimir; Jacobsen, Dag

    2015-11-01

    The standard diagnostic approach to methanol poisoning is chromatographic measurement of methanol on centrally placed stationary equipment. Methanol poisoning in places where such equipment is unavailable is thus often not diagnosed. Methanol is metabolized to a toxic metabolite, formate; the presence of this compound indicates methanol poisoning. We have developed an enzymatic test for formate and modified it into a portable dry chemistry system that could be used anywhere. The method consists of two enzymatic steps: Formation of NADH from NAD by formate dehydrogenase, and subsequent use of NADH as a reductant of a tetrazolium into a formazan dye that can be quantified photometrically or visually. The photometer gave a good correlation of R(2) = 0.9893 in serum and R(2) = 0.9949 in whole blood, showing an instrumental detection limit of less than 1 mM (4.5 mg/dL). The visual readings showed a correlation of R(2) = 0.8966. Users experienced some difficulty in separating the negative control from the low positives. We have documented the feasibility of an affordable formate strip test for bedside diagnosis of methanol poisoning and for screening of metabolic acidosis of unknown origin. Visual reading is possible, but a reader will improve reliability at lower levels of formate. Future studies are necessary to study the sensitivity and specificity towards other causes of metabolic acidosis and other acids present in human blood.

  13. [Vertigo in the Emergency Department: new bedside tests].

    Science.gov (United States)

    Tamás, T László; Garai, Tibor; Tompos, Tamás; Szirmai, Ágnes

    2016-03-13

    According to international statistics, the first examination of 25% of patients with vertigo is carried out in Emergency Departments. The most important task of the examining physician is to diagnose life threatening pathologic processes. One of the most difficult otoneurological diagnostic challange in Emergency Departments is to differentiate between dangerous posterior scale stroke presenting with isolated vertigo and the benign vestibular neuritis.These two disorders can be safely differentiated using fast, non-invasive, evidence based bedside tests which have been introduced in the past few years. 35% of stroke cases mimicking vestibular neuritis (pseudoneuritis) are misdiagnosed at the Emergency Department, and 40% of these cases develop complications. During the first 48 hours, sensitivity for stroke of the new test that is based on the malfunction of the oculomotor system is better than the diffusion-weighted cranial magnetic resonance imaging. Using special test glasses each component of the new test can be made objective and repeatable.

  14. Medical immunology: two-way bridge connecting bench and bedside.

    Science.gov (United States)

    Rijkers, Ger T; Damoiseaux, Jan G M C; Hooijkaas, Herbert

    2014-12-01

    Medical immunology in The Netherlands is a laboratory specialism dealing with immunological analyses as well as pre- and post-analytical consultation to clinicians (clinical immunologists and other specialists) involved in patients with immune mediated diseases. The scope of medical immunology includes immunodeficiencies, autoimmune diseases, allergy, transfusion and transplantation immunology, and lymphoproliferative disorders plus the monitoring of these patients. The training, professional criteria, quality control of procedures and laboratories is well organized. As examples of the bridge function of medical immunology between laboratory (bench) and patient (bedside) the contribution of medical immunologists to diagnosis and treatment of primary immunodeficiency diseases (in particular: humoral immunodeficiencies) as well as autoantibodies (anti-citrullinated proteins in rheumatoid arthritis) are given. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Implementing interprofessional bedside rounding at the prequalification stage

    Directory of Open Access Journals (Sweden)

    Tuite DR

    2016-10-01

    Full Text Available Daniel R Tuite,1 David Healy,1 Thomas S MacKinnon2 1Faculty of Medicine, Brighton and Sussex Medical School, Brighton, 2School of Medicine, Imperial College London, London, UKWe read with great interest the paper by Henkin et al,1 demonstrating that the use of interprofessional bedside rounding (IBR significantly improved nurse–physician teamwork, particularly from the nurses’ point of view. This finding is relevant when one takes into account the importance of interdisciplinary teamwork; a review conducted by Epstein concluded that effective interprofessional teamwork both maximizes patient safety and increases job satisfaction and efficiency.2 We, as medical students, believe that inadequate emphasis is placed on interprofessional collaboration at the prequalification phase, and therefore, we suggest that implementing IBR at the university level could represent a method to improve teamwork between the nurses and doctors of the future.  View the original paper by Henkin et al.  

  16. Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses.

    Science.gov (United States)

    Sagherian, Knar; Clinton, Michael E; Abu-Saad Huijer, Huda; Geiger-Brown, Jeanne

    2017-07-01

    Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses' practice that should be monitored by nursing management.

  17. Signs of political economy

    Directory of Open Access Journals (Sweden)

    Bernard Lamizet

    2015-12-01

    Full Text Available Like any political system, economy is a system of signs and representations. The Semiotics of economy elaborates its analytical methods to interpret such signs, which give meaning to the economy by representing its performances in public debate and in the media. Four major features distinguish the Semiotics of political economy from other semiotic forms or other systems of information and political representation. First of all, the relationship between the signification of the economy and the real or the imaginary phenomena to which they refer always pertains to the order of values. The second characteristic of economic signs is the significance of the state of lack they express. The third characteristic of signs of the economy is the form of sign production, which can be designated by the concept of emission of signs and their diffusion. Finally, as all signs, the economic sign is arbitrary. In the field of Economics, such arbitrariness does not imply that the Subject is free to superimpose whatever value to the signs themselves, but refers to the rupture between the world and its possible transformation. The very meaning of the word economy is here at stake. Oikos, in Greek (the term from which the word economy is derived refers to a known, familiar space. Economy transforms the real, natural world into a symbolic social world, into a world of relations with others whom we recognise and whose actions are relatively predictable. It might be useful to consider the contemporary issue of debt, its implications and its multiple meanings, which includes both the ethical and moral dimension of the condemnation of debt as well as the imaginary political dimension based on the expression of an idea of independence.

  18. A Waveform Archiving System for the GE Solar 8000i Bedside Monitor.

    Science.gov (United States)

    Fanelli, Andrea; Jaishankar, Rohan; Filippidis, Aristotelis; Holsapple, James; Heldt, Thomas

    2018-01-01

    Our objective was to develop, deploy, and test a data-acquisition system for the reliable and robust archiving of high-resolution physiological waveform data from a variety of bedside monitoring devices, including the GE Solar 8000i patient monitor, and for the logging of ancillary clinical and demographic information. The data-acquisition system consists of a computer-based archiving unit and a GE Tram Rac 4A that connects to the GE Solar 8000i monitor. Standard physiological front-end sensors connect directly to the Tram Rac, which serves as a port replicator for the GE monitor and provides access to these waveform signals through an analog data interface. Together with the GE monitoring data streams, we simultaneously collect the cerebral blood flow velocity envelope from a transcranial Doppler ultrasound system and a non-invasive arterial blood pressure waveform along a common time axis. All waveform signals are digitized and archived through a LabView-controlled interface that also allows for the logging of relevant meta-data such as clinical and patient demographic information. The acquisition system was certified for hospital use by the clinical engineering team at Boston Medical Center, Boston, MA, USA. Over a 12-month period, we collected 57 datasets from 11 neuro-ICU patients. The system provided reliable and failure-free waveform archiving. We measured an average temporal drift between waveforms from different monitoring devices of 1 ms every 66 min of recorded data. The waveform acquisition system allows for robust real-time data acquisition, processing, and archiving of waveforms. The temporal drift between waveforms archived from different devices is entirely negligible, even for long-term recording.

  19. The sign learning theory

    African Journals Online (AJOL)

    KING OF DAWN

    The sign learning theory also holds secrets that could be exploited in accomplishing motor tasks. ... Introduction ... In his classic work: Cognitive Map in Rats and Men (1948),Tolman talked about five groups of experiments viz: latent learning ...

  20. Crocodile jaw sign

    Directory of Open Access Journals (Sweden)

    Brij Sharma

    2016-01-01

    Full Text Available This teaching image highlights the CT abdominal imaging finding of 'crocodile jaw sign' which should raise concern about the presence of an incomplete annular pancreas which causes partial encasement of the duodenum.

  1. Reliable rapid blood test for the exclusion of venous thromboembolism in symptomatic outpatients

    NARCIS (Netherlands)

    Turkstra, F.; van Beek, E. J.; ten Cate, J. W.; Büller, H. R.

    1996-01-01

    In this study we assessed the reliability of a rapid bed-side whole blood D-dimer assay prospectively in patients with clinically suspected venous thromboembolism, referred to the Academic Medical Centre, Amsterdam. In consecutive outpatients with clinically suspected deep vein thrombosis or

  2. Fatigue risks in the connections of sign support structures.

    Science.gov (United States)

    2013-05-01

    This research effort develops a reliability-based approach for prescribing inspection intervals for mast-arm sign support : structures corresponding to user-specified levels of fatigue-induced fracture risk. The resulting level of risk for a : partic...

  3. Roadmap to Wellness: Exploring Live Customized Music at the Bedside for Hospitalized Children.

    Science.gov (United States)

    Perkins, R Serene; Boyce, Maura; Byrtek, Megan C; Ellis, Regina C; Hill, Cindy; Fitzpatrick, Paul S; Demirel, Shaban

    2018-01-01

    Randomized trials on clinical outcomes of music are conflicting, with few performed in the postoperative pediatric population. We aimed to determine if there was a benefit of a live, customized bedside music delivery program (MyMusicRx ® ) for children hospitalized after pediatric surgery. We present our perspective on the utility of music medicine, review others' work in this area, and discuss future directions. All admitted postsurgical patients aged between 5 and 18 years were considered. One live, customized music session was delivered by a MyMusicRx ® music specialist to intervention participants, and compared with matched controls who did not receive music intervention. Pain, cumulative analgesia dosage, and vital signs within 12 h after unit arrival were compared between groups. Thirty-two participants (16 intervention, 16 controls; 8:8 females:males per group) were enrolled. No differences in age, surgery length, or duration of music intervention were found between groups. No differences in pain scores ( p  = 0.73), heart rate ( p  = 0.82), respirations ( p  = 84), narcotic ( p  = 0.92) or non-narcotic medication usage ( p  = 0.88, 0.86, 0.95; ibuprofen, acetaminophen, and ketorolac, respectively), or time to first narcotic dose ( p  = 0.64) were found. A single music intervention in the acute postoperative period did not appear to be adequate to augment traditional methods of pain and hemodynamic control. Prior studies have similar outcome measures but conflicting results. We did not evaluate psychological well-being, patient engagement, or family perception in this pilot study. Future directions include developing and validating a tool that explores the observable impact of music medicine on children's emotions and behaviors.

  4. Roadmap to Wellness: Exploring Live Customized Music at the Bedside for Hospitalized Children

    Directory of Open Access Journals (Sweden)

    R. Serene Perkins

    2018-02-01

    Full Text Available BackgroundRandomized trials on clinical outcomes of music are conflicting, with few performed in the postoperative pediatric population. We aimed to determine if there was a benefit of a live, customized bedside music delivery program (MyMusicRx® for children hospitalized after pediatric surgery. We present our perspective on the utility of music medicine, review others’ work in this area, and discuss future directions.MethodsAll admitted postsurgical patients aged between 5 and 18 years were considered. One live, customized music session was delivered by a MyMusicRx® music specialist to intervention participants, and compared with matched controls who did not receive music intervention. Pain, cumulative analgesia dosage, and vital signs within 12 h after unit arrival were compared between groups.ResultsThirty-two participants (16 intervention, 16 controls; 8:8 females:males per group were enrolled. No differences in age, surgery length, or duration of music intervention were found between groups. No differences in pain scores (p = 0.73, heart rate (p = 0.82, respirations (p = 84, narcotic (p = 0.92 or non-narcotic medication usage (p = 0.88, 0.86, 0.95; ibuprofen, acetaminophen, and ketorolac, respectively, or time to first narcotic dose (p = 0.64 were found.ConclusionA single music intervention in the acute postoperative period did not appear to be adequate to augment traditional methods of pain and hemodynamic control. Prior studies have similar outcome measures but conflicting results. We did not evaluate psychological well-being, patient engagement, or family perception in this pilot study. Future directions include developing and validating a tool that explores the observable impact of music medicine on children’s emotions and behaviors.

  5. Nurses' Perceived Barriers to Bedside Handover and Their Implication for Clinical Practice.

    Science.gov (United States)

    Tobiano, Georgia; Whitty, Jennifer A; Bucknall, Tracey; Chaboyer, Wendy

    2017-10-01

    Bedside handover during the change of shift allows nurses to visualize patients and facilitate patient participation, both purported to improve patient safety. But, bedside handover does not always occur and when it does, it may not involve the patient. To explore and understand barriers nurses perceive in undertaking bedside handover. A cross-sectional survey was administered to 200 nurses working on medical wards, recruited from two Australian hospitals, one private and one public. As part of the survey, there was one open-ended question asking about perceived barriers to bedside handover. Content analysis was used to analyze data. Barriers were assessed using a determinant framework. The open-ended question was answered by 176 (88%) participants. Three categories were identified. First, censoring the message showed nurses were concerned about patients and third-parties hearing sensitive information. In the second category, disrupting the communication flow, nurses perceived patients, family members, other nurses and external sources, interrupted the flow of handover and increased its duration. Finally, inhibiting characteristics demonstrated that individual patient and nurse views or capabilities hindered bedside handover. Barriers to bedside handover were determined to relate to individual nurse factors, patient factors, social, political and legal factors, and guideline factors. Suggestions for enhancing bedside handover include debunking nurses' misconceptions, reflecting on nurses' viewpoints, using active educational approaches, and promotion of legal requirements to heighten nurses' confidence dealing with sensitive information. Regular patient rounding, and standardized handover may enable patient involvement in handover. Finally, reviewing the local context to ensure organizational processes support bedside handover is recommended. © 2017 Sigma Theta Tau International.

  6. Bedside Echocardiography for Rapid Diagnosis of Malignant Cardiac Tamponade

    Directory of Open Access Journals (Sweden)

    Alaina Brinley

    2017-01-01

    Full Text Available History of present illness: A 47-year-old female with metastatic breast cancer presented to the Emergency Department with chest pain and shortness of breath. She was hypotensive and her EKG showed sinus tachycardia with low voltage. A bedside ultrasound was performed that detected a pericardial effusion and evidence of cardiac tamponade. The patient’s vitals improved with a fluid bolus and she went emergently to the cardiac catheterization lab for fluoroscopy and echocardiography guided pericardiocentesis. A total of 770 mL of fluid was removed from her pericardial space. Significant findings: The video shows a subxiphoid view of the heart with evidence of a large pericardial effusion with tamponade – note the anechoic stripe in the pericardial sac (see red arrow. This video demonstrates paradoxical right ventricular collapse during diastole and right atrial collapse during systole which is indicative of tamponade.1,2 Figure 1 is from the same patient and shows sonographic pulsus paradoxus. This is an apical 4 chamber view of the heart with the sampling gate of the pulsed wave doppler placed over the mitral valve. The Vpeak max and Vpeak min are indicated. If there is more than a 25% difference with inspiration between these 2 values, this is highly suggestive of tamponade.1 In this case, there is a 32.4% difference between the Vpeak max 69.55 cm/s and Vpeak min 46.99 cm/s. Discussion: Cardiac tamponade is distinguished from pericardial effusion by right ventricular compression/collapse and hemodynamic instability. Findings can include hypotension, tachycardia, distant heart sounds, and jugular venous distension.3,4 One might also see a plethoric IVC without respiratory variation indicative of elevated right atrial pressures.1 Detection of right ventricular collapse for cardiac tamponade has sensitivities ranging from 48%-100% and specificities ranging from 33%-100%.5 A larger effusion is more likely to lead to cardiac tamponade. However

  7. Adolf Kussmaul and Kussmaul's sign

    Directory of Open Access Journals (Sweden)

    Navreet Singh

    2015-01-01

    Full Text Available Kussmaul's has provided us with three important signs: Pulses paradoxus, Kussmaul's sign and Kussmaul Breathing. This article discusses Kussmaul's sign, its discovery, first description, pathophyiology and exceptions.

  8. Surgical bedside master console for neurosurgical robotic system.

    Science.gov (United States)

    Arata, Jumpei; Kenmotsu, Hajime; Takagi, Motoki; Hori, Tatsuya; Miyagi, Takahiro; Fujimoto, Hideo; Kajita, Yasukazu; Hayashi, Yuichiro; Chinzei, Kiyoyuki; Hashizume, Makoto

    2013-01-01

    We are currently developing a neurosurgical robotic system that facilitates access to residual tumors and improves brain tumor removal surgical outcomes. The system combines conventional and robotic surgery allowing for a quick conversion between the procedures. This concept requires a new master console that can be positioned at the surgical bedside and be sterilized. The master console was developed using new technologies, such as a parallel mechanism and pneumatic sensors. The parallel mechanism is a purely passive 5-DOF (degrees of freedom) joystick based on the author's haptic research. The parallel mechanism enables motion input of conventional brain tumor removal surgery with a compact, intuitive interface that can be used in a conventional surgical environment. In addition, the pneumatic sensors implemented on the mechanism provide an intuitive interface and electrically isolate the tool parts from the mechanism so they can be easily sterilized. The 5-DOF parallel mechanism is compact (17 cm width, 19cm depth, and 15cm height), provides a 505,050 mm and 90° workspace and is highly backdrivable (0.27N of resistance force representing the surgical motion). The evaluation tests revealed that the pneumatic sensors can properly measure the suction strength, grasping force, and hand contact. In addition, an installability test showed that the master console can be used in a conventional surgical environment. The proposed master console design was shown to be feasible for operative neurosurgery based on comprehensive testing. This master console is currently being tested for master-slave control with a surgical robotic system.

  9. Surfactant from neonatal to pediatric ICU: bench and bedside evidence.

    Science.gov (United States)

    Boet, A; Brat, R; Aguilera, S S; Tissieres, P; De Luca, D

    2014-12-01

    Surfactant is a cornerstone of neonatal critical care for the treatment of respiratory distress syndrome of preterm babies. However, other indications have been studied for various clinical conditions both in term neonates and in children beyond neonatal age. A high degree of evidence is not yet available in some cases and this is due to the complex and not yet totally understood physiopathology of the different types of pediatric and neonatal lung injury. We here summarise the state of the art of the bench and bedside knowledge about surfactant use for the respiratory conditions usually cared for in neonatal and pediatric intensive care units. Future research direction will also be presented. On the whole, surfactant is able to improve oxygenation in infection related respiratory failure, pulmonary hemorrhage and meconium aspiration syndrome. Bronchoalveolar lavage with surfactant solution is currently the only means to reduce mortality or need for extracorporeal life support in neonates with meconium aspiration. While surfactant bolus or lavage only improves the oxygenation and ventilatory requirements in other types of postneonatal acute respiratory distress syndrome (ARDS), there seems to be a reduction in the mortality of small infants with RSV-related ARDS.

  10. Mechanisms of Inflammation in Proliferative Vitreoretinopathy: From Bench to Bedside

    Directory of Open Access Journals (Sweden)

    Stavros N. Moysidis

    2012-01-01

    Full Text Available Proliferative vitreoretinopathy (PVR is a vision-threatening disease and a common complication of surgery to correct rhegmatogenous retinal detachment (RRD. Several models of the pathogenesis of this disease have been described with some of these models focusing on the role of inflammatory cells and other models focusing on the role of growth factors and cytokines in the vitreous which come into contact with intraretinal and retinal pigment epithelial cells. New experiments have shed light on the pathogenesis of PVR and offer promising avenues for clinical intervention before PVR develops. One such target is the indirect pathway of activation of platelet-derived growth factor receptor alpha (PDGRα, which plays an important role in PVR. Clinical trials assessing the efficacy of 5-fluorouracil (5-FU and low-molecular-weight heparin (LMWH, daunorubicin, and 13-cis-retinoic acid, among other therapies, have yielded mixed results. Here we review inflammatory and other mechanisms involved in the pathogenesis of PVR, we highlight important clinical trials, and we discuss how findings at the bench have the potential to be translated to the bedside.

  11. Pathophysiology of septic shock: From bench to bedside.

    Science.gov (United States)

    McConnell, Kevin W; Coopersmith, Craig M

    2016-04-01

    Our understanding of sepsis and its resultant outcomes remains a paradox. On the one hand, we know more about the pathophysiology of sepsis than ever before. However, this knowledge has not been successfully translated to the bedside, as the vast majority of clinical trials for sepsis have been negative. Yet even in the general absence of positive clinical trials, mortality from sepsis has fallen to its lowest point in history, in large part due to educational campaigns that stress timely antibiotics and hemodynamic support. While additional improvements in outcome will assuredly result from further compliance with evidence based practices, a deeper understanding of the science that underlies the host response in sepsis is critical to the development of novel therapeutics. In this review, we outline immunopathologic abnormalities in sepsis, and then look at potential approaches to therapeutically modulate them. Ultimately, an understanding of the science underlying sepsis should allow the critical care community to utilize precision medicine to combat this devastating disease on an individual basis leading to improved outcomes. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Software reliability

    CERN Document Server

    Bendell, A

    1986-01-01

    Software Reliability reviews some fundamental issues of software reliability as well as the techniques, models, and metrics used to predict the reliability of software. Topics covered include fault avoidance, fault removal, and fault tolerance, along with statistical methods for the objective assessment of predictive accuracy. Development cost models and life-cycle cost models are also discussed. This book is divided into eight sections and begins with a chapter on adaptive modeling used to predict software reliability, followed by a discussion on failure rate in software reliability growth mo

  13. Computational triadic algebras of signs

    Energy Technology Data Exchange (ETDEWEB)

    Zadrozny, W. [T.J. Watson Research Center, Yorktown Heights, NY (United States)

    1996-12-31

    We present a finite model of Peirce`s ten classes of signs. We briefly describe Peirce`s taxonomy of signs; we prove that any finite collection of signs can be extended to a finite algebra of signs in which all interpretants are themselves being interpreted; and we argue that Peirce`s ten classes of signs can be defined using constraints on algebras of signs. The paper opens the possibility of defining multimodal cognitive agents using Peirce`s classes of signs, and is a first step towards building a computational logic of signs based on Peirce`s taxonomies.

  14. Toward the Ideal Signing Avatar

    Directory of Open Access Journals (Sweden)

    Nicoletta Adamo-Villani

    2016-06-01

    Full Text Available The paper discusses ongoing research on the effects of a signing avatar's modeling/rendering features on the perception of sign language animation. It reports a recent study that aimed to determine whether a character's visual style has an effect on how signing animated characters are perceived by viewers. The stimuli of the study were two polygonal characters presenting two different visual styles: stylized and realistic. Each character signed four sentences. Forty-seven participants with experience in American Sign Language (ASL viewed the animated signing clips in random order via web survey. They (1 identified the signed sentences (if recognizable, (2 rated their legibility, and (3 rated the appeal of the signing avatar. Findings show that while character's visual style does not have an effect on subjects' perceived legibility of the signs and sign recognition, it has an effect on subjects' interest in the character. The stylized signing avatar was perceived as more appealing than the realistic one.

  15. The CT signs of intestinal volvulus

    International Nuclear Information System (INIS)

    Ji Jiansong; Wang Zufei; Xu Zhaolong; Lv Guijian; Xu Min; Zhao Zhongwei; Su Jinliang; Zhou Limin

    2005-01-01

    Objective: To improve the accuracy rate of spiral CT diagnosing intestinal volvulus. Methods: To analysis the CT findings of 9 cases of intestinal volvulus proved by operation, the main reconstruction techniques were multiplanar reformation (MPR) and sliding thin-slab maximum intensity projection (STS-MIP). Results: All the 9 cases were diagnosed accurately, the main signs were 'whirlpool' of intestine (6 cases) and vessels (9 cases),'target loop' (2 cases),'beak'(6 cases). Conclusion: 'Whirlpool' of vessels is a specific sign to diagnose intestinal volvulus, 'target loop', reduced enhancement of intestinal wall and ascites are the reliable signs to strangulated intestinal obstruction. Spiral CT and reconstructions have important value to diagnose the intestinal volvulus. (authors)

  16. Human reliability

    International Nuclear Information System (INIS)

    Embrey, D.E.

    1987-01-01

    Concepts and techniques of human reliability have been developed and are used mostly in probabilistic risk assessment. For this, the major application of human reliability assessment has been to identify the human errors which have a significant effect on the overall safety of the system and to quantify the probability of their occurrence. Some of the major issues within human reliability studies are reviewed and it is shown how these are applied to the assessment of human failures in systems. This is done under the following headings; models of human performance used in human reliability assessment, the nature of human error, classification of errors in man-machine systems, practical aspects, human reliability modelling in complex situations, quantification and examination of human reliability, judgement based approaches, holistic techniques and decision analytic approaches. (UK)

  17. Reliability Calculations

    DEFF Research Database (Denmark)

    Petersen, Kurt Erling

    1986-01-01

    Risk and reliability analysis is increasingly being used in evaluations of plant safety and plant reliability. The analysis can be performed either during the design process or during the operation time, with the purpose to improve the safety or the reliability. Due to plant complexity and safety...... and availability requirements, sophisticated tools, which are flexible and efficient, are needed. Such tools have been developed in the last 20 years and they have to be continuously refined to meet the growing requirements. Two different areas of application were analysed. In structural reliability probabilistic...... approaches have been introduced in some cases for the calculation of the reliability of structures or components. A new computer program has been developed based upon numerical integration in several variables. In systems reliability Monte Carlo simulation programs are used especially in analysis of very...

  18. The Forbidden Signs

    DEFF Research Database (Denmark)

    Kilstrup, Mogens

    2016-01-01

    While the field of semiotics has been active since it was started by Peirce, it appears like the last decade has been especially productive with a number of important new concepts being developed within the biosemiotics community. The novel concept of the Semiotic scaffold by Hoffmeyer is an impo......While the field of semiotics has been active since it was started by Peirce, it appears like the last decade has been especially productive with a number of important new concepts being developed within the biosemiotics community. The novel concept of the Semiotic scaffold by Hoffmeyer...... is an important addition that offers insight into the hardware requirements for bio-semiosis. As any type of semiosis must be dependent upon Semiotic scaffolds, I recently argued that the process of semiosis has to be divided into two separate processes of sign establishment and sign interpretation....... I also show that biological semiosis offers examples of forbidden signs, where the faulty interpretation of signs may lead to decimation of whole evolutionary lines of organisms. A new concept of Evolutionary memory which is applicable to both human and biological semiosis is explained...

  19. Sign Language Web Pages

    Science.gov (United States)

    Fels, Deborah I.; Richards, Jan; Hardman, Jim; Lee, Daniel G.

    2006-01-01

    The World Wide Web has changed the way people interact. It has also become an important equalizer of information access for many social sectors. However, for many people, including some sign language users, Web accessing can be difficult. For some, it not only presents another barrier to overcome but has left them without cultural equality. The…

  20. Buffer Zone Sign Template

    Science.gov (United States)

    The certified pesticide applicator is required to post a comparable sign, designating a buffer zone around the soil fumigant application block in order to control exposure risk. It must include the don't walk symbol, product name, and applicator contact.

  1. Flemish Sign Language Standardisation

    Science.gov (United States)

    Van Herreweghe, Mieke; Vermeerbergen, Myriam

    2009-01-01

    In 1997, the Flemish Deaf community officially rejected standardisation of Flemish Sign Language. It was a bold choice, which at the time was not in line with some of the decisions taken in the neighbouring countries. In this article, we shall discuss the choices the Flemish Deaf community has made in this respect and explore why the Flemish Deaf…

  2. Cellular and Molecular Anesthesia: from Bench to Bedside

    Directory of Open Access Journals (Sweden)

    Ali Dabbagh

    2015-12-01

    Full Text Available Cellular and Molecular Anesthesia: from Bench to BedsideIn the current practice of anesthesia, each day, anesthesiologists deal with a great work: they use the cellular mechanisms of drug molecules to induce their desired effects for induction and maintenance of anesthesia to achieve appropriate tolerance of surgery and its pain, modulation of stress response, sedation needed for performing a variety of procedures, emergency anesthesia care, acute and chronic pain management or other everyday jobs of anesthesiologists during perioperative period.As a matter of fact, molecular anesthesia has been cited for more than 6 decades though in avery limited scale. In 1956, the molecular mechanisms of morphine and pethidine are described (1. Pauling in 1961 published an article in Science describing a molecular theorey for general anesthesia (2.In its report “the World in 2025”, Thomson Reuters has predicted clinical medicine would be the most active research front; while molecular biology has the 9th rank (3. But are we still practicing in clinic the same as today?In fact, the future trend of anesthesia is highly dependent on finding the novel cellular and molecular mechanisms and the possible interactions of the newly discovered molecules and inreraction mechanisms with organ systems. Today, we emphasize on the role of pharmacologists, physiologists, immunologists, anatomists, embryologists, geneticians, cellular medicine specialists, physicists and other basic science specialists; some very interesting examples are published in this volume of the Journal (4-7.However, changes that have well started now would “revolutionize” our daily practice during the next decade in such a way that it will change the basis of medicine: presumably we will have a new model medicine known as “personalized medicine” or “precision medicine”. In this approach, the content of each patient’s genes accompanied with his/her cellular and molecular analysis is

  3. Eating disorders: from bench to bedside and back.

    Science.gov (United States)

    Gaetani, Silvana; Romano, Adele; Provensi, Gustavo; Ricca, Valdo; Lutz, Thomas; Passani, Maria Beatrice

    2016-12-01

    The central nervous system and viscera constitute a functional ensemble, the gut-brain axis, that allows bidirectional information flow that contributes to the control of feeding behavior based not only on the homeostatic, but also on the hedonic aspects of food intake. The prevalence of eating disorders, such as anorexia nervosa, binge eating and obesity, poses an enormous clinical burden, and involves an ever-growing percentage of the population worldwide. Clinical and preclinical research is constantly adding new information to the field and orienting further studies with the aim of providing a foundation for developing more specific and effective treatment approaches to pathological conditions. A recent symposium at the XVI Congress of the Societá Italiana di Neuroscienze (SINS, 2015) 'Eating disorders: from bench to bedside and back' brought together basic scientists and clinicians with the objective of presenting novel perspectives in the neurobiology of eating disorders. Clinical studies presented by V. Ricca illustrated some genetic aspects of the psychopathology of anorexia nervosa. Preclinical studies addressed different issues ranging from the description of animal models that mimic human pathologies such as anorexia nervosa, diet-induced obesity, and binge eating disorders (T. Lutz), to novel interactions between peripheral signals and central circuits that govern food intake, mood and stress (A. Romano and G. Provensi). The gut-brain axis has received increasing attention in the recent years as preclinical studies are demonstrating that the brain and visceral organs such as the liver and guts, but also the microbiota are constantly engaged in processes of reciprocal communication, with unexpected physiological and pathological implications. Eating is controlled by a plethora of factors; genetic predisposition, early life adverse conditions, peripheral gastrointestinal hormones that act directly or indirectly on the central nervous system, all are

  4. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Michael P Chae

    2015-06-01

    Full Text Available Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D reconstructions, are limited by their representation on 2D workstations. 3D printing has been embraced by early adopters to produce medical imaging-guided 3D printed biomodels that facilitate various aspects of clinical practice. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. With increasing accessibility, investigators are now able to convert standard imaging data into Computer Aided Design (CAD files using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography (SLA, multijet modeling (MJM, selective laser sintering (SLS, binder jet technique (BJT, and fused deposition modeling (FDM. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without out-sourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. In this review the existing uses of 3D printing in plastic surgery practice, spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative aesthetics, are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, patient and surgical trainee education, and the development of intraoperative guidance tools and patient-specific prosthetics in everyday surgical practice.

  5. Emerging Applications of Bedside 3D Printing in Plastic Surgery.

    Science.gov (United States)

    Chae, Michael P; Rozen, Warren M; McMenamin, Paul G; Findlay, Michael W; Spychal, Robert T; Hunter-Smith, David J

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  6. Bedside Ultrasound for the Diagnosis of Small Bowel Obstruction

    Directory of Open Access Journals (Sweden)

    Alexander Anshus

    2017-09-01

    Full Text Available History of present illness: An elderly female with no history of prior abdominal surgeries presented to the emergency department (ED with acute onset of abdominal pain and distention. Upon arrival, she began having large volume bilious emesis. While waiting for a computed tomography (CT scan of her abdomen and pelvis, a point of care ultrasound (POCUS was performed which showed evidence of a small bowel obstruction (SBO. The patient had a nasogastric tube placed that put out over two liters of bilious contents. A subsequent CT scan confirmed the diagnosis of SBO from a left inguinal hernia and the patient was admitted to the surgical service. Significant findings: The POCUS utilizing the low frequency curvilinear probe demonstrates fluid-filled, dilated bowel loops greater than 2.5cm with to-and-fro peristalsis, and thickened bowel walls greater than 3mm, concerning for SBO. Discussion: Gastrointestinal obstruction is a common diagnosis in the ED, accounting for approximately 15% of all ED visits for acute abdominal pain.1 SBO accounts for approximately 80% of all obstructions.2 In the diagnosis of SBO, studies show that abdominal x-rays have a sensitivity of 66-77% and specificity of 50-57%,3 CT scans have a sensitivity of 92% and specificity of 93%,4 and ultrasound has a sensitivity of 88% and specificity of 96%.5 While CT scan remains a widely accepted modality for diagnosing SBO, ultrasound is more cost effective, well tolerated, does not involve ionizing radiation, and can be done in a timely manner at the patient’s bedside. Ultrasound can also identify transition points as well as distinguish between functional and mechanical obstruction.6 In addition to SBO, ultrasound can be used to diagnose external hernias, intussusception, tumors, superior mesenteric artery (SMA syndrome, foreign bodies, bezoars, and ascariasis.7

  7. Emerging Applications of Bedside 3D Printing in Plastic Surgery

    Science.gov (United States)

    Chae, Michael P.; Rozen, Warren M.; McMenamin, Paul G.; Findlay, Michael W.; Spychal, Robert T.; Hunter-Smith, David J.

    2015-01-01

    Modern imaging techniques are an essential component of preoperative planning in plastic and reconstructive surgery. However, conventional modalities, including three-dimensional (3D) reconstructions, are limited by their representation on 2D workstations. 3D printing, also known as rapid prototyping or additive manufacturing, was once the province of industry to fabricate models from a computer-aided design (CAD) in a layer-by-layer manner. The early adopters in clinical practice have embraced the medical imaging-guided 3D-printed biomodels for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between anatomical structures. With increasing accessibility, investigators are able to convert standard imaging data into a CAD file using various 3D reconstruction softwares and ultimately fabricate 3D models using 3D printing techniques, such as stereolithography, multijet modeling, selective laser sintering, binder jet technique, and fused deposition modeling. However, many clinicians have questioned whether the cost-to-benefit ratio justifies its ongoing use. The cost and size of 3D printers have rapidly decreased over the past decade in parallel with the expiration of key 3D printing patents. Significant improvements in clinical imaging and user-friendly 3D software have permitted computer-aided 3D modeling of anatomical structures and implants without outsourcing in many cases. These developments offer immense potential for the application of 3D printing at the bedside for a variety of clinical applications. In this review, existing uses of 3D printing in plastic surgery practice spanning the spectrum from templates for facial transplantation surgery through to the formation of bespoke craniofacial implants to optimize post-operative esthetics are described. Furthermore, we discuss the potential of 3D printing to become an essential office-based tool in plastic surgery to assist in preoperative planning, developing

  8. A bedside measure of body composition in Duchenne muscular dystrophy.

    Science.gov (United States)

    Elliott, Sarah A; Davidson, Zoe E; Davies, Peter S W; Truby, Helen

    2015-01-01

    In clinical practice, monitoring body composition is a critical component of nutritional assessment and weight management in boys with Duchenne muscular dystrophy. We aimed to evaluate the accuracy of a simple bedside measurement tool for body composition, namely bioelectrical impedance analysis, in boys with Duchenne muscular dystrophy. Measures of fat-free mass were determined using a bioelectrical impedance analysis machine and compared against estimations obtained from a reference body composition model. Additionally, the use of raw impedance values was analyzed using three existing predictive equations for the estimation of fat-free mass. Accuracy of bioelectrical impedance analysis was assessed by comparison against the reference model by calculation of biases and limits of agreement. Body composition was measured in 10 boys with Duchenne muscular dystrophy, mean age 9.01 ± 2.34 years. The bioelectrical impedance analysis machine values of fat-free mass were on average 2.3 ± 14.1 kg higher than reference values. Limits of agreement (based on 95% confidence interval of the mean) were -7.4 to 2.9 kg. There was a significant correlation between the mean fat-free mass and difference in fat-free mass between the bioelectrical impedance analysis machine and the reference model (r = -0.86; P = 0.02) suggesting that the bias was not consistent across the range of measurements. The most accurate predictive equation for the estimation of fat-free mass using raw impedance values was the equation by Pietrobelli et al. (mean difference, -0.7 kg; 95% limits of agreement, -3.5 to 2.0 kg). In a clinical setting, where a rapid assessment of body composition is advantageous, the use of raw impedance values, combined with the equation by Pietrobelli et al., is recommended for the accurate estimation of fat-free mass, in boys with Duchenne muscular dystrophy. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation.

    Science.gov (United States)

    Narula, Jagat; Chandrashekhar, Y; Braunwald, Eugene

    2018-04-01

    Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.

  10. Pneumothorax 'unmasked'. A compilation of essential, masked diagnostic signs for fresh-up

    International Nuclear Information System (INIS)

    Schratter, M.; Richter-Schlosser, R.; Knittel, M.; Schratter-Sehn, A.U.

    1997-01-01

    This review presents a compilation and explanation of the indirect signs pointing to occurrence of a pneumothorax, going into detail as to their diagnostic worth. In the case of diagnostic information bearing remaining uncertainties it is recommended to perform CT scans for orientation, with patients in bed but transportable; with bedfast, non-transportable patients, bedside scans can be made in horizontal beam mode, positioning the patient so as to show as full as possible the pneumo-suspected body side, or selecting a slightly oblique beam mode from caudal to cranial position, if patient is restricted to lying on his back. (orig./CB) [de

  11. The clinical application of computed radiography in bedside photography of newborn

    International Nuclear Information System (INIS)

    Peng Sen; Guo Tianchang

    2005-01-01

    Objective: To evaluate the computed radiography in bedside photography of newborn, especially in chest radiography. Methods: Bedside CR images were selected in 100 cases randomly. The exposure parameters were optimized using the large latitude of CR. The details of images were post-processed and adjusted using spatial tuning technique. Then CR photography was compared with conventional X-ray photography. Results: The images acquired with CR had good contrast, high definition, and little distortion, in which the condemned image rate was 1%. While in conventional X-ray photography, the unsuccessful imaging rate is 9%. Conclusion: Bedside computed radiography of new-born, especially the chest imaging, is very helpful to improve image quality and positive rate of the diagnosis. (authors)

  12. [Rationalization and rationing at the bedside. A normative and empirical status quo analysis].

    Science.gov (United States)

    Strech, D

    2014-02-01

    The topic of bedside rationing is increasingly discussed in Germany. Further need for clarification exists for the question how bedside rationing (e.g., in the area of overcare) can be justified despite coexistent inefficiencies. This paper outlines and analyses the relationship of waste avoidance and rationing from an ethical perspective. Empirical findings regarding the status quo of bedside rationing and rationalization are presented. These normative and empirical explorations will then be further specified regarding opportunities for future physician-driven activities to tackle overuse. The self-government partners in Germany should communicate more explicitly within their communities and to the public how and with which benchmarks they aim to reduce inefficient health care (overuse) in an appropriate manner. Physician-driven activities such as the "Choosing Wisely®" initiative in the USA could provide a first step to raise the awareness for overuse among physicians as well as in the public.

  13. Bedside diagnosis of imported malaria using the Binax Now malaria antigen detection test

    DEFF Research Database (Denmark)

    Wiese, Lothar; Bruun, Brita; Baek, Leif

    2006-01-01

    Malaria may be misdiagnosed in non-endemic countries when the necessary experience for rapid expert microscopy is lacking. Rapid diagnostic tests may improve the diagnosis and may play a role as a bedside diagnostic tool. In a multicentre study we recruited patients suspected of malaria over...... a period of 14 months. The Binax Now Malaria rapid test was used at the bedside and in the clinical microbiology laboratory. The training of clinical staff was monitored and their experience with the use of the test was recorded. 542 patients were included, 80 of whom had malaria diagnosed by microscopy...... be useful for the diagnosis of P. falciparum malaria when used by routine laboratory staff, but could lead to misdiagnoses when used at the bedside. Microscopy is still essential in order to identify the few missed diagnoses, to determine the degree of parasitaemia, and to ensure species diagnosis...

  14. Planetary Vital Signs

    Science.gov (United States)

    Kennel, Charles; Briggs, Stephen; Victor, David

    2016-07-01

    The climate is beginning to behave in unusual ways. The global temperature reached unprecedented highs in 2015 and 2016, which led climatologists to predict an enormous El Nino that would cure California's record drought. It did not happen the way they expected. That tells us just how unreliable temperature has become as an indicator of important aspects of climate change. The world needs to go beyond global temperature to a set of planetary vital signs. Politicians should not over focus policy on one indicator. They need to look at the balance of evidence. A coalition of scientists and policy makers should start to develop vital signs at once, since they should be ready at the entry into force of the Paris Agreement in 2020. But vital signs are only the beginning. The world needs to learn how to use the vast knowledge we will be acquiring about climate change and its impacts. Is it not time to use all the tools at hand- observations from space and ground networks; demographic, economic and societal measures; big data statistical techniques; and numerical models-to inform politicians, managers, and the public of the evolving risks of climate change at global, regional, and local scales? Should we not think in advance of an always-on social and information network that provides decision-ready knowledge to those who hold the responsibility to act, wherever they are, at times of their choosing?

  15. Splenic Rupture Diagnosed with Bedside Ultrasound in a Patient with Shock in the Emergency Department Following Colonoscopy

    Directory of Open Access Journals (Sweden)

    William Mulkerin

    2015-10-01

    Full Text Available A 64-year-old male presented to the emergency department (ED with near syncope and worsening left flank and shoulder pain. He had undergone a difficult colonoscopy two days prior due to a tortuous colon. Initial vital signs were normal. He looked uncomfortable and had significant left upper quadrant abdominal tenderness with guarding. Thirty minutes after ED arrival, his blood pressure dropped to 73/59 mmHg, requiring aggressive fluid resuscitation. Bedside focused assessment with sonography in trauma (FAST exam demonstrated free fluid in the abdomen with mixed echogenicity of the spleen, suggestive of splenic injury. Computed tomography (CT demonstrated a large subcapsular splenic hematoma with active extravasation and surrounding intraperitoneal free fluid (Figure, Video. He was admitted to the surgical intensive care unit. Hemorrhage continued after interventional radiology performed embolization of the splenic artery. He then required laparoscopic splenectomy on hospital day 2 to control bleeding. He subsequently did well and was discharged on hospital day 10.

  16. The status of bedside teaching in the United Kingdom: the student perspective

    Directory of Open Access Journals (Sweden)

    Jones P

    2015-06-01

    Full Text Available Patrick Jones, Bhavan Prasad Rai Department of Surgery, Ninewells Hospital, Dundee, UK Purpose: Bedside teaching holds a strong tradition as a key-learning platform for clinical examination in the basic medical clerkship. There is a growing body of literature expressing concern for its witnessed decline in medical school curricula. However, the views of students toward this patient-centered cornerstone in surgical education remain under-reported. The purpose of this study was to gain a nationwide perspective on bedside teaching according to medical students in the United Kingdom. Materials and methods: An adapted Delphi method was employed to formulate the question series as part of a multi-step process including a pilot study, which was used to construct this survey. The target population was medical undergraduates in the United Kingdom and participants were recruited via social media. Outcomes assessed included exposure to bedside teaching, perceived benefits of clinical simulation, and junior doctors as clinical teachers. Barriers to clinical examination were also evaluated. Results: Overall, 368 completed surveys were received (completion rate 98.9%. Final year students were significantly more likely to report receiving insufficient bedside teaching (P<0.01. Seventy-eight percent of the study group agreed that clinical simulation is a good learning tool for clinical examination. Seventy percent of students felt junior doctors were as able as senior doctors to teach. Lack of confidence was identified as the commonest barrier to overcome when examining patients and two-thirds of students felt they burdened patients during bedside teaching. Conclusion: This prospective study confirms the exposure deficit, which medical students experience in bedside teaching. The junior doctor represents a dynamic clinical teacher in the face of working time directives. Peer learning is a novel solution to such pressures. Work is needed to re-establish the

  17. The Danish Sign Language Dictionary

    DEFF Research Database (Denmark)

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas

    2010-01-01

    The entries of the The Danish Sign Language Dictionary have four sections:  Entry header: In this section the sign headword is shown as a photo and a gloss. The first occurring location and handshape of the sign are shown as icons.  Video window: By default the base form of the sign headword...... forms of the sign (only for classifier entries). In addition to this, frequent co-occurrences with the sign are shown in this section. The signs in the The Danish Sign Language Dictionary can be looked up through:  Handshape: Particular handshapes for the active and the passive hand can be specified...... to find signs that are not themselves lemmas in the dictionary, but appear in example sentences.  Topic: Topics can be chosen as search criteria from a list of 70 topics....

  18. Reliability Engineering

    CERN Document Server

    Lazzaroni, Massimo

    2012-01-01

    This book gives a practical guide for designers and users in Information and Communication Technology context. In particular, in the first Section, the definition of the fundamental terms according to the international standards are given. Then, some theoretical concepts and reliability models are presented in Chapters 2 and 3: the aim is to evaluate performance for components and systems and reliability growth. Chapter 4, by introducing the laboratory tests, puts in evidence the reliability concept from the experimental point of view. In ICT context, the failure rate for a given system can be

  19. Reliability training

    Science.gov (United States)

    Lalli, Vincent R. (Editor); Malec, Henry A. (Editor); Dillard, Richard B.; Wong, Kam L.; Barber, Frank J.; Barina, Frank J.

    1992-01-01

    Discussed here is failure physics, the study of how products, hardware, software, and systems fail and what can be done about it. The intent is to impart useful information, to extend the limits of production capability, and to assist in achieving low cost reliable products. A review of reliability for the years 1940 to 2000 is given. Next, a review of mathematics is given as well as a description of what elements contribute to product failures. Basic reliability theory and the disciplines that allow us to control and eliminate failures are elucidated.

  20. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Samuel H.F. Lam

    2014-11-01

    Full Text Available Introduction: Appendicitis is a common condition presenting to the emergency department (ED. Increasingly emergency physicians (EP are using bedside ultrasound (BUS as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They then recorded elements of clinical history, physical examination, white blood cell count (WBC with polymophonuclear percentage (PMN, and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results: A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87-100% and 32% specific (95% CI 14-57% for detection of appendicitis, with a positive predictive value of 72% (95% CI 56-84%, and a negative predictive value of 100% (95% CI 52-100%. Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were

  1. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    Science.gov (United States)

    Lam, Samuel H.F.; Grippo, Anthony; Kerwin, Chistopher; Konicki, P. John; Goodwine, Diana; Lambert, Michael J.

    2014-01-01

    Introduction Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods Patients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis. They then recorded elements of clinical history, physical examination, white blood cell count (WBC) with polymophonuclear percentage (PMN), and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up. Results A total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87–100%) and 32% specific (95% CI 14–57%) for detection of appendicitis, with a positive predictive value of 72% (95% CI 56–84%), and a negative predictive value of 100% (95% CI 52–100%). Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p6mm, appendix wall thickness >2mm, periappendiceal fluid were found

  2. Bedside Endoscopic Retrograde Cholangiopancreatography Using Portable X-Ray in Acute Severe Cholangitis

    Directory of Open Access Journals (Sweden)

    Rushikesh Shah

    2018-01-01

    Full Text Available Patients with acute cholangitis require emergent biliary decompression. Those who are hemodynamically unstable on vasopressor support and mechanical ventilation are too critically ill to move outside of the intensive care unit. This prohibits performing Endoscopic Retrograde Cholangiopancreatography (ERCP in the endoscopy unit. Fluoroscopic guidance is required to confirm deep biliary cannulation during ERCP. There are a few reported cases of bedside ERCP using portable C-arm fluoroscopy unit or ultrasound guided cannulation. We present a unique case of life-saving emergent bedside ERCP in a severely ill patient with cholangitis and septic shock, using simple portable X-ray to confirm biliary cannulation.

  3. The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade

    Directory of Open Access Journals (Sweden)

    Adam Goodman

    2012-01-01

    Full Text Available This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.

  4. Malaysian sign language dataset for automatic sign language ...

    African Journals Online (AJOL)

    Journal of Fundamental and Applied Sciences. Journal Home · ABOUT ... SL recognition system based on the Malaysian Sign Language (MSL). Implementation results are described. Keywords: sign language; pattern classification; database.

  5. Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study.

    Science.gov (United States)

    Despins, Laurel A

    2017-12-01

    This study examines what prompts the intensive care unit (ICU) nurse to go to the patient's bedside to investigate an alarm and the influences on the nurse's determination regarding how quickly this needs to occur. A qualitative descriptive design guided data collection and analysis. Individual semi-structured interviews were conducted. Thematic analysis guided by the Patient Risk Detection Theoretical Framework was applied to the data. Four specialty intensive care units in an academic medical center. ICU nurses go the patient's bedside in response to an alarm to catch patient deterioration and avert harm. Their determination of the immediacy of patient risk and their desire to prioritize their bedside investigations to true alarms influences how quickly they proceed to the bedside. Ready visual access to physiological data and waveform configurations, experience, teamwork, and false alarms are important determinants in the timing of ICU nurses' bedside alarm investigations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Green's Theorem for Sign Data

    OpenAIRE

    Houston, Louis M.

    2012-01-01

    Sign data are the signs of signal added to noise. It is well known that a constant signal can be recovered from sign data. In this paper, we show that an integral over variant signal can be recovered from an integral over sign data based on the variant signal. We refer to this as a generalized sign data average. We use this result to derive a Green's theorem for sign data. Green's theorem is important to various seismic processing methods, including seismic migration. Results in this paper ge...

  7. Reliability calculations

    International Nuclear Information System (INIS)

    Petersen, K.E.

    1986-03-01

    Risk and reliability analysis is increasingly being used in evaluations of plant safety and plant reliability. The analysis can be performed either during the design process or during the operation time, with the purpose to improve the safety or the reliability. Due to plant complexity and safety and availability requirements, sophisticated tools, which are flexible and efficient, are needed. Such tools have been developed in the last 20 years and they have to be continuously refined to meet the growing requirements. Two different areas of application were analysed. In structural reliability probabilistic approaches have been introduced in some cases for the calculation of the reliability of structures or components. A new computer program has been developed based upon numerical integration in several variables. In systems reliability Monte Carlo simulation programs are used especially in analysis of very complex systems. In order to increase the applicability of the programs variance reduction techniques can be applied to speed up the calculation process. Variance reduction techniques have been studied and procedures for implementation of importance sampling are suggested. (author)

  8. Sign language typology: The contribution of rural sign languages

    NARCIS (Netherlands)

    de Vos, C.; Pfau, R.

    2015-01-01

    Since the 1990s, the field of sign language typology has shown that sign languages exhibit typological variation at all relevant levels of linguistic description. These initial typological comparisons were heavily skewed toward the urban sign languages of developed countries, mostly in the Western

  9. Sign language perception research for improving automatic sign language recognition

    NARCIS (Netherlands)

    Ten Holt, G.A.; Arendsen, J.; De Ridder, H.; Van Doorn, A.J.; Reinders, M.J.T.; Hendriks, E.A.

    2009-01-01

    Current automatic sign language recognition (ASLR) seldom uses perceptual knowledge about the recognition of sign language. Using such knowledge can improve ASLR because it can give an indication which elements or phases of a sign are important for its meaning. Also, the current generation of

  10. Sign Lowering and Phonetic Reduction in American Sign Language.

    Science.gov (United States)

    Tyrone, Martha E; Mauk, Claude E

    2010-04-01

    This study examines sign lowering as a form of phonetic reduction in American Sign Language. Phonetic reduction occurs in the course of normal language production, when instead of producing a carefully articulated form of a word, the language user produces a less clearly articulated form. When signs are produced in context by native signers, they often differ from the citation forms of signs. In some cases, phonetic reduction is manifested as a sign being produced at a lower location than in the citation form. Sign lowering has been documented previously, but this is the first study to examine it in phonetic detail. The data presented here are tokens of the sign WONDER, as produced by six native signers, in two phonetic contexts and at three signing rates, which were captured by optoelectronic motion capture. The results indicate that sign lowering occurred for all signers, according to the factors we manipulated. Sign production was affected by several phonetic factors that also influence speech production, namely, production rate, phonetic context, and position within an utterance. In addition, we have discovered interesting variations in sign production, which could underlie distinctions in signing style, analogous to accent or voice quality in speech.

  11. Uncovertebral joint injury in cervical facet dislocation: the headphones sign

    Energy Technology Data Exchange (ETDEWEB)

    Palmieri, Francesco; Cassar-Pullicino, Victor N.; Dell' Atti, Claudia; Lalam, Radhesh K.; Tins, Bernhard J.; Tyrrell, Prudencia N.M.; McCall, Iain W. [Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Department of Radiology, Oswestry, England (United Kingdom)

    2006-06-15

    The purpose of our study is to demonstrate the uncovertebral mal-alignment as a reliable indirect sign of cervical facet joint dislocation. We examined the uncovertebral axial plane alignment of 12 patients with unilateral and bilateral cervical facet joint dislocation (UCFJD and BCFJD, respectively), comparing its frequency to the reverse hamburger bun sign on CT and MR axial images. Of the seven cases with BCFJD, five clearly demonstrated the diagnostic reverse facet joint hamburger bun sign on CT and MR images, but in two cases this sign was not detectable. In the five cases with UCFJD, four demonstrated the reverse hamburger bun sign on both CT and MRI. In one case the reverse hamburger bun sign was not seen adequately with either image modality, but the facet dislocation was identified on sagittal imaging. The uncovertebral mal-alignment was detected in all 12 cases. Normally, the two components of the uncovertebral joint enjoy a concentric relationship that in the axial plane is reminiscent of the relationship of headphones with the wearer's head. We name this appearance the 'headphones' sign. Radiologists should be aware of the headphones sign as a reliable indicator of facet joint dislocation on axial imaging used in the assessment of cervical spine injuries. (orig.)

  12. Signs in Place

    DEFF Research Database (Denmark)

    Hamid, Salmiah Binti Abdul; Jensen, Ole B.; Silva, Victor

    Travelling in unfamiliar areas is usually very interesting, however it can also be stressful. People travel or move around in an urban space according to their needs, and the environment can also influence the way people move about from one place to another. If a person gets lost, a map or GPS can...... and geosemiotic studies with regards to the road traffic signs used in urban spaces. The paper ends with a discussion on how people choreograph their movement in their everyday life from two different perspectives: above vs. below....

  13. Signs In Place

    DEFF Research Database (Denmark)

    Hamid, Salmiah Binti Abdul; Jensen, Ole B.; Silva, Victor

    2012-01-01

    Travelling in unfamiliar areas is usually very interesting; however, it can also be stressful. People travel or move around in an urban space according to their needs, and the environment can influence the way people move about from one place to another. If a person gets lost, a map or GPS can...... and geosemiotic studies with regards to the road traffic signs used in urban spaces. The paper ends with a discussion on how people choreograph their movement in their everyday life from two different perspectives: above vs. below...

  14. Designing radiation protection signs

    International Nuclear Information System (INIS)

    Rodriguez, M.A.; Richey, C.L.

    1995-01-01

    Entry into hazardous areas without the proper protective equipment is extremely dangerous and must be prevented whenever possible. Current postings of radiological hazards at the Rocky Flats Environmental Technology Site (RFETS) do not incorporate recent findings concerning effective warning presentation. Warning information should be highly visible, quickly, and easily understood. While continuing to comply with industry standards (e.g., Department of Energy (DOE) guidelines), these findings can be incorporated into existing radiological sign design, making them more effective in terms of usability and compliance. Suggestions are provided for designing more effective postings within stated guidelines

  15. Systems reliability/structural reliability

    International Nuclear Information System (INIS)

    Green, A.E.

    1980-01-01

    The question of reliability technology using quantified techniques is considered for systems and structures. Systems reliability analysis has progressed to a viable and proven methodology whereas this has yet to be fully achieved for large scale structures. Structural loading variants over the half-time of the plant are considered to be more difficult to analyse than for systems, even though a relatively crude model may be a necessary starting point. Various reliability characteristics and environmental conditions are considered which enter this problem. The rare event situation is briefly mentioned together with aspects of proof testing and normal and upset loading conditions. (orig.)

  16. INFINITY construction contract signed

    Science.gov (United States)

    2010-01-01

    Key state and community leaders celebrated April 6 with the signing of a construction contract for the state-of-the-art INFINITY Science Center planned near John C. Stennis Space Center in south Mississippi. Gulfport Mayor George Schloegel (l to r), chair of non-profit INFINITY Science Center Inc., was joined for the signing ceremony at the Hancock Bank in Gulfport by Virginia Wagner, sister of late Hancock Bank President Leo Seal Jr.; and Roy Anderson III, president and CEO of Roy Anderson Corp. Seal was the first chair of INFINITY Science Center Inc., which has led in development of the project. Roy Anderson Corp. plans to begin construction on the 72,000-square-foot, $28 million science and education center in May. The Mississippi Department of Transportation (MDOT) also is set to begin construction of a $2 million access road to the new center. The April 6 ceremony was attended by numerous officials, including former Stennis Space Center Directors Jerry Hlass and Roy Estess; Mississippi Senate President Pro Tempore Billy Hewes, R-Gulfport; Mississippi Rep. Diane Peranich, D-Pass Christian; and MDOT Southern District Commissioner Wayne Brown.

  17. Sign language: an international handbook

    NARCIS (Netherlands)

    Pfau, R.; Steinbach, M.; Woll, B.

    2012-01-01

    Sign language linguists show here that all the questions relevant to the linguistic investigation of spoken languages can be asked about sign languages. Conversely, questions that sign language linguists consider - even if spoken language researchers have not asked them yet - should also be asked of

  18. Kinship in Mongolian Sign Language

    Science.gov (United States)

    Geer, Leah

    2011-01-01

    Information and research on Mongolian Sign Language is scant. To date, only one dictionary is available in the United States (Badnaa and Boll 1995), and even that dictionary presents only a subset of the signs employed in Mongolia. The present study describes the kinship system used in Mongolian Sign Language (MSL) based on data elicited from…

  19. Traffic sign detection and analysis

    DEFF Research Database (Denmark)

    Møgelmose, Andreas; Trivedi, Mohan M.; Moeslund, Thomas B.

    2012-01-01

    Traffic sign recognition (TSR) is a research field that has seen much activity in the recent decade. This paper introduces the problem and presents 4 recent papers on traffic sign detection and 4 recent papers on traffic sign classification. It attempts to extract recent trends in the field...

  20. Integration of evidence-based practice in bedside teaching paediatrics supported by e-learning.

    Science.gov (United States)

    Potomkova, Jarmila; Mihal, Vladimir; Zapletalova, Jirina; Subova, Dana

    2010-03-01

    Bedside teaching with evidence-based practice elements, supported by e-learning activities, can play an important role in modern medical education. Teachers have to incorporate evidence from the medical literature to increase student motivation and interactivity. An integral part of the medical curricula at Palacky University Olomouc (Czech Republic) are real paediatric scenarios supplemented with a review of current literature to enhance evidence-based bedside teaching & learning. Searching for evidence is taught through librarian-guided interactive hands-on sessions and/or web-based tutorials followed by clinical case presentations and feedback. Innovated EBM paediatric clerkship demonstrated students' preferences towards web-based interactive bedside teaching & learning. In two academic years (2007/2008, 2008/2009), learning-focused feedback from 106 and 131 students, resp. was obtained about their attitudes towards evidence-based bedside teaching. The assessment included among others the overall level of instruction, quality of practical evidence-based training, teacher willingness and impact of instruction on increased interest in the specialty. There was some criticism about excessive workload. A parallel survey was carried out on the perceived values of different forms of information skills training (i.e. demonstration, online tutorials, and librarian-guided interactive search sessions) and post-training self-reported level of search skills. The new teaching/learning paediatric portfolio is a challenge for further activities, including effective knowledge translation, continuing medical & professional development of teachers, and didactic, clinically integrated teaching approaches.

  1. Transillumination test: A bedside aid for differentiating meningocele from myelomeningocele: Point of care testing

    Directory of Open Access Journals (Sweden)

    Aakash Pandita

    2015-01-01

    Full Text Available Transillumination test is a bedside and simple technique to illuminate the body cavity by transmission of light through the cavity. Transillumination test is used in a variety of conditions like hydrocele, Hydrocephalus, pneumoperitonium and pneumothorax in neonatology. We describe use of transillumination for differentiating meningocele and myelomeningocele.

  2. Retained Products of Conception: An Atypical Presentation Diagnosed Immediately with Bedside Emergency Ultrasound

    Directory of Open Access Journals (Sweden)

    Kristin Adkins

    2016-01-01

    Full Text Available Background. Retained products of conception is an important diagnosis to consider in patients presenting with postpartum complaints. Bedside ultrasound is a rapid, accurate, noninvasive modality to evaluate these patients. Objective. To report an atypical case of retained products of conception diagnosed with bedside ultrasound in the emergency department. Case Report. A 27-year-old female who was 1-month postpartum presented with vaginal bleeding, pelvic pain, and no fever. At the time of initial H&P, bedside ultrasound revealed echogenic material within the endometrial cavity with blood flow seen by color Doppler consistent with retained products of conception. The bedside ultrasound rapidly narrowed the differential and allowed a definitive diagnosis immediately. Ob/Gyn was consulted and dilation and curettage was performed in the operating room. Conclusions. Retained products of conception is an important diagnosis for the emergency physician to consider in at-risk patients. The sonographic findings are easily obtained and interpreted by emergency physicians. Earlier diagnosis of this disease process should lead to more focused patient evaluations and management.

  3. "Back to Bedside": Residents' and Fellows' Perspectives on Finding Meaning in Work.

    Science.gov (United States)

    Hipp, Dustin M; Rialon, Kristy L; Nevel, Kathryn; Kothari, Anai N; Jardine, Lcdr Dinchen A

    2017-04-01

    Physician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work. To provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts. "Back to Bedside" resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions. Back to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals. A national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.

  4. Human reliability

    International Nuclear Information System (INIS)

    Bubb, H.

    1992-01-01

    This book resulted from the activity of Task Force 4.2 - 'Human Reliability'. This group was established on February 27th, 1986, at the plenary meeting of the Technical Reliability Committee of VDI, within the framework of the joint committee of VDI on industrial systems technology - GIS. It is composed of representatives of industry, representatives of research institutes, of technical control boards and universities, whose job it is to study how man fits into the technical side of the world of work and to optimize this interaction. In a total of 17 sessions, information from the part of ergonomy dealing with human reliability in using technical systems at work was exchanged, and different methods for its evaluation were examined and analyzed. The outcome of this work was systematized and compiled in this book. (orig.) [de

  5. Microelectronics Reliability

    Science.gov (United States)

    2017-01-17

    inverters  connected in a chain. ................................................. 5  Figure 3  Typical graph showing frequency versus square root of...developing an experimental  reliability estimating methodology that could both illuminate the  lifetime  reliability of advanced devices,  circuits and...or  FIT of the device. In other words an accurate estimate of the device  lifetime  was found and thus the  reliability  that  can  be  conveniently

  6. Signs in neuroradiology - part 1

    Energy Technology Data Exchange (ETDEWEB)

    Goncalves, Fabricio Guimaraes, E-mail: goncalves.neuroradio@gmail.co [McGill University Health Centre (MUHC), Montreal, Quebec (Canada). Montreal General Hospital; Barra, Filipe Ramos; Jovem, Cassio Lemos [Hospital Universitario de Brasilia, DF (Brazil). Dept. of Radiology and Imaging Diagnosis; Matos, Valter de Lima [Hospital Santa Luzia, Brasilia, DF (Brazil); Amaral, Lazaro Luis Faria do [MedImagem - Hospital da Beneficencia Portuguesa de Sao Paulo, SP (Brazil). Dept. of Neuroradiology; Carpio-O' Donovan, Raquel del [McGill University Health Centre (MUHC), Montreal, Quebec (Canada)

    2011-03-15

    The use of signs or analogies for interpretation and description of medical images is an old and common practice among radiologists. Comparison of findings with animals, food or objects is not unprecedented and routinely performed. Many signs are quite specific and, in some cases, pathognomonic. Indeed, notwithstanding their degree of specificity, signs may help in the characterization of certain diseases. Several neuroradiological signs have been already described. The authors will present 15 neuroradiology signs in the present essay, approaching their main characteristics, the significance of their role in the clinical practice, as well as their respective imaging findings. (author)

  7. Signs in neuroradiology - part 1

    International Nuclear Information System (INIS)

    Goncalves, Fabricio Guimaraes; Amaral, Lazaro Luis Faria do

    2011-01-01

    The use of signs or analogies for interpretation and description of medical images is an old and common practice among radiologists. Comparison of findings with animals, food or objects is not unprecedented and routinely performed. Many signs are quite specific and, in some cases, pathognomonic. Indeed, notwithstanding their degree of specificity, signs may help in the characterization of certain diseases. Several neuroradiological signs have been already described. The authors will present 15 neuroradiology signs in the present essay, approaching their main characteristics, the significance of their role in the clinical practice, as well as their respective imaging findings. (author)

  8. Hyperdense middle cerebral artery CT sign

    International Nuclear Information System (INIS)

    Bastianello, S.; Pierallini, A.; Colonnese, C.; Brughitta, G.; Angeloni, U.; Antonelli, M.; Fantozzi, L.M.; Fieschi, C.; Bozzao, L.

    1991-01-01

    The early CT finding of an hyperdensity of a portion of the middle cerebral artery Hyperdense Middle Cerebral Artery Sign (HMCAS), in patients with supratentorial stroke, is often indicative of an embolic occlusion. Aim of this study was to verify the incidence and reliability of the HMCAS and its possible correlation with early CT findings and with the extent of late brain damage. We studied 36 patients presenting with symptoms of stroke in the MCA territory, by means of CT and angiography performed respectively within 4 and 6 hours. Follow-up CT scans were then obtained after one week and three months from the ischemic event. The HMCAS was present in 50% of our patients and in this group it always correlated positively with the angiographic finding of occlusion. The same group presented a high incidence of early CT hypodensity (88%). Finally the presence of HMCAS might be considered a negative prognostic sign for the development of extensive brain damage. (orig.)

  9. Translating Signs, Producing Subjects

    Directory of Open Access Journals (Sweden)

    Brett Neilson

    2009-08-01

    Full Text Available This paper moves between two streets: Liverpool Road in the Sydney suburb of Ashfield and Via Sarpi in the Italian city of Milan. What connects these streets is that both have become important sites for businesses in the Chinese diaspora. Moreover, both are streets on which locals have expressed desires for Chinese signs to be translated into the national lingua franca. The paper argues that the cultural politics inherent in this demand for translation cannot be fully understood in the context of national debates about diversity and integration. It is also necessary to consider the emergence of the official Chinese Putonghua as global language, which competes with English but also colonizes dialects and minority languages. In the case of these dual language signs, the space between languages can neither be reduced to a contact zone of minority and majority cultures nor celebrated as a ‘third space’ where the power relations implied by such differences are subverted. At stake is rather a space characterised by what Naoki Sakai calls the schema of co-figuration, which allows the representation of translation as the passage between two equivalents that resemble each other and thus makes possible their determination as conceptually different and comparable. Drawing on arguments about translation and citizenship, the paper critically interrogates the ethos of interchangeability implied by this regime of translation. A closing argument is made for a vision of the common that implies neither civilisational harmony nor the translation of all values into a general equivalent. Primary sources include government reports, internet texts and media stories. These are analyzed using techniques of discourse analysis and interpreted with the help of secondary literature concerning globalisation, language and migration. The disciplinary matrix cuts and mixes between cultural studies, translation studies, citizenship studies, globalization studies and

  10. The construction of power in family medicine bedside teaching: a video observation study.

    Science.gov (United States)

    Rees, Charlotte E; Ajjawi, Rola; Monrouxe, Lynn V

    2013-02-01

    Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short individual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student

  11. Negation switching invariant signed graphs

    Directory of Open Access Journals (Sweden)

    Deepa Sinha

    2014-04-01

    Full Text Available A signed graph (or, $sigraph$ in short is a graph G in which each edge x carries a value $\\sigma(x \\in \\{-, +\\}$ called its sign. Given a sigraph S, the negation $\\eta(S$ of the sigraph S is a sigraph obtained from S by reversing the sign of every edge of S. Two sigraphs $S_{1}$ and $S_{2}$ on the same underlying graph are switching equivalent if it is possible to assign signs `+' (`plus' or `-' (`minus' to vertices of $S_{1}$ such that by reversing the sign of each of its edges that has received opposite signs at its ends, one obtains $S_{2}$. In this paper, we characterize sigraphs which are negation switching invariant and also see for what sigraphs, S and $\\eta (S$ are signed isomorphic.

  12. Sign language comprehension: the case of Spanish sign language.

    Science.gov (United States)

    Rodríguez Ortiz, I R

    2008-01-01

    This study aims to answer the question, how much of Spanish Sign Language interpreting deaf individuals really understand. Study sampling included 36 deaf people (deafness ranging from severe to profound; variety depending on the age at which they learned sign language) and 36 hearing people who had good knowledge of sign language (most were interpreters). Sign language comprehension was assessed using passages of secondary level. After being exposed to the passages, the participants had to tell what they had understood about them, answer a set of related questions, and offer a title for the passage. Sign language comprehension by deaf participants was quite acceptable but not as good as that by hearing signers who, unlike deaf participants, were not only late learners of sign language as a second language but had also learned it through formal training.

  13. Ergonomics and design: traffic sign and street name sign.

    Science.gov (United States)

    Moroni, Janaina Luisa da Silva; Aymone, José Luís Farinatti

    2012-01-01

    This work proposes a design methodology using ergonomics and anthropometry concepts applied to traffic sign and street name sign projects. Initially, a literature revision on cognitive ergonomics and anthropometry is performed. Several authors and their design methodologies are analyzed and the aspects to be considered in projects of traffic and street name signs are selected and other specific aspects are proposed for the design methodology. A case study of the signs of "Street of Antiques" in Porto Alegre city is presented. To do that, interviews with the population are made to evaluate the current situation of signs. After that, a new sign proposal with virtual prototyping is done using the developed methodology. The results obtained with new interviews about the proposal show the user satisfaction and the importance of cognitive ergonomics to development of this type of urban furniture.

  14. Pediatric Vital Sign Distribution Derived From a Multi-Centered Emergency Department Database

    Directory of Open Access Journals (Sweden)

    Robert J. Sepanski

    2018-03-01

    Full Text Available BackgroundWe hypothesized that current vital sign thresholds used in pediatric emergency department (ED screening tools do not reflect observed vital signs in this population. We analyzed a large multi-centered database to develop heart rate (HR and respiratory rate centile rankings and z-scores that could be incorporated into electronic health record ED screening tools and we compared our derived centiles to previously published centiles and Pediatric Advanced Life Support (PALS vital sign thresholds.MethodsInitial HR and respiratory rate data entered into the Cerner™ electronic health record at 169 participating hospitals’ ED over 5 years (2009 through 2013 as part of routine care were analyzed. Analysis was restricted to non-admitted children (0 to <18 years. Centile curves and z-scores were developed using generalized additive models for location, scale, and shape. A split-sample validation using two-thirds of the sample was compared with the remaining one-third. Centile values were compared with results from previous studies and guidelines.ResultsHR and RR centiles and z-scores were determined from ~1.2 million records. Empirical 95th centiles for HR and respiratory rate were higher than previously published results and both deviated from PALS guideline recommendations.ConclusionHeart and respiratory rate centiles derived from a large real-world non-hospitalized ED pediatric population can inform the modification of electronic and paper-based screening tools to stratify children by the degree of deviation from normal for age rather than dichotomizing children into groups having “normal” versus “abnormal” vital signs. Furthermore, these centiles also may be useful in paper-based screening tools and bedside alarm limits for children in areas other than the ED and may establish improved alarm limits for bedside monitors.

  15. LSE-Sign: A lexical database for Spanish Sign Language.

    Science.gov (United States)

    Gutierrez-Sigut, Eva; Costello, Brendan; Baus, Cristina; Carreiras, Manuel

    2016-03-01

    The LSE-Sign database is a free online tool for selecting Spanish Sign Language stimulus materials to be used in experiments. It contains 2,400 individual signs taken from a recent standardized LSE dictionary, and a further 2,700 related nonsigns. Each entry is coded for a wide range of grammatical, phonological, and articulatory information, including handshape, location, movement, and non-manual elements. The database is accessible via a graphically based search facility which is highly flexible both in terms of the search options available and the way the results are displayed. LSE-Sign is available at the following website: http://www.bcbl.eu/databases/lse/.

  16. Hutchinson’s Sign

    Directory of Open Access Journals (Sweden)

    Lawrence Lau

    2018-01-01

    Full Text Available History of present illness: A 30-year-old African American male presents with two days of gradually worsening vesicular pruritic rash over the left naris, left upper lip, and inferior to medial epicanthus, initially noted just on the upper lip the night before. By the next day it had spread to the nose and cheek. Patient denies any fever, pain, discharge from the rash, ear or nose, or changes in vision. He denies exposure to any new hygiene products, household cleaning products, recent outdoor activities, travel, or insect bites. Past medical history significant for a childhood varicella infection. Patient works for a moving company, and had an episode of heat exhaustion at work one week prior to onset. Denies alcohol or drug abuse. Significant findings: The unilateral distribution of vesicular lesions over the patient’s left naris, cheek, and upper lip are consistent with Herpes zoster reactivation with Hutchinson’s sign. Hutchinson’s sign is a herpes zoster vesicle present on the tip or side of the nose.1 It reflects zoster involvement of the 1st branch of the trigeminal nerve, and is concerning for herpes zoster ophthalmicus.1 Herpes zoster vesicles may present as papular lesions or macular vesicles on an erythematous base.2,3 Emergent diagnosis must be made to prevent long-term visual sequelae.4 Discussion: The history of a childhood viral exanthem, specifically a past varicella infection, helps direct the diagnosis.2 Herpes zoster ophthalmicus is an ophthalmological emergency and results from viral reactivation within the V1 branch of CN V, leading to direct ocular involvement.1 Symptoms of ocular involvement include red eye, blurry vision, eye pain or photophobia.1 If left untreated, corneal ulceration, scarring, perforation, glaucoma, cataracts, and blindness may occur.1 Fluorescein staining with slit lamp examination will show a characteristic “dendritic ulcer” within the epithelial layer of the cornea.1 Treatment is generally

  17. Redefining reliability

    International Nuclear Information System (INIS)

    Paulson, S.L.

    1995-01-01

    Want to buy some reliability? The question would have been unthinkable in some markets served by the natural gas business even a few years ago, but in the new gas marketplace, industrial, commercial and even some residential customers have the opportunity to choose from among an array of options about the kind of natural gas service they need--and are willing to pay for. The complexities of this brave new world of restructuring and competition have sent the industry scrambling to find ways to educate and inform its customers about the increased responsibility they will have in determining the level of gas reliability they choose. This article discusses the new options and the new responsibilities of customers, the needed for continuous education, and MidAmerican Energy Company's experiment in direct marketing of natural gas

  18. Landsat 6 contract signed

    Science.gov (United States)

    Maggs, William Ward

    A new agreement provides $220 million for development and construction of the Landsat 6 remote sensing satellite and its ground systems. The contract, signed on March 31, 1988, by the Department of Commerce (DOC) and the Earth Observation Satellite (EOSAT) Company of Lanham, Md., came just days after approval of DOC's Landsat commercialization plan by subcommittees of the House and Senate appropriations committees.The Landsat 6 spacecraft is due to be launched into orbit on a Titan II rocket in June 1991 from Vandenburg Air Force Base, Calif. The satellite will carry an Enhanced Thematic Mapper (ETM) sensor, an instrument sensitive to electromagnetic radiation in seven ranges or bands of wavelengths. The satellite's payload will also include the Sea Wide Field Sensor (Sea-WiFS), designed to provide information on sea surface temperature and ocean color. The sensor is being developed in a cooperative effort by EOSAT and the National Aeronautics and Space Administration (NASA). A less certain passenger is a proposed 5-m resolution, three-band sensor sensitive to visible light. EOSAT is trying to find both private financing for the device and potential buyers of the high-resolution imagery that it could produce. The company has been actively courting U.S. television networks, which have in the past used imagery from the European Système Probatoire d'Observation de la Terre (SPOT) satellite for news coverage.

  19. Sociolinguistic Typology and Sign Languages

    OpenAIRE

    Adam Schembri; Jordan Fenlon; Kearsy Cormier; Trevor Johnston

    2018-01-01

    This paper examines the possible relationship between proposed social determinants of morphological ‘complexity’ and how this contributes to linguistic diversity, specifically via the typological nature of the sign languages of deaf communities. We sketch how the notion of morphological complexity, as defined by Trudgill (2011), applies to sign languages. Using these criteria, sign languages appear to be languages with low to moderate levels of morphological complexity. This may partly reflec...

  20. Awareness of Deaf Sign Language and Gang Signs.

    Science.gov (United States)

    Smith, Cynthia; Morgan, Robert L.

    There have been increasing incidents of innocent people who use American Sign Language (ASL) or another form of sign language being victimized by gang violence due to misinterpretation of ASL hand formations. ASL is familiar to learners with a variety of disabilities, particularly those in the deaf community. The problem is that gang members have…

  1. Automatic sign language recognition inspired by human sign perception

    NARCIS (Netherlands)

    Ten Holt, G.A.

    2010-01-01

    Automatic sign language recognition is a relatively new field of research (since ca. 1990). Its objectives are to automatically analyze sign language utterances. There are several issues within the research area that merit investigation: how to capture the utterances (cameras, magnetic sensors,

  2. Inuit Sign Language: a contribution to sign language typology

    NARCIS (Netherlands)

    Schuit, J.; Baker, A.; Pfau, R.

    2011-01-01

    Sign language typology is a fairly new research field and typological classifications have yet to be established. For spoken languages, these classifications are generally based on typological parameters; it would thus be desirable to establish these for sign languages. In this paper, different

  3. Signs of the arctic: Typological aspects of Inuit Sign Language

    NARCIS (Netherlands)

    Schuit, J.M.

    2014-01-01

    In this thesis, the native sign language used by deaf Inuit people is described. Inuit Sign Language (IUR) is used by less than 40 people as their sole means of communication, and is therefore highly endangered. Apart from the description of IUR as such, an additional goal is to contribute to the

  4. Ranks of dense alternating sign matrices and their sign patterns

    Czech Academy of Sciences Publication Activity Database

    Fiedler, Miroslav; Gao, W.; Hall, F.J.; Jing, G.; Li, Z.; Stroev, M.

    2015-01-01

    Roč. 471, April (2015), s. 109-121 ISSN 0024-3795 R&D Projects: GA ČR(CZ) GA14-07880S Institutional support: RVO:67985840 Keywords : alternating sign matrix * dense matrix * sign pattern matrix Subject RIV: BA - General Mathematics Impact factor: 0.965, year: 2015 http://www.sciencedirect.com/science/article/pii/S0024379515000257

  5. Planning Sign Languages: Promoting Hearing Hegemony? Conceptualizing Sign Language Standardization

    Science.gov (United States)

    Eichmann, Hanna

    2009-01-01

    In light of the absence of a codified standard variety in British Sign Language and German Sign Language ("Deutsche Gebardensprache") there have been repeated calls for the standardization of both languages primarily from outside the Deaf community. The paper is based on a recent grounded theory study which explored perspectives on sign…

  6. Relationship between Quality of Life and Nurse-led Bedside Symptom Evaluations in Patients with Chemotherapy-induced Peripheral Neuropathy

    Directory of Open Access Journals (Sweden)

    Yang-Sook Yoo, RN, PhD

    2014-03-01

    Conclusion: Collectively, our results indicate that nurse-led bedside evaluation is a noninvasive and useful method for detecting neurotoxicity and evaluating the patient’s QOL both during and after treatment.

  7. The Usefulness of Intensivist-Performed Bedside Drainage of Pleural Effusion via Ultrasound-Guided Pigtail Catheter

    Directory of Open Access Journals (Sweden)

    Joo Won Min

    2014-08-01

    CONCLUSIONS: Intensivist-performed bedside drainage of pleural effusion via ultrasound (US-guided pigtail catheter is useful and safe and may be recommended in some patients in an intensive care unit.

  8. Africa: signs of hope?

    Directory of Open Access Journals (Sweden)

    J.F. Kirsten

    2008-07-01

    Full Text Available The dawning of the 21st century generally brought new hope to African leaders and countless thousands of ordinary citizens of many countries on the continent. The first signs of a new turn of events shone through by the end of the last decade of the previous century. This was manifested by economic growth rates that started to pick up in a number of African states, by pro-democracy movements which in country after country succeeded in replacing authoritarian regimes, and by the winding down and termination of some of Africa’s most devastating wars. The results of this analysis confirm the above-mentioned positive political, economic and conflict trends in Africa. It is clearly a significant turn of events given the well-known political and economic predicament with which Africa is struggling. When this negative legacy and Cold War background of Africa is considered, the importance of present developments is clear to see. The identified heightened sense of purpose among the leaders and peoples of Africa and the changed mood and need among Africans to take charge of their own future that found expression in the New Partnership for Africa’s Development (NEPAD are indeed significant and bode well for the future of the continent. A word of warning here is, however, necessary. Our conduct with Africa must be very cautious and we must guard against over-optimism and the exaggerated belief that Africa is now on a trajectory of sustained development and peace. We cannot generalise about Africa – for that the continent is just too big and diverse from a geographical, cultural, economic and political point of view.

  9. Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage.

    Science.gov (United States)

    Sporns, Peter B; Schwake, Michael; Kemmling, André; Minnerup, Jens; Schwindt, Wolfram; Niederstadt, Thomas; Schmidt, Rene; Hanning, Uta

    2017-09-01

    Blend sign (BS) and black hole sign (BHS) on non-contrast computed tomography (NCCT) and spot sign (SS) on CT-angiography (CTA) are indicators of early hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, their independent contributions to outcome have not been well explored. In this retrospective study, inclusion criteria were: 1) spontaneous ICH and 2) NCCT and CTA performed on admission within 6 hours after onset of symptoms. Discharge outcome was dichotomized as good (modified Rankin Scale [mRS] 0-3) and poor (mRS 4-6) outcomes. The impacts of BHS, BS and SS on outcome were assessed in univariate and multivariable logistic regression models. Of 182 patients with spontaneous ICH, 26 (14.3%) presented with BHS, 37 (20.3%) with BS and 39 (21.4%) with SS. There was a substantial correlation between SS and BS (κ=0.701) and a moderate correlation between SS and BHS (κ=0.424). In univariable logistic regression, higher baseline hematoma volume ( P <0.001), intraventricular hemorrhage ( P =0.002) and the presence of BHS/BS/SS (all P <0.001) on admission CT scan were associated with poor outcome. Multivariable analysis identified intraventricular haemorrhage (odds ratio [OR] 2.22 per mL, P =0.022), baseline hematoma volume (OR 1.03 per mL, P <0.001) and SS on CTA (OR 11.43, P <0.001) as independent predictors of poor outcome, showing that SS compared to BS and BHS was more powerful to predict poor outcome. The NCCT BHS and BS are correlated with the CTA SS and are reliable predictors of poor outcome in patients with ICH. Of the CT variables indicating early hematoma expansion, SS on CTA was the most reliable outcome predictor. However, given their correlation with SS on CTA, BS and BHS on NCCT can be useful for predicting outcome if CTA is not obtainable.

  10. Methodological and Theoretical Issues in the Adaptation of Sign Language Tests: An Example from the Adaptation of a Test to German Sign Language

    Science.gov (United States)

    Haug, Tobias

    2012-01-01

    Despite the current need for reliable and valid test instruments in different countries in order to monitor the sign language acquisition of deaf children, very few tests are commercially available that offer strong evidence for their psychometric properties. This mirrors the current state of affairs for many sign languages, where very little…

  11. Art at the Bedside: Reflections on Use of Visual Imagery in Hospital Chaplaincy.

    Science.gov (United States)

    Dodge-Peters Daiss, Susan

    2016-03-01

    'Art at the Bedside' is the name given to a hospital visitation program during which works of art loaded onto a computer are used to start conversations with patients and their families. The article traces the genesis of the program that evolved from the author's dual training in art museum education and hospital chaplaincy through the evolution of the practice, now in its sixth year. Reflections on the practice itself are the focus of this article, from identifying the kinds of responses frequently elicited by the artwork to understanding how these works of art seem to forge immediate connections between the patient and the facilitator. Ultimately posed in this reflection is whether the 'Art at the Bedside' experience might suggest a future for the integration of the visual arts more broadly into hospital - and related - chaplaincy. © The Author(s) 2016.

  12. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review.

    Science.gov (United States)

    Kertscher, Berit; Speyer, Renée; Palmieri, Maria; Plant, Chris

    2014-04-01

    Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

  13. Rapid Bedside Inactivation of Ebola Virus for Safe Nucleic Acid Tests

    DEFF Research Database (Denmark)

    Rosenstierne, Maiken Worsøe; Karlberg, Helen; Bragstad, Karoline

    2016-01-01

    Rapid bedside inactivation of Ebola virus would be a solution for the safety of medical and technical staff, risk containment, sample transport, and high-throughput or rapid diagnostic testing during an outbreak. We show that the commercially available Magna Pure lysis/binding buffer used...... for nucleic acid extraction inactivates Ebola virus. A rapid bedside inactivation method for nucleic acid tests is obtained by simply adding Magna Pure lysis/binding buffer directly into vacuum blood collection EDTA tubes using a thin needle and syringe prior to sampling. The ready-to-use inactivation vacuum...... tubes are stable for more than 4 months, and Ebola virus RNA is preserved in the Magna Pure lysis/binding buffer for at least 5 weeks independent of the storage temperature. We also show that Ebola virus RNA can be manually extracted from Magna Pure lysis/binding buffer-inactivated samples using...

  14. A bedside technique for the diagnosis of acute rejection in renal transplants using 111-In platelets

    International Nuclear Information System (INIS)

    Chandler, S.T.; Buckels, J.A.C.; Drolc, Z.; Hawker, R.J.; Barnes, A.D.; McCollum, C.N.

    1982-01-01

    A total of 33 patients was studied with the aim of developing a bedside method for providing early diagnosis of acute rejection using 111-In labelled platelets. Platelet deposition was detected in all patients suffering acute rejection. A significant increase in kidney/aortic arch ratio, as measured by the portable bedside system, preceded the clinical diagnosis in 70% of patients. Using this system, it appeared possible not only to diagnose acute rejection at an earlier stage but also to predict irrecoverable transplant loss even in the presence of tubular necrosis. By labelling the platelets repeatedly for at least two weeks after transplantation, the period of highest risk for acute rejection and other complications. The gamma camera should still be employed in the event of markedly increased platelet deposition to differentiate between rejection and vascular complications

  15. Technology-enhanced learning should be employed alongside – not instead of – bedside teaching

    Directory of Open Access Journals (Sweden)

    Ferguson Z

    2016-02-01

    Full Text Available Zachary FergusonSouth Thames Foundation School, London, UKI read with great interest the editorial by Al-jibury et al1 regarding the digitalization of medical education, particularly as I was part of the team that produced the YouTube video on heart murmurs which they reference in their paper.I agree wholeheartedly that digital resources cannot and must not replace bedside teaching. The video in question carries a disclaimer at the beginning, encouraging learners to use the resource as a companion to – not a substitute for – real-life patient contact. Convenient though YouTube might be, it cannot compare to the learning experience Al-jibury et al1 describes: listening to a live, beating heart. Bedside teaching has been around since the days of Hippocrates and it is not going anywhere anytime soon.Read the original article by Al-jibury et al.

  16. Measurement of irradiation doses secondary to bedside radiographs in a medical intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Boles, J M; Boussert, F; Manens, J P; Le Cam, B; Bellet, M; Garre, M

    1987-01-01

    The authors prospectively studied the radiation doses to radio-sensitive organs secondary to bedside radiographs in intensive care patients and in a control phantom. Dosimeters were taped on different organs during each bedside X-ray. The mean radiation doses, expressed in 10(-5) Gy (m-rad), for an ''average patient'' who was hospitalized 9 days and had 6 chest X-rays were respectively: 292 to the sternal bone marrow; 239 to the thyroid gland; 3 to the testes; 1 to the ovaries; 605 to the eye for 2 maxillary sinus X-rays. No diffused irradiation was measured during a 2-month period in the intensive care unit nor on dosimeters worn by four nurses.

  17. Bedside Teaching in Undergraduate Medical Education: Issues, Strategies, and New Models for Better Preparation of New Generation Doctors

    Directory of Open Access Journals (Sweden)

    Abdus Salam

    2011-03-01

    Full Text Available AbstractBedside teaching is a vital component of medical education. It isapplicable to any situation where teaching is imparted in thepresence of patients. In teaching in the patients’ presence, learnershave the opportunities to use all of their senses and learn thehumanistic aspect of medicine such as role modeling, which isvital but difficult to communicate in words. Unfortunately, bedsideteaching has been on the decline. To investigate the reasonsfor the decline in bedside teaching, its importance and its revival,a review of literature was carried out using PubMed and otherdata bases. The review revealed that the major concerns of bedsideteaching were time constraint, false preceptors’ concernabout patients’ comfort, short stay of patients in hospitals, learnerdistraction by technology, lack of experience and unrealistic facultyexpectation. Whatsoever the reasons, bedside teaching cannotbe replaced with anything else. There are newer approachesof effective bedside teaching, and the core focus of all such approachesis educational process. A bedside teacher must learnhow to involve patients and learners in the educational processes.Moreover, bedside teaching is the process through which learnersacquire the skills of communication by asking patients’ permission,establishing ground rules, setting time limit, introducing theteam, diagnosing learner, diagnosing patient, conducting focusedteaching, using simple language, asking patient if there is anyquestion, closing with encouraging thanks, and giving feedbackprivately. It is most important to ensure a comfortable environmentfor all participants, the learner, the patient and the bedsideteacher. Ongoing faculty development programs on educationalprocesses and realistic faculty expectations may overcome theproblems.

  18. Learning to Detect Traffic Signs

    DEFF Research Database (Denmark)

    Møgelmose, Andreas; Trivedi, Mohan M.; Moeslund, Thomas B.

    2012-01-01

    This study compares the performance of sign detection based on synthetic training data to the performance of detection based on real-world training images. Viola-Jones detectors are created for 4 different traffic signs with both synthetic and real data, and varying numbers of training samples. T...

  19. Issues in Sign Language Lexicography

    DEFF Research Database (Denmark)

    Zwitserlood, Inge; Kristoffersen, Jette Hedegaard; Troelsgård, Thomas

    2013-01-01

    ge lexicography has thus far been a relatively obscure area in the world of lexicography. Therefore, this article will contain background information on signed languages and the communities in which they are used, on the lexicography of sign languages, the situation in the Netherlands as well...

  20. Concise Lexicon for Sign Linguistics

    NARCIS (Netherlands)

    dr. Jan Nijen Twilhaar; Dr. Beppie van den Bogaerde

    2016-01-01

    This extensive, well-researched and clearly formatted lexicon of a wide variety of linguistic terms is a long overdue. It is an extremely welcome addition to the bookshelves of sign language teachers, interpreters, linguists, learners and other sign language users, and of course of the Deaf

  1. Assessing the implementation of a bedside service handoff on an academic hospitalist service.

    Science.gov (United States)

    Wray, Charlie M; Arora, Vineet M; Hedeker, Donald; Meltzer, David O

    2018-06-01

    Inpatient service handoffs are a vulnerable transition during a patients' hospitalization. We hypothesized that performing the service handoff at the patients' bedside may be one mechanism to more efficiently transfer patient information between physicians, while further integrating the patient into their hospital care. We performed a 6-month prospective study of performing a bedside handoff (BHO) at the service transition on a non-teaching hospitalist service. On a weekly basis, transitioning hospitalists co-rounded at patient's bedsides. Post-handoff surveys assessed for completeness of handoff, communication, missed information, and adverse events. A control group who performed the handoff via email, phone or face-to-face was also surveyed. Chi-square and item-response theory (IRT) analysis assessed for differences between BHO and control groups. Narrative responses were elicited to qualitatively describe the BHO. In total, 21/31 (67%) scheduled BHOs were performed. On average, 4 out of 6 eligible patients experienced a BHO, with a total of 90 patients experiencing a BHO. Of those asked to perform the BHO, 52% stated the service transition took 31-60 min compared to 24% in the control group. Controlling for the nesting of observations within physicians, IRT analysis found that BHO respondents had statistically significant greater odds of: reporting increased patient awareness of the service handoff, more certainty in the plan for each patient, less discovery of missed information, and less time needed to learn about the patient on the first day compared to control methods. Narrative responses described a more patient-centered handoff with improved communication that was time-consuming and often logistically difficult to implement. Despite its time-intensive nature, performing the service handoff at the patient's bedside may lead to a more complete and efficient service transition. Published by Elsevier Inc.

  2. Portable bedside ultrasound: the visual stethoscope of the 21st century

    Directory of Open Access Journals (Sweden)

    Gillman Lawrence M

    2012-03-01

    Full Text Available Abstract Over the past decade technological advances in the realm of ultrasound have allowed what was once a cumbersome and large machine to become essentially hand-held. This coupled with a greater understanding of lung sonography has revolutionized our bedside assessment of patients. Using ultrasound not as a diagnostic test, but instead as a component of the physical exam, may allow it to become the stethoscope of the 21st century.

  3. ICU Bedside Nurses' Involvement in Palliative Care Communication: A Multicenter Survey.

    Science.gov (United States)

    Anderson, Wendy G; Puntillo, Kathleen; Boyle, Deborah; Barbour, Susan; Turner, Kathleen; Cimino, Jenica; Moore, Eric; Noort, Janice; MacMillan, John; Pearson, Diana; Grywalski, Michelle; Liao, Solomon; Ferrell, Bruce; Meyer, Jeannette; O'Neil-Page, Edith; Cain, Julia; Herman, Heather; Mitchell, William; Pantilat, Steven

    2016-03-01

    Successful and sustained integration of palliative care into the intensive care unit (ICU) requires the active engagement of bedside nurses. To describe the perspectives of ICU bedside nurses on their involvement in palliative care communication. A survey was designed, based on prior work, to assess nurses' perspectives on palliative care communication, including the importance and frequency of their involvement, confidence, and barriers. The 46-item survey was distributed via e-mail in 2013 to bedside nurses working in ICUs across the five academic medical centers of the University of California, U.S. The survey was sent to 1791 nurses; 598 (33%) responded. Most participants (88%) reported that their engagement in discussions of prognosis, goals of care, and palliative care was very important to the quality of patient care. A minority reported often discussing palliative care consultations with physicians (31%) or families (33%); 45% reported rarely or never participating in family meeting discussions. Participating nurses most frequently cited the following barriers to their involvement in palliative care communication: need for more training (66%), physicians not asking their perspective (60%), and the emotional toll of discussions (43%). ICU bedside nurses see their involvement in discussions of prognosis, goals of care, and palliative care as a key element of overall quality of patient care. Based on the barriers participants identified regarding their engagement, interventions are needed to ensure that nurses have the education, opportunities, and support to actively participate in these discussions. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  4. Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?

    Science.gov (United States)

    Donmez, Halil; Tokmak, Turgut Tursem; Yildirim, Afra; Buyukoglan, Hakan; Ozturk, Mehmet; Yaşar Ayaz, Umit; Mavili, Ertugrul

    2012-01-01

    BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax. Copyright © 2012 Wiley Periodicals, Inc.

  5. Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

    OpenAIRE

    Lam, Samuel H.F.; Grippo, Anthony; Kerwin, Chistopher; Konicki, P. John; Goodwine, Diana; Lambert, Michael J.

    2014-01-01

    Introduction: Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis. Methods: Patients four years of age and older presenting to the ED with suspect...

  6. Modeling online social signed networks

    Science.gov (United States)

    Li, Le; Gu, Ke; Zeng, An; Fan, Ying; Di, Zengru

    2018-04-01

    People's online rating behavior can be modeled by user-object bipartite networks directly. However, few works have been devoted to reveal the hidden relations between users, especially from the perspective of signed networks. We analyze the signed monopartite networks projected by the signed user-object bipartite networks, finding that the networks are highly clustered with obvious community structure. Interestingly, the positive clustering coefficient is remarkably higher than the negative clustering coefficient. Then, a Signed Growing Network model (SGN) based on local preferential attachment is proposed to generate a user's signed network that has community structure and high positive clustering coefficient. Other structural properties of the modeled networks are also found to be similar to the empirical networks.

  7. Explaining why nurses remain in or leave bedside nursing: a critical ethnography.

    Science.gov (United States)

    Mahon, Paula; McPherson, Gladys

    2014-09-01

    To describe the application of critical ethnography to explain nurses' decisions to remain in or leave bedside nursing, and to describe researcher positioning and reflexivity. Enquiry into hospital nurses' decisions to remain in or leave bedside nursing positions has been conducted from a variety of theoretical perspectives by researchers adopting a range of methodological approaches. This research helps to explain how work environments can affect variables such as job satisfaction and turnover, but provides less insight into how personal and professional factors shape decisions to remain in or leave bedside nursing. A critical theoretical perspective was taken to examine the employment decisions made by nurses in a paediatric intensive care unit (PICU). Data was collected from nurses (n=31) through semi-structured interviews and unobtrusive observation. The authors describe critical ethnography as a powerful research framework for enquiry that allowed them to challenge assumptions about why nurses remain in or leave their jobs, and to explore how issues of fairness and equity contribute to these decisions. Critical ethnography offers a powerful methodology for investigations into complex interactions, such as those between nurses in a PICU. In adopting this methodology, researchers should be sensitised to manifestations of power, attend to their stance and location, and reflexion. The greatest challenges from this research included how to make sense of the insider position, how to acknowledge assumptions and allow these to be challenged, and how to ensure that power relationships in the environment and in the research were attended to.

  8. Clinical validation study of the SignCare Vital Signs Monitor of Fundación Cardiovascular de Colombia

    Directory of Open Access Journals (Sweden)

    Leonardo Andrés Rodríguez-Salazar

    2016-07-01

    Conclusions: The SignCare device is as reliable as the commercial monitor in the qualitative detection of morphologic alterations of electrocardiogram records, as well as in breathing, temperature, oxygen saturation and blood pressure parameters, which makes it recommendable for clinical use in adult population.

  9. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus

    International Nuclear Information System (INIS)

    Rutten, Matthieu J.C.M.; Jager, Gerrit J.; Waal malefijt, Maarten C. de; Blickman, Johan G.

    2007-01-01

    The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability following trauma. All cases were prospectively reviewed for the presence of a humeral fracture. Sonographic signs of fractures, with special emphasis on what was termed the 'double line sign' (DLS), were assessed. Plain radiography was considered the standard of reference and in equivocal cases magnetic resonance imaging (MRI). Twenty-eight patients had a tuberosity complex fracture, which were all detected at US examination. Sonographic features of a fracture were periosteal elevation, corticol bone discontinuity, step-off deformity or a combination of these findings. This study showed that in 26 (93%) patients an additional sonographic feature, a DLS, could be demonstrated. The DLS is a helpful and probably reliable sonographic sign to indicate a humeral fracture. High-spatial-resolution US substantially increases the detection of fractures of the proximal humerus and should be considered as an alternative diagnostic tool prior to computed tomography (CT), MRI and arthroscopy in patients with persisting shoulder pain and/or disability following trauma. (orig.)

  10. Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus

    Energy Technology Data Exchange (ETDEWEB)

    Rutten, Matthieu J.C.M.; Jager, Gerrit J. [Jeroen Bosch Hospital, Department of Radiology, Hertogenbosch (Netherlands); Waal malefijt, Maarten C. de [University Medical Center Nijmegen, Department of Orthopedic Surgery, Nijmegen (Netherlands); Blickman, Johan G. [University Medical Center Nijmegen, Department of Radiology, Nijmegen (Netherlands)

    2007-03-15

    The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability following trauma. All cases were prospectively reviewed for the presence of a humeral fracture. Sonographic signs of fractures, with special emphasis on what was termed the 'double line sign' (DLS), were assessed. Plain radiography was considered the standard of reference and in equivocal cases magnetic resonance imaging (MRI). Twenty-eight patients had a tuberosity complex fracture, which were all detected at US examination. Sonographic features of a fracture were periosteal elevation, corticol bone discontinuity, step-off deformity or a combination of these findings. This study showed that in 26 (93%) patients an additional sonographic feature, a DLS, could be demonstrated. The DLS is a helpful and probably reliable sonographic sign to indicate a humeral fracture. High-spatial-resolution US substantially increases the detection of fractures of the proximal humerus and should be considered as an alternative diagnostic tool prior to computed tomography (CT), MRI and arthroscopy in patients with persisting shoulder pain and/or disability following trauma. (orig.)

  11. An Introduction To Reliability

    International Nuclear Information System (INIS)

    Park, Kyoung Su

    1993-08-01

    This book introduces reliability with definition of reliability, requirement of reliability, system of life cycle and reliability, reliability and failure rate such as summary, reliability characteristic, chance failure, failure rate which changes over time, failure mode, replacement, reliability in engineering design, reliability test over assumption of failure rate, and drawing of reliability data, prediction of system reliability, conservation of system, failure such as summary and failure relay and analysis of system safety.

  12. Sign Inference for Dynamic Signed Networks via Dictionary Learning

    Directory of Open Access Journals (Sweden)

    Yi Cen

    2013-01-01

    Full Text Available Mobile online social network (mOSN is a burgeoning research area. However, most existing works referring to mOSNs deal with static network structures and simply encode whether relationships among entities exist or not. In contrast, relationships in signed mOSNs can be positive or negative and may be changed with time and locations. Applying certain global characteristics of social balance, in this paper, we aim to infer the unknown relationships in dynamic signed mOSNs and formulate this sign inference problem as a low-rank matrix estimation problem. Specifically, motivated by the Singular Value Thresholding (SVT algorithm, a compact dictionary is selected from the observed dataset. Based on this compact dictionary, the relationships in the dynamic signed mOSNs are estimated via solving the formulated problem. Furthermore, the estimation accuracy is improved by employing a dictionary self-updating mechanism.

  13. Sociolinguistic Typology and Sign Languages.

    Science.gov (United States)

    Schembri, Adam; Fenlon, Jordan; Cormier, Kearsy; Johnston, Trevor

    2018-01-01

    This paper examines the possible relationship between proposed social determinants of morphological 'complexity' and how this contributes to linguistic diversity, specifically via the typological nature of the sign languages of deaf communities. We sketch how the notion of morphological complexity, as defined by Trudgill (2011), applies to sign languages. Using these criteria, sign languages appear to be languages with low to moderate levels of morphological complexity. This may partly reflect the influence of key social characteristics of communities on the typological nature of languages. Although many deaf communities are relatively small and may involve dense social networks (both social characteristics that Trudgill claimed may lend themselves to morphological 'complexification'), the picture is complicated by the highly variable nature of the sign language acquisition for most deaf people, and the ongoing contact between native signers, hearing non-native signers, and those deaf individuals who only acquire sign languages in later childhood and early adulthood. These are all factors that may work against the emergence of morphological complexification. The relationship between linguistic typology and these key social factors may lead to a better understanding of the nature of sign language grammar. This perspective stands in contrast to other work where sign languages are sometimes presented as having complex morphology despite being young languages (e.g., Aronoff et al., 2005); in some descriptions, the social determinants of morphological complexity have not received much attention, nor has the notion of complexity itself been specifically explored.

  14. Sociolinguistic Typology and Sign Languages

    Science.gov (United States)

    Schembri, Adam; Fenlon, Jordan; Cormier, Kearsy; Johnston, Trevor

    2018-01-01

    This paper examines the possible relationship between proposed social determinants of morphological ‘complexity’ and how this contributes to linguistic diversity, specifically via the typological nature of the sign languages of deaf communities. We sketch how the notion of morphological complexity, as defined by Trudgill (2011), applies to sign languages. Using these criteria, sign languages appear to be languages with low to moderate levels of morphological complexity. This may partly reflect the influence of key social characteristics of communities on the typological nature of languages. Although many deaf communities are relatively small and may involve dense social networks (both social characteristics that Trudgill claimed may lend themselves to morphological ‘complexification’), the picture is complicated by the highly variable nature of the sign language acquisition for most deaf people, and the ongoing contact between native signers, hearing non-native signers, and those deaf individuals who only acquire sign languages in later childhood and early adulthood. These are all factors that may work against the emergence of morphological complexification. The relationship between linguistic typology and these key social factors may lead to a better understanding of the nature of sign language grammar. This perspective stands in contrast to other work where sign languages are sometimes presented as having complex morphology despite being young languages (e.g., Aronoff et al., 2005); in some descriptions, the social determinants of morphological complexity have not received much attention, nor has the notion of complexity itself been specifically explored. PMID:29515506

  15. Sociolinguistic Typology and Sign Languages

    Directory of Open Access Journals (Sweden)

    Adam Schembri

    2018-02-01

    Full Text Available This paper examines the possible relationship between proposed social determinants of morphological ‘complexity’ and how this contributes to linguistic diversity, specifically via the typological nature of the sign languages of deaf communities. We sketch how the notion of morphological complexity, as defined by Trudgill (2011, applies to sign languages. Using these criteria, sign languages appear to be languages with low to moderate levels of morphological complexity. This may partly reflect the influence of key social characteristics of communities on the typological nature of languages. Although many deaf communities are relatively small and may involve dense social networks (both social characteristics that Trudgill claimed may lend themselves to morphological ‘complexification’, the picture is complicated by the highly variable nature of the sign language acquisition for most deaf people, and the ongoing contact between native signers, hearing non-native signers, and those deaf individuals who only acquire sign languages in later childhood and early adulthood. These are all factors that may work against the emergence of morphological complexification. The relationship between linguistic typology and these key social factors may lead to a better understanding of the nature of sign language grammar. This perspective stands in contrast to other work where sign languages are sometimes presented as having complex morphology despite being young languages (e.g., Aronoff et al., 2005; in some descriptions, the social determinants of morphological complexity have not received much attention, nor has the notion of complexity itself been specifically explored.

  16. 3 CFR - Presidential Signing Statements

    Science.gov (United States)

    2010-01-01

    ... basis of policy disagreements. At the same time, such signing statements serve a legitimate function in... United States, its departments, agencies, or entities, its officers, employees, or agents, or any other...

  17. Warning Signs of Childhood Emergencies

    Science.gov (United States)

    ... signs - and act on them - by taking a first aid class and learning CPR (cardiopulmonary resuscitation). Your local hospital, ... Care For You Copyright © American College of Emergency Physicians ...

  18. Quantifiers in Russian Sign Language

    NARCIS (Netherlands)

    Kimmelman, V.; Paperno, D.; Keenan, E.L.

    2017-01-01

    After presenting some basic genetic, historical and typological information about Russian Sign Language, this chapter outlines the quantification patterns it expresses. It illustrates various semantic types of quantifiers, such as generalized existential, generalized universal, proportional,

  19. CDC Vital Signs: Legionnaires' Disease

    Science.gov (United States)

    ... gov . Vital Signs Topics Covered Alcohol Antibiotic Resistance Cancer Cardiovascular Diseases Diseases & Conditions Food Safety Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity ...

  20. Diagnosing Dementia—Positive Signs

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Diagnosing Dementia—Positive Signs Past Issues / Fall 2007 Table of ... easy, affordable blood test that could accurately diagnose Alzheimer's disease (AD)—even before symptoms began to show? Researchers ...

  1. Single Sign On Internal (SSOi)

    Data.gov (United States)

    Department of Veterans Affairs — Provides single sign-on solution for internal facing VA applications. Allows internal users access to a variety of VA systems and applications using a reduced set of...

  2. Aging changes in vital signs

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/004019.htm Aging changes in vital signs To use the sharing ... Normal body temperature does not change much with aging. But as you get older, it becomes harder ...

  3. Vital Signs-Secondhand Smoke

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the February 2015 CDC Vital Signs report. Secondhand smoke kills more than 400 infants and 41,000 adult nonsmokers every year. Learn what can be done to prevent secondhand smoke exposure.

  4. The utility of the elbow sign in the diagnosis of OSA

    Directory of Open Access Journals (Sweden)

    Haytham Samy Diab

    2015-04-01

    Conclusion: The elbow sign questionnaire is a simple and quick screening tool for OSA with good sensitivity and specificity in comparison to other questionnaires, further studies are needed in other populations to determine its reliability and predictive utility.

  5. Kinematic parameters of signed verbs.

    Science.gov (United States)

    Malaia, Evie; Wilbur, Ronnie B; Milkovic, Marina

    2013-10-01

    Sign language users recruit physical properties of visual motion to convey linguistic information. Research on American Sign Language (ASL) indicates that signers systematically use kinematic features (e.g., velocity, deceleration) of dominant hand motion for distinguishing specific semantic properties of verb classes in production ( Malaia & Wilbur, 2012a) and process these distinctions as part of the phonological structure of these verb classes in comprehension ( Malaia, Ranaweera, Wilbur, & Talavage, 2012). These studies are driven by the event visibility hypothesis by Wilbur (2003), who proposed that such use of kinematic features should be universal to sign language (SL) by the grammaticalization of physics and geometry for linguistic purposes. In a prior motion capture study, Malaia and Wilbur (2012a) lent support for the event visibility hypothesis in ASL, but there has not been quantitative data from other SLs to test the generalization to other languages. The authors investigated the kinematic parameters of predicates in Croatian Sign Language ( Hrvatskom Znakovnom Jeziku [HZJ]). Kinematic features of verb signs were affected both by event structure of the predicate (semantics) and phrase position within the sentence (prosody). The data demonstrate that kinematic features of motion in HZJ verb signs are recruited to convey morphological and prosodic information. This is the first crosslinguistic motion capture confirmation that specific kinematic properties of articulator motion are grammaticalized in other SLs to express linguistic features.

  6. Psychometric properties of a sign language version of the Mini International Neuropsychiatric Interview (MINI)

    OpenAIRE

    Øhre, Beate; Saltnes, Hege; von Tetzchner, Stephen; Falkum, Erik

    2014-01-01

    Background There is a need for psychiatric assessment instruments that enable reliable diagnoses in persons with hearing loss who have sign language as their primary language. The objective of this study was to assess the validity of the Norwegian Sign Language (NSL) version of the Mini International Neuropsychiatric Interview (MINI). Methods The MINI was translated into NSL. Forty-one signing patients consecutively referred to two specialised psychiatric units were assessed with a diagnos...

  7. Reevaluation of psoas sign analyzed by CT

    International Nuclear Information System (INIS)

    Huh, Jin Do; Park, Yeon Won; Kim, So Seon; Kim, Ho Joon; Joh, Young Duk; Chun, Byung Hee

    1986-01-01

    The lateral margin of the psoas muscle, contrasted by retroperitoneal fat, is usually visualized on plain abdominal radiography. Failure to visualize all or segment of lateral margin of the psoas muscle, so called psoas sign, has been emphasized as reliable finding of retroperitoneal pathology. But the significance of psoas sign has been controversial. The authors reevaluated psoas sign by comparing 160 abdominal radiographs with CT. The results were as follows: 1. In 160 supine radiographs, good visualization was present in 106 cases (63.3%), faint visualization in 24 (15.0%), segmental nonvisualization in 18 (11.3%), and complete nonvisualization in 12 (7.5%). In 113 erect radiographs, good visualization was present in only 36 cases (31.9%). 2. Asymmetric visualization was present in 84 out of 160 cases. In patient with scoliosis, lateral margin of convex side was seen more clearly than concave side, and this finding was statistically significant (p<0.005). 3. Ascites did not directly influence to psoa visualization, contrary to common belief. 4. In 54 cases of faint or nonvisualization, normal was 16 (29.6%), intraperitoneal pathology was 16 (29.6%), and retroperitoneal pathology was 22 (40.7%). 1) In normal patient, psoas contact with kidney or intestine and deformed psoas muscle were responsible for poor visualization. 2) The major cause of poor visualization in intraperitoneal pathology were psoas contact with displaced kidney by hepatomegaly, ascites with scanty retroperitoneal fat and deformed psoas muscle. 3) The major cause of poor visualization in retroperitoneal pathology were psoas invasion by tumor or inflammation, psoas contact with enlarged kidney or perirenal lesion. 5. In summary, the mechanism of faint or nonvisualization of psoas margin were: 1) psoas contact with normal or pathologic organs 2) psoas invasion by tumor or inflammation 3) deformed psoas muscle 4) scanty retroperitoneal fat

  8. From bench to bedside: use of human adipose-derived stem cells

    Directory of Open Access Journals (Sweden)

    Feisst V

    2015-11-01

    Full Text Available Vaughan Feisst,1 Sarah Meidinger,1 Michelle B Locke2 1Dunbar Laboratory, School of Biological Sciences, 2Department of Surgery, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand Abstract: Since the discovery of adipose-derived stem cells (ASC in human adipose tissue nearly 15 years ago, significant advances have been made in progressing this promising cell therapy tool from the laboratory bench to bedside usage. Standardization of nomenclature around the different cell types used is finally being adopted, which facilitates comparison of results between research groups. In vitro studies have assessed the ability of ASC to undergo mesenchymal differentiation as well as differentiation along alternate lineages (transdifferentiation. Recently, focus has shifted to the immune modulatory and paracrine effects of transplanted ASC, with growing interest in the ASC secretome as a source of clinical effect. Bedside use of ASC is advancing alongside basic research. An increasing number of safety-focused Phase I and Phase IIb trials have been published without identifying any significant risks or adverse events in the short term. Phase III trials to assess efficacy are currently underway. In many countries, regulatory frameworks are being developed to monitor their use and assure their safety. As many trials rely on ASC injected at a distant site from the area of clinical need, strategies to improve the homing and efficacy of transplanted cells are also being explored. This review highlights each of these aspects of the bench-to-bedside use of ASC and summarizes their clinical utility across a variety of medical specialties. Keywords: standardization, bystander effect, stromal cells, mesenchymal stem cells, stromal vascular fraction

  9. Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department?

    Science.gov (United States)

    Thamburaj, Ravi; Sivitz, Adam

    2013-01-01

    Diagnostic ultrasounds by emergency medicine (EM) and pediatric emergency medicine (PEM) physicians have increased because of ultrasonography training during residency and fellowship. The availability of ultrasound in radiology departments is limited or difficult to obtain especially during nighttime hours. Studies have shown that EM physicians can accurately perform goal-directed ultrasound after appropriate training. The goal of this study was to compare the length of stay for patients receiving an ultrasound to confirm intrauterine pregnancies. The hypothesis of this study is that a bedside ultrasound by a trained EM/PEM physician can reduce length of stay in the emergency department (ED) by 1 hour. This was a case cohort retrospective review for patients aged 13 to 21 years who received pelvic ultrasounds in the ED during 2007. Each patient was placed into 1 of 2 groups. Group 1 received bedside ultrasounds done by institutionally credentialed EM/PEM attending physicians. Group 2 received radiology department ultrasound only. Each group had subanalysis done including chief complaint, time of presentation, time to completion of ultrasound, length of stay, diagnosis, and disposition. Daytime was defined as presentation between 7 AM and 9 PM when radiology ultrasound technologists were routinely available. We studied 330 patients, with 244 patients (74%) in the bedside ultrasound group. The demographics of both groups showed no difference in age, presenting complaints, discharge diagnoses, and ultimate disposition. Group 1 had a significant reduction (P ultrasound compared with group 2 (mean, 82 minutes [range, 1-901 minutes] vs 149 minutes [range, 7-506 minutes]) and length of stay (142 [16-2268] vs. 230 [16-844]). Of those presenting during the day (66%), group 1 showed a significant reduction in length of stay (P ultrasound by trained EM/PEM physicians produced a significant reduction in length of stay in the ED, regardless of radiology ultrasound technologist

  10. Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature.

    Science.gov (United States)

    Goyal, Anupama A; Tur, Komalpreet; Mann, Jason; Townsend, Whitney; Flanders, Scott A; Chopra, Vineet

    2017-11-01

    Although common, the impact of low-cost bedside visual tools, such as whiteboards, on patient care is unclear. To systematically review the literature and assess the influence of bedside visual tools on patient satisfaction. Medline, Embase, SCOPUS, Web of Science, CINAHL, and CENTRAL. Studies of adult or pediatric hospitalized patients reporting physician identification, understanding of provider roles, patient-provider communication, and satisfaction with care from the use of visual tools were included. Outcomes were categorized as positive, negative, or neutral based on survey responses for identification, communication, and satisfaction. Two reviewers screened studies, extracted data, and assessed the risk of study bias. Sixteen studies met the inclusion criteria. Visual tools included whiteboards (n = 4), physician pictures (n = 7), whiteboard and picture (n = 1), electronic medical record-based patient portals (n = 3), and formatted notepads (n = 1). Tools improved patients' identification of providers (13/13 studies). The impact on understanding the providers' roles was largely positive (8/10 studies). Visual tools improved patient-provider communication (4/5 studies) and satisfaction (6/8 studies). In adults, satisfaction varied between positive with the use of whiteboards (2/5 studies) and neutral with pictures (1/5 studies). Satisfaction related to pictures in pediatric patients was either positive (1/3 studies) or neutral (1/3 studies). Differences in tool format (individual pictures vs handouts with pictures of all providers) and study design (randomized vs cohort) may explain variable outcomes. The use of bedside visual tools appears to improve patient recognition of providers and patient-provider communication. Future studies that include better design and outcome assessment are necessary before widespread use can be recommended. © 2017 Society of Hospital Medicine

  11. Integrated sign management system : ADOT maintenance group

    Science.gov (United States)

    2003-12-01

    The Arizona Department of Transportation (ADOT) maintains and manages an inventory of roadway signs. Before the implementation of this project, sign technicians maintained inventory records on individual laptops to track their daily sign maintenance ...

  12. Assistance System for Traffic Signs Inventory

    Directory of Open Access Journals (Sweden)

    Karel Zídek

    2015-01-01

    Full Text Available We can see arising trend in the automotive industry in last years – autonomous cars that are driven just by on-board computers. The traffic signs tracking system must deal with real conditions with data that are frequently obtained in poor light conditions, fog, heavy rain or are otherwise disturbed. Completely same problem is solved by mapping companies that are producing geospatial data for different information systems, navigations, etc. They are frequently using cars equipped with a wide range of measuring instruments including panoramic cameras. These measurements are frequently done during early morning hours when the traffic conditions are acceptable. However, in this time, the sun position is usually not optimal for the photography. Most of the traffic signs and other street objects are heavily underexposed. Hence, it is difficult to find an automatic approach that can identify them reliably. In this article, we focus on methods designed to deal with the described conditions. An overview of the state-of-the-art methods is outlined. Further, where it is possible, we outline an implementation of the described methods using well-known Open Computer Vision library. Finally, emphasis is placed on the methods that can deal with low light conditions, fog or other situations that complicate the detection process.

  13. Radiologic signs of detrusor instability in children

    International Nuclear Information System (INIS)

    Hidalgo Teran, D.G.; Podesta, M.; Mendel, R.

    2004-01-01

    Purpose: To revalue radiologic signs of detrusor instability in children. Material and Methods: Retrospective analysis of videourodynamic studies performed in 85 children consulting for urinary incontinence and/or infection. Patients were free from neuropathic diseases, alterations of the urinary tract, previous surgery or anticholinergic treatment. Images of the bladder coinciding to the peaks of unstable detrusor contractions in patients with unstable bladders, and those at the end of filling in stable bladders were analyzed. Results: Bladder outlets were open in 38 patients and close in 47. Detrusor instability was found in 97 % of those with an open bladder outlet and in 36 % when close. Bladder outlets were open in all cases with contractions stronger than 60 cm.water. All 'spinning-top' urethras were associated to contractions stronger than 70 cm.water. Most false negatives (close bladder outlet in unstable bladders) corresponded to contractions lower than 30 cm.water. Different shapes of the bladder were found irrespective of detrusor instability. Conclusions: 1) An open bladder outlet observed during bladder filling is a reliable sign of significant detrusor instability in children without neuropathy; 2) It is highly specific of instability; 3) Most false negatives coincide with low amplitude contractions; 4) 'Spinning-top' images indicate strong contractions. (author)

  14. Frontiers of reliability

    CERN Document Server

    Basu, Asit P; Basu, Sujit K

    1998-01-01

    This volume presents recent results in reliability theory by leading experts in the world. It will prove valuable for researchers, and users of reliability theory. It consists of refereed invited papers on a broad spectrum of topics in reliability. The subjects covered include Bayesian reliability, Bayesian reliability modeling, confounding in a series system, DF tests, Edgeworth approximation to reliability, estimation under random censoring, fault tree reduction for reliability, inference about changes in hazard rates, information theory and reliability, mixture experiment, mixture of Weibul

  15. Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis

    DEFF Research Database (Denmark)

    Rom Poulsen, Frantz; Schulz, Mette; Jacobsen, Anne

    2015-01-01

    BACKGROUND: Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate...... that this technique may separate ischemia and non-ischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis. METHODS: Cerebral energy metabolism was monitored in 15 patients with severe...... community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio >30 with intracerebral pyruvate level

  16. Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures?

    Science.gov (United States)

    Lichtenberg, Miranda C.; Koster, Christiaan H.; Teunissen, Lennart P.J.; Oosterveld, Frits G.J.; Harmsen, Annelieke M.K.; Haverkamp, Daniel; Hoornenborg, Daniel; Berg, Robert P.; Bloemers, Frank W.; Faber, Irene R.

    2018-01-01

    Background: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. Purpose: To evaluate the reliability and diagnostic value of the lever sign test. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test’s diagnostic value. Results: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%. Conclusion: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value

  17. Photonics approach to traffic signs

    Science.gov (United States)

    Litwin, Dariusz; Galas, Jacek; CzyŻewski, Adam; Rymsza, Barbara; Kornalewski, Leszek; Kryszczyński, Tadeusz; Mikucki, Jerzy; Wikliński, Piotr; Daszkiewicz, Marek; Malasek, Jacek

    2016-12-01

    The automotive industry has been always a driving force for all economies. Despite of its beneficial meaning to every society it brings also many issues including wide area of road safety. The latter has been enforced by the increasing number of cars and the dynamic development of the traffic as a whole. Road signs and traffic lights are crucial in context of good traffic arrangement and its fluency. Traffic designers are used to treat horizontal road signs independently of vertical signs. However, modern light sources and growing flexibility in shaping optical systems create opportunity to design more advanced and smart solutions. In this paper we present an innovative, multidisciplinary approach that consists in tight interdependence of different traffic signals. We describe new optical systems together with their influence on the perception of the road user. The analysis includes maintenance and visibility in different weather conditions. A special attention has been focused on intersections of complex geometry.

  18. Compiling a Sign Language Dictionary

    DEFF Research Database (Denmark)

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas

    2010-01-01

    As we began working on the Danish Sign Language (DTS) Dictionary, we soon realised the truth in the statement that a lexicographer has to deal with problems within almost any linguistic discipline. Most of these problems come down to establishing simple rules, rules that can easily be applied every...... – or are they homonyms?" and so on. Very often such questions demand further research and can't be answered sufficiently through a simple standard formula. Therefore lexicographic work often seems like an endless series of compromises. Another source of compromise arises when you set out to decide which information...... this dilemma, as we see DTS learners and teachers as well as native DTS signers as our target users. In the following we will focus on four problem areas with particular relevance for the sign language lexicographer: Sign representation Spoken languague equivalents and mouth movements Example sentences Partial...

  19. Characteristic CT signs in oligodendrogliomas

    International Nuclear Information System (INIS)

    Marcu, H.; Vonofakos, D.; Hacker, H.

    1980-01-01

    Computed tomography offers valuable aid for improving the diagnostic capabilities for oligodendrogliomas. The authors have attempted to determine more precisely the CT characteristic signs for this type of tumor and to establish criteria for predicting malignancy grade. They can conclude that calcifications are the main signs which lead to the diagnosis of oligodendroglioma, as the most usual calcifying glioma. This finding was known before the CT era, but with the CT one can be more exact with regard to form, growth, number and density of the calcifications and especially the smallest of them, which are not to be seen on the conventional X-ray examination. The cyst formation is another feature of oligodendroglioma. The occurrence of contrast enhancement and cyst formation are the most characteristic signs of malignancy. (C.F.)

  20. Limitations of a Short Demographic Questionnaire for Bedside Estimation of Patients’ Global Cognitive Functioning in Epilepsy Patients

    Directory of Open Access Journals (Sweden)

    Iris Gorny

    2018-03-01

    Full Text Available ObjectivesThe German socio-demographic estimation scale was developed by Jahn et al. (1 to quickly predict premorbid global cognitive functioning in patients. So far, it has been validated in healthy adults and has shown a good correlation with the full and verbal IQ of the Wechsler Adult Intelligence Scale (WAIS in this group. However, there are no data regarding its use as a bedside test in epilepsy patients.MethodsForty native German speaking adult patients with refractory epilepsy were included. They completed a neuropsychological assessment, including a nine scale short form of the German version of the WAIS-III and the German socio-demographic estimation scale by Jahn et al. (1 during their presurgical diagnostic stay in our center. We calculated means, correlations, and the rate of concordance (range ±5 and ±7.5 IQ score points between these two measures for the whole group, and a subsample of 19 patients with a global cognitive functioning level within 1 SD of the mean (IQ score range 85–115 and who had completed their formal education before epilepsy onset.ResultsThe German demographic estimation scale by Jahn et al. (1 showed a significant mean overestimation of the global cognitive functioning level of eight points in the epilepsy patient sample compared with the short form WAIS-III score. The accuracy within a range of ±5 or ±7.5 IQ score points for each patient was similar to that of the healthy controls reported by Jahn et al. (1 in our subsample, but not in our whole sample.ConclusionOur results show that the socio-demographic scale by Jahn et al. (1 is not sufficiently reliable as an estimation tool of global cognitive functioning in epilepsy patients. It can be used to estimate global cognitive functioning in a subset of patients with a normal global cognitive functioning level who have completed their formal education before epilepsy onset, but it does not reliably predict global cognitive functioning in epilepsy patients

  1. Ischemic Left Ventricular Perforation Covered by a Thrombus in a Patient Presenting with Cerebral Ischemia: Importance of Time-Sensitive Performance and Adequate Interpretation of Bedside Transthoracic Echography

    Directory of Open Access Journals (Sweden)

    A. J. Fischer

    2016-01-01

    Full Text Available If myocardial infarction remains silent, only clinical signs of complications may unveil its presence. Life-threatening complications include myocardial rupture, thrombus formation, or arterial embolization. In the presented case, a 76-year-old patient was admitted with left-sided hemiparesis. In duplex sonography, a critical stenosis of the right internal carotid artery was identified and initially but retrospectively incorrectly judged as the potential cause for ischemia. During operative thromboendarterectomy, arterial embolism of the right leg occurred coincidentally, more likely pointing towards a cardioembolic origin. Percutaneous interventions remained unsuccessful and local fibrinolysis was applied. Delayed bedside echocardiography by an experienced cardiologist demonstrated a discontinuity of the normal myocardial texture of the left ventricular apex together with an echodense, partly floating structure merely attached by a thin bridge not completely sealing the myocardial defect, accompanied by pericardial effusion. The patient was immediately transferred to emergency cardiac surgery with extirpation of the thrombus, aortocoronary bypass graft placement, and aneurysmectomy. This didactic case reveals decisive structural shortcomings in patient’s admission and triage processes and underlines, if performed timely and correctly, the value of transthoracic echocardiography as a noninvasive and cost-effective tool allowing immediate decision-making, which, in this case, led to the correct but almost fatally delayed diagnosis.

  2. Ischemic Left Ventricular Perforation Covered by a Thrombus in a Patient Presenting with Cerebral Ischemia: Importance of Time-Sensitive Performance and Adequate Interpretation of Bedside Transthoracic Echography.

    Science.gov (United States)

    Fischer, A J; Lebiedz, P; Wiaderek, M; Lichtenberg, M; Böse, D; Martens, S; Breuckmann, F

    2016-01-01

    If myocardial infarction remains silent, only clinical signs of complications may unveil its presence. Life-threatening complications include myocardial rupture, thrombus formation, or arterial embolization. In the presented case, a 76-year-old patient was admitted with left-sided hemiparesis. In duplex sonography, a critical stenosis of the right internal carotid artery was identified and initially but retrospectively incorrectly judged as the potential cause for ischemia. During operative thromboendarterectomy, arterial embolism of the right leg occurred coincidentally, more likely pointing towards a cardioembolic origin. Percutaneous interventions remained unsuccessful and local fibrinolysis was applied. Delayed bedside echocardiography by an experienced cardiologist demonstrated a discontinuity of the normal myocardial texture of the left ventricular apex together with an echodense, partly floating structure merely attached by a thin bridge not completely sealing the myocardial defect, accompanied by pericardial effusion. The patient was immediately transferred to emergency cardiac surgery with extirpation of the thrombus, aortocoronary bypass graft placement, and aneurysmectomy. This didactic case reveals decisive structural shortcomings in patient's admission and triage processes and underlines, if performed timely and correctly, the value of transthoracic echocardiography as a noninvasive and cost-effective tool allowing immediate decision-making, which, in this case, led to the correct but almost fatally delayed diagnosis.

  3. In diagnosis of pleural effusion and pneumothorax in the intensive care unit patients: Can chest us replace bedside plain radiography?

    Directory of Open Access Journals (Sweden)

    ElShaimaa Mohamed Mohamed

    2018-06-01

    Conclusions: In evaluation of ICU patients with pleural effusion and pneumothorax, chest US is the first bedside tool with high diagnostic performance. These chest conditions are urgent especially in seriously ill patients, as both need US guided drainage. Chest US has many advantages, including non invasive examination in multiple planes, free of radiation hazard, less expensive, real-time, high sensitivity and diagnostic accuracy in chest lesions detection. Lung ultrasound is being exclusive than bedside chest X-ray and equal to chest CT in diagnosing pleural effusion and pneumothorax.

  4. Computed tomography signs of pulmonary hypertension: old and new observations

    International Nuclear Information System (INIS)

    Devaraj, A.; Hansell, D.M.

    2009-01-01

    Pulmonary hypertension (PH) has a poor prognosis. It may be idiopathic or develop secondary to various cardiac and respiratory disorders. The diagnosis of PH is challenging because its signs and symptoms are non-specific and there is no completely reliable non-invasive test for its detection. Most patients with suspected PH or with the non-specific symptoms of PH will undergo computed tomography (CT) as part of their diagnostic work-up and, therefore, it is important for radiologists to be aware of the CT signs that may suggest the diagnosis. This article will review the numerous CT signs of PH describing their individual strengths and weaknesses, and discuss how they may be applied in clinical practice.

  5. Computed tomography signs of pulmonary hypertension: old and new observations

    Energy Technology Data Exchange (ETDEWEB)

    Devaraj, A. [Department of Radiology, Royal Brompton Hospital, London (United Kingdom); Hansell, D.M. [Department of Radiology, Royal Brompton Hospital, London (United Kingdom)], E-mail: davidhansell@rbht.nhs.uk

    2009-08-15

    Pulmonary hypertension (PH) has a poor prognosis. It may be idiopathic or develop secondary to various cardiac and respiratory disorders. The diagnosis of PH is challenging because its signs and symptoms are non-specific and there is no completely reliable non-invasive test for its detection. Most patients with suspected PH or with the non-specific symptoms of PH will undergo computed tomography (CT) as part of their diagnostic work-up and, therefore, it is important for radiologists to be aware of the CT signs that may suggest the diagnosis. This article will review the numerous CT signs of PH describing their individual strengths and weaknesses, and discuss how they may be applied in clinical practice.

  6. Reliability of wireless monitoring using a wearable patch sensor in high-risk surgical patients at a step-down unit in the Netherlands: a clinical validation study.

    Science.gov (United States)

    Breteler, Martine J M; Huizinga, Erik; van Loon, Kim; Leenen, Luke P H; Dohmen, Daan A J; Kalkman, Cor J; Blokhuis, Taco J

    2018-02-27

    Intermittent vital signs measurements are the current standard on hospital wards, typically recorded once every 8 hours. Early signs of deterioration may therefore be missed. Recent innovations have resulted in 'wearable' sensors, which may capture patient deterioration at an earlier stage. The objective of this study was to determine whether a wireless 'patch' sensor is able to reliably measure respiratory and heart rate continuously in high-risk surgical patients. The secondary objective was to explore the potential of the wireless sensor to serve as a safety monitor. In an observational methods comparisons study, patients were measured with both the wireless sensor and bedside routine standard for at least 24 hours. University teaching hospital, single centre. Twenty-five postoperative surgical patients admitted to a step-down unit. Primary outcome measures were limits of agreement and bias of heart rate and respiratory rate. Secondary outcome measures were sensor reliability, defined as time until first occurrence of data loss. 1568 hours of vital signs data were analysed. Bias and 95% limits of agreement for heart rate were -1.1 (-8.8 to 6.5) beats per minute. For respiration rate, bias was -2.3 breaths per minute with wide limits of agreement (-15.8 to 11.2 breaths per minute). Median filtering over a 15 min period improved limits of agreement of both respiration and heart rate. 63% of the measurements were performed without data loss greater than 2 min. Overall data loss was limited (6% of time). The wireless sensor is capable of accurately measuring heart rate, but accuracy for respiratory rate was outside acceptable limits. Remote monitoring has the potential to contribute to early recognition of physiological decline in high-risk patients. Future studies should focus on the ability to detect patient deterioration on low care environments and at home after discharge. © Article author(s) (or their employer(s) unless otherwise stated in the text of

  7. Innovative integrative bedside teaching model improves tutors’ self-assessments of teaching skills and attitudes

    Directory of Open Access Journals (Sweden)

    Itai Gat

    2016-02-01

    Full Text Available Introduction: Patient bedside is the ideal setting for teaching physical examination, medical interviewing, and interpersonal skills. Herein we describe a novel model for bedside teaching (BST practiced during tutor training workshop and its resulting effect on practitioners’ self assessment of teaching skills and perceptions. Methods: One-day tutor training workshop included theoretical knowledge supplementation regarding tutors’ roles as well as implementing practical tools for clinical education, mainly BST model. The model, which emphasizes simultaneous clinical and communication teaching in a stepwise approach, was practiced by consecutive simulations with a gradual escalation of difficulty and adjusted instruction approaches. Pre- and post-workshop-adjusted questionnaires using a Likert scale of 1 to 4 were completed by participants and compared. Results: Analysis was based on 25 out of 48 participants who completed both questionnaires. Significantly improved teaching skills were demonstrated upon workshop completion (mean 3.3, SD 0.5 compared with pre-training (mean 2.6, SD 0.6; p<0.001 with significant increase in most examined parameters. Significantly improved tutor's roles internalization was demonstrated after training completion (mean 3.7, SD 0.3 compared with pre-workshop (mean 3.5 SD 0.5; p=0.002. Discussion: Successful BST involves combination of clinical and communication skills. BST model practiced during the workshop may contribute to improved teaching skills in this challenging environment.

  8. The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses’ Perceptions

    Directory of Open Access Journals (Sweden)

    Inga E. Larsson

    2016-01-01

    Full Text Available Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses’ perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses (n=15. Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients’ best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers’ professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.

  9. Acceptance of a Mobile Application Supporting Nurses Workflow at Patient Bedside: Results from a Pilot Study.

    Science.gov (United States)

    Ehrler, Frederic; Ducloux, Pascal; Wu, Danny T Y; Lovis, Christian; Blondon, Katherine

    2018-01-01

    Supporting caregivers' workflow with mobile applications (apps) is a growing trend. At the bedside, apps can provide new ways to support the documentation process rather than using a desktop computer in a nursing office. Although these applications show potential, few existing reports have studied the real impact of such solutions. At the University Hospitals of Geneva, we developed BEDside Mobility, a mobile application supporting nurses' daily workflow. In a pilot study, the app was trialed in two wards for a period of one month. We collected data of the actual usage of the app and asked the users to complete a tailored technology acceptance model questionnaire at the end of the study period. Results show that participation remain stable with time with participants using in average the tool for almost 29 minutes per day. The technology acceptance questionnaires revealed a high usability of the app and good promotion from the institution although users did not perceive any increase in productivity. Overall, intent of use was divergent between promoters and antagonist. Furthermore, some participants considered the tool as an addition to their workload. This evaluation underlines the importance of helping all end users perceive the benefits of a new intervention since coworkers strong influence each other.

  10. A cost-effective peripheral venous port system placed at the bedside.

    Science.gov (United States)

    Finney, R; Albrink, M H; Hart, M B; Rosemurgy, A S

    1992-07-01

    High costs and a paucity of available operating time have led us to seek alternatives to operatively placed vascular access systems. This prospective study is the initial report of a peripheral port system (P.A.S. PORT System, Pharmacia Deltec, Inc.) placed at the bedside. Seventy-nine patients (52 male, 27 female), ages 3-92 years, had ports implanted by surgical residents with attending supervision. Sixty-eight (86%) received the P.A.S. PORT for long-term antibiotics, antifungal, or antiviral therapy; four (5%) for TPN infusion; three (4%) for blood products; two (3%) for chemotherapy; and two (3%) for iv narcotics. Ports were placed in 10 (13%) HIV(+) patients, three (4%) who were fully anticoagulated, and one who was a hemophiliac with a platelet count of zero. Eight patients (10%) developed superficial phlebitis, all of which resolved with nonsteroidal anti-inflammatory agents within 48 hr without port removal. Seven patients (9%) had their port removed due to infection. The average hospital charge to place the P.A.S. PORT System was $1488.00 vs $2811.00 for a tunneled external chest catheter and $3729.00 for the placement of a chest port. Bedside insertion of vascular access devices can be safely performed with acceptable infection rates allowing more efficient use of hospital operating rooms and with substantial cost savings.

  11. Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

    Science.gov (United States)

    Litaker, D; Pioro, M; El Bilbeisi, H; Brems, J

    2000-12-01

    To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). Retrospective chart review Orthopedic practice limited to disorders of the shoulder 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period Presence of partial or complete RCT on arthrogram 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

  12. Innovative integrative bedside teaching model improves tutors' self-assessments of teaching skills and attitudes.

    Science.gov (United States)

    Gat, Itai; Pessach-Gelblum, Liat; Givati, Gili; Haim, Nadav; Paluch-Shimon, Shani; Unterman, Avraham; Bar-Shavit, Yochay; Grabler, Galit; Sagi, Doron; Achiron, Anat; Ziv, Amitai

    2016-01-01

    Patient bedside is the ideal setting for teaching physical examination, medical interviewing, and interpersonal skills. Herein we describe a novel model for bedside teaching (BST) practiced during tutor training workshop and its resulting effect on practitioners' self assessment of teaching skills and perceptions. One-day tutor training workshop included theoretical knowledge supplementation regarding tutors' roles as well as implementing practical tools for clinical education, mainly BST model. The model, which emphasizes simultaneous clinical and communication teaching in a stepwise approach, was practiced by consecutive simulations with a gradual escalation of difficulty and adjusted instruction approaches. Pre- and post-workshop-adjusted questionnaires using a Likert scale of 1 to 4 were completed by participants and compared. Analysis was based on 25 out of 48 participants who completed both questionnaires. Significantly improved teaching skills were demonstrated upon workshop completion (mean 3.3, SD 0.5) compared with pre-training (mean 2.6, SD 0.6; pteaching skills in this challenging environment.

  13. Testing a bedside personal computer Clinical Care Classification System for nursing students using Microsoft Access.

    Science.gov (United States)

    Feeg, Veronica D; Saba, Virginia K; Feeg, Alan N

    2008-01-01

    This study tested a personal computer-based version of the Sabacare Clinical Care Classification System on students' performance of charting patient care plans. The application was designed as an inexpensive alternative to teach electronic charting for use on any laptop or personal computer with Windows and Microsoft Access. The data-based system was tested in a randomized trial with the control group using a type-in text-based-only system also mounted on a laptop at the bedside in the laboratory. Student care plans were more complete using the data-based system over the type-in text version. Students were more positive but not necessarily more efficient with the data-based system. The results demonstrate that the application is effective for improving student nursing care charting using the nursing process and capturing patient care information with a language that is standardized and ready for integration with other patient electronic health record data. It can be implemented on a bedside stand in the clinical laboratory or used to aggregate care planning over a student's clinical experience.

  14. Hepatic dimple sign on CT

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Kunihiko; Nakajima, Teiichi; Ishikawa, Nobuyoshi; Ebihara, Reiko; Saida, Yukihisa

    1983-06-01

    The ''Dimple sign'' has been coined by Baltaxe et al. in 1974 and was said to be useful angiographic sign of avascular tumor. Similar dimple can be seen in the margin of the liver on CT examination of the hepatic tumors. We called this hepatic dimple sign and its clinical usefulness on CT examination was studied with 133 cases of hepatic tumors. Among 133 cases, there were 68 cases of hepatocellular carcinoma, 57 cases of metastatic liver tumor, 5 cases of hemangioma of the liver and 3 cases of hepatoblastoma. Hepatic dimple sign was recognized on 2 cases of metastatic liver tumor, 1 case of hemangioma, and 1 case of carcinoma of the gallbladder with hepatic infiltration. Cases experienced in the affiliated hospitals were also studied. A case of hepatocellular carcinoma and a case of metastatic liver tumor were evaluated. These tumors were relativly large measuring over 5cm in the greatest diameter and low density areas were apparent on plain CT. Therefore, dimples in the hepatic margin seen in CT scan did not contribute to the diagnostic accuracy of the liver tumor in these cases. (author).

  15. Hepatic dimple sign on CT

    International Nuclear Information System (INIS)

    Matsumoto, Kunihiko; Nakajima, Teiichi; Ishikawa, Nobuyoshi; Ebihara, Reiko; Saida, Yukihisa

    1983-01-01

    The ''Dimple sign'' has been coined by Baltaxe et al. in 1974 and was said to be useful angiographic sign of avascular tumor. Similar dimple can be seen in the margin of the liver on CT examination of the hepatic tumors. We called this hepatic dimple sign and its clinical usefulness on CT examination was studied with 133 cases of hepatic tumors. Among 133 cases, there were 68 cases of hepatocellular carcinoma, 57 cases of metastatic liver tumor, 5 cases of hemangioma of the liver and 3 cases of hepatoblastoma. Hepatic dimple sign was recognized on 2 cases of metastatic liver tumor, 1 case of hemangioma, and 1 case of carcinoma of the gallbladder with hepatic infiltration. Cases experienced in the affiliated hospitals were also studied. A case of hepatocellular carcinoma and a case of metastatic liver tumor were evaluated. These tumors were relativly large measuring over 5cm in the greatest diameter and low density areas were apparent on plain CT. Therefore, dimples in the hepatic margin seen in CT scan did not contribute to the diagnostic accuracy of the liver tumor in these cases. (author)

  16. BOOMERANG SIGN - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Justin

    2016-01-01

    Full Text Available INTRODUCTION Boomerang sign is a transient abnormality at the level of splenium of corpus callosum in MRI seen in various conditions.[1-2] We do here report a case of malaria, which presented with the above findings. The transient appearance of such findings need not need any aggressive management, other than managing the underlying cause.

  17. Sign Languages of the World

    DEFF Research Database (Denmark)

    This handbook provides information on some 38 sign languages, including basic facts about each of the languages, structural aspects, history and culture of the Deaf communities, and history of research. The papers are all original, and each has been specifically written for the volume by an expert...

  18. Vital Signs - Child Passenger Safety

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the February 2014 CDC Vital Signs report. Over the past 10 years, more than 9,000 children 12 and under died in motor vehicle crashes, and a third who died in 2011 weren't buckled up. Buckling up is the best way to reduce injuries and save lives.

  19. Laryngopyocele: signs on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nazaroglu, Hasan E-mail: hnazarog@dicle.edu.tr; Oezates, Mustafa; Uyar, Asur; Deger, Emin; Simsek, Masum

    2000-01-01

    A laryngocele is an air-filled dilation of the saccule of the larynx. An infected laryngocele is called a laryngopyocele. Our experience with a case of laryngopyocele with signs on computed tomography before and after antibiotic therapy is presented since laryngopyocele is more unusual.

  20. Laryngopyocele: signs on computed tomography

    International Nuclear Information System (INIS)

    Nazaroglu, Hasan; Oezates, Mustafa; Uyar, Asur; Deger, Emin; Simsek, Masum

    2000-01-01

    A laryngocele is an air-filled dilation of the saccule of the larynx. An infected laryngocele is called a laryngopyocele. Our experience with a case of laryngopyocele with signs on computed tomography before and after antibiotic therapy is presented since laryngopyocele is more unusual

  1. To compare the accuracy of Prayer's sign and Mallampatti test in predicting difficult intubation in Diabetic patients

    International Nuclear Information System (INIS)

    Baig, M. M. A.; Khan, F. H.

    2014-01-01

    Objective: To determine the accuracy of Prayer's sign and Mallampatti test in predicting difficult endotracheal intubation in diabetic patients. Methods: The cross-sectional study was performed at Aga Khan University Hospital, Karachi, over a period from January 2009 to April 2010, and comprised 357 patients who required endotracheal intubation for elective surgical procedures. Prayer's sign and Mallampatti tests were performed for the assessment of airway by trained observers. Ease or difficulty of laryngoscopy after the patient was fully anaesthetised with standard technique were observed and laryngoscopic view of first attempt was rated according to Cormack-Lehan grade of intubation. SPSS 15 was used for statistical analysis. Results: Of the 357 patients, 125(35%) were classified as difficult to intubate. Prayer's sign showed significantly lower accuracy, positive and negative predictive values than Mallampatti test. The sensitivity of Prayer's sign was lower 29.6 (95% Confidence Interval, 21.9-38.5) than Mallampatti test 79.3 (95% confidence interval, 70.8-85.7) while specificity of both the tests was not found to be significantly different. Conclusion: Prayer's sign is not acceptable as a single best bedside test for prediction of difficult intubation. (author)

  2. System Reliability Engineering

    International Nuclear Information System (INIS)

    Lim, Tae Jin

    2005-02-01

    This book tells of reliability engineering, which includes quality and reliability, reliability data, importance of reliability engineering, reliability and measure, the poisson process like goodness of fit test and the poisson arrival model, reliability estimation like exponential distribution, reliability of systems, availability, preventive maintenance such as replacement policies, minimal repair policy, shock models, spares, group maintenance and periodic inspection, analysis of common cause failure, and analysis model of repair effect.

  3. 13 CFR 305.12 - Project sign.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Project sign. 305.12 Section 305... WORKS AND ECONOMIC DEVELOPMENT INVESTMENTS Requirements for Approved Projects § 305.12 Project sign. The... the construction period of a sign or signs at a conspicuous place at the Project site indicating that...

  4. Eye Gaze in Creative Sign Language

    Science.gov (United States)

    Kaneko, Michiko; Mesch, Johanna

    2013-01-01

    This article discusses the role of eye gaze in creative sign language. Because eye gaze conveys various types of linguistic and poetic information, it is an intrinsic part of sign language linguistics in general and of creative signing in particular. We discuss various functions of eye gaze in poetic signing and propose a classification of gaze…

  5. Numeral Incorporation in Japanese Sign Language

    Science.gov (United States)

    Ktejik, Mish

    2013-01-01

    This article explores the morphological process of numeral incorporation in Japanese Sign Language. Numeral incorporation is defined and the available research on numeral incorporation in signed language is discussed. The numeral signs in Japanese Sign Language are then introduced and followed by an explanation of the numeral morphemes which are…

  6. [Neurological soft signs in schizophrenia: correlations with age, sex, educational status and psychopathology].

    Science.gov (United States)

    Panagiotidis, P; Kaprinis, G; Iacovides, A; Fountoulakis, K

    2013-01-01

    Though the pathobiology of schizophrenia can be examined in multiple levels, the organic notion of brain disease suggests that neurological features will be present. One straightforward, inexpensive method of investigating brain dysfunction in schizophrenia is thought the bedside assessment of neurological abnormalities with a standard neurological examination. Neurological abnormalities are traditionally classified as "hard signs" (impairments in basic motor, sensory, and reflex behaviors, which do not appear to be affected in schizophrenia) and "soft signs", which refer to more complex phenomena such as abnormalities in motor control, integrative sensory function, sensorimotor integration, and cerebral laterality. Additionally, neurological soft signs (NSS) are minor motor and sensory abnormalities that are considered to be normal in the course of early development but abnormal when elicited in later life or persist beyond childhood. Soft signs also, have no definitive localizing significance but are indicative of subtle brain dysfunction. Most authors believe that they are a reflection not only of deficient integration between the sensory and motor systems, but also of dysfunctional neuronal circuits linking subcortical brain structures such as the basal ganglia, the brain stem, and the limbic system. Throughout the last four decades, studies have consistently shown that NSS are more frequently present in patients with schizophrenia than in normal subjects and non-psychotic psychiatric patients. However, the functional relevance of NSS remains unclear and their specificity has often been challenged, even though there is indication for a relative specificity with regard to diagnosis, or symptomatology. Many studies have considered soft signs as categorical variables thus hampering the evaluation of fluctuation with symptomatology and/or treatment, whereas other studies included insufficient number of assessed signs, or lacked a comprehensive assessment of

  7. Magnetic field control of 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign domain wall resistance

    Energy Technology Data Exchange (ETDEWEB)

    Majidi, Roya, E-mail: royamajidi@gmail.com [Department of Physics, Shahid Rajaee Teacher Training University, Lavizan, 16788-15811 Tehran (Iran, Islamic Republic of)

    2012-10-01

    In the present work, we have compared the resistance of the 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign domain walls in the presence of external magnetic field. The calculations are based on the Boltzmann transport equation within the relaxation time approximation. One-dimensional Neel-type domain walls between two domains whose magnetization differs by angle of 90 Degree-Sign , 180 Degree-Sign , and 360 Degree-Sign are considered. The results indicate that the resistance of the 360 Degree-Sign DW is more considerable than that of the 90 Degree-Sign and 180 Degree-Sign DWs. It is also found that the domain wall resistance can be controlled by applying transverse magnetic field. Increasing the strength of the external magnetic field enhances the domain wall resistance. In providing spintronic devices based on magnetic nanomaterials, considering and controlling the effect of domain wall on resistivity are essential.

  8. Bedside ultrasound training at Muhimbili National Hospital in Dar es Salaam, Tanzania and Hospital San Carlos in Chiapas, Mexico

    Directory of Open Access Journals (Sweden)

    Teri A. Reynolds

    2016-09-01

    Discussion: Introducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.

  9. Lower incidence of unexpected in-hospital death after interprofessional implementation of a bedside track-and-trigger system

    DEFF Research Database (Denmark)

    Bunkenborg, Gitte; Samuelson, Karin Samuelsonkarin; Poulsen, Ingrid

    2014-01-01

    In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional u...... of early warning scoring, structured observation charts, and clinical algorithms for bedside action....

  10. Training auscultatory skills: computer simulated heart sounds or additional bedside training? A randomized trial on third-year medical students

    Science.gov (United States)

    2010-01-01

    Background The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3rd year medical students at Oslo University Medical School. Methods In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student's t-test. Results At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training. Conclusions Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training. PMID:20082701

  11. Sikker brug af bedside_UL-vejledt pleuracentese og ascitesdrændge hos patienter med maligne sygdomme

    DEFF Research Database (Denmark)

    Damstrup, Camilla Vantore

    2014-01-01

    and investigated the patients' medical files with regard to complications. In 29 pleuracentesises and 43 laparocentesises only one pneumothorax was registered (3.4%). This is comparable to previous studies and may suggest that it is safe to perform these procedures bedside in cancer patients with no complications....

  12. The city as a sign

    DEFF Research Database (Denmark)

    Kharlamov, Nikita

    2012-01-01

    . This question is tackled through Jaan Valsiner’s notions of semiotic mediation and regulation. I specifically focus on spatial signs that humans use to regulate the meaning-making process that creates as meaningful what Georges Perec called species of spaces, such as towns and cities. “The city,” from...... this standpoint, becomes one of the most important signs that mediate and regulate our experience of environments we inhabit. I discuss a number of theoretical and methodological directions in which this framework could be further developed to revive the urban, or settlement, psychology, which failed to develop...... Werner, and Bernard Kaplan, and developed as cultural-developmental approach by Jaan Valsiner, the proposed framework centers on the experience of individual organismic relating to spatial environment. I draw on the work of Manuel Castells, Edward Soja, and Yi-Fu Tuan to conceptualize the emergence...

  13. Tension pneumocephalus: Mount Fuji sign

    Directory of Open Access Journals (Sweden)

    Pulastya Sanyal

    2015-01-01

    Full Text Available A 13-year-old male was operated for a space occupying lesion in the brain. A noncontrast computed tomography scan done in the late postoperative period showed massive subdural air collection causing compression of bilateral frontal lobes with widening of interhemispheric fissure and the frontal lobes acquiring a peak like configuration - causing tension pneumocephalus-"Mount Fuji sign." Tension pneumocephalus occurs when air enters the extradural or intradural spaces in sufficient volume to exert a mass or pressure effect on the brain, leading to brain herniation. Tension pneumocephalus is a surgical emergency, which needs immediate intervention in the form of decompression of the cranial cavity by a burr hole or needle aspiration. The Mount Fuji sign differentiates tension pneumocephalus from pneumocephalus.

  14. Reliability and Validity of Korean Version of Apraxia Screen of TULIA (K-AST).

    Science.gov (United States)

    Kim, Soo Jin; Yang, You-Na; Lee, Jong Won; Lee, Jin-Youn; Jeong, Eunhwa; Kim, Bo-Ram; Lee, Jongmin

    2016-10-01

    To evaluate the reliability and validity of Korean version of AST (K-AST) as a bedside screening test of apraxia in patients with stroke for early and reliable detection. AST was translated into Korean, and the translated version received authorization from the author of AST. The performances of K-AST in 26 patients (21 males, 5 females; mean age 65.42±17.31 years) with stroke (23 ischemic, 3 hemorrhagic) were videotaped. To test the reliability and validity of K-AST, the recorded performances were assessed by two physiatrists and two occupational therapists twice at a 1-week interval. The patient performances at admission in Korean version of Mini-Mental State Examination (K-MMSE), self-care and transfer categories of Functional Independence Measure (FIM), and motor praxis area of Loewenstein Occupational Therapy Cognitive Assessment, the second edition (LOTCA-II) were also evaluated. Scores of motor praxis area of LOTCA-II was used to assess the validity of K-AST. Inter-rater reliabilities were 0.983 (preliable and valid test for bedside screening of apraxia.

  15. Vital Signs-Secondhand Smoke

    Centers for Disease Control (CDC) Podcasts

    2015-02-03

    This podcast is based on the February 2015 CDC Vital Signs report. Secondhand smoke kills more than 400 infants and 41,000 adult nonsmokers every year. Learn what can be done to prevent secondhand smoke exposure.  Created: 2/3/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 2/3/2015.

  16. Signed Networks in Social Media

    OpenAIRE

    Leskovec, Jure; Huttenlocher, Daniel; Kleinberg, Jon

    2010-01-01

    Relations between users on social media sites often reflect a mixture of positive (friendly) and negative (antagonistic) interactions. In contrast to the bulk of research on social networks that has focused almost exclusively on positive interpretations of links between people, we study how the interplay between positive and negative relationships affects the structure of on-line social networks. We connect our analyses to theories of signed networks from social psychology. We find that the c...

  17. Vital Signs - Child Passenger Safety

    Centers for Disease Control (CDC) Podcasts

    2014-02-04

    This podcast is based on the February 2014 CDC Vital Signs report. Over the past 10 years, more than 9,000 children 12 and under died in motor vehicle crashes, and a third who died in 2011 weren't buckled up. Buckling up is the best way to reduce injuries and save lives.  Created: 2/4/2014 by National Center for Injury Prevention and Control (NCIPC).   Date Released: 2/4/2014.

  18. Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass.

    Science.gov (United States)

    Paris, Michael T; Lafleur, Benoit; Dubin, Joel A; Mourtzakis, Marina

    2017-10-01

    Ultrasound is a non-invasive and readily available tool that can be prospectively applied at the bedside to assess muscle mass in clinical settings. The four-site protocol, which images two anatomical sites on each quadriceps, may be a viable bedside method, but its ability to predict musculature has not been compared against whole-body reference methods. Our primary objectives were to (i) compare the four-site protocol's ability to predict appendicular lean tissue mass from dual-energy X-ray absorptiometry; (ii) optimize the predictability of the four-site protocol with additional anatomical muscle thicknesses and easily obtained covariates; and (iii) assess the ability of the optimized protocol to identify individuals with low lean tissue mass. This observational cross-sectional study recruited 96 university and community dwelling adults. Participants underwent ultrasound scans for assessment of muscle thickness and whole-body dual-energy X-ray absorptiometry scans for assessment of appendicular lean tissue. Ultrasound protocols included (i) the nine-site protocol, which images nine anterior and posterior muscle groups in supine and prone positions, and (ii) the four-site protocol, which images two anterior sites on each quadriceps muscle group in a supine position. The four-site protocol was strongly associated (R 2  = 0.72) with appendicular lean tissue mass, but Bland-Altman analysis displayed wide limits of agreement (-5.67, 5.67 kg). Incorporating the anterior upper arm muscle thickness, and covariates age and sex, alongside the four-site protocol, improved the association (R 2  = 0.91) with appendicular lean tissue and displayed narrower limits of agreement (-3.18, 3.18 kg). The optimized protocol demonstrated a strong ability to identify low lean tissue mass (area under the curve = 0.89). The four-site protocol can be improved with the addition of the anterior upper arm muscle thickness, sex, and age when predicting appendicular lean tissue mass

  19. CERN single sign on solution

    International Nuclear Information System (INIS)

    Ormancey, E

    2008-01-01

    The need for Single Sign On has always been restricted by the absence of cross platform solutions: a single sign on working only on one platform or technology is nearly useless. The recent improvements in Web Services Federation (WS-Federation) standard enabling federation of identity, attribute, authentication and authorization information can now provide real extended Single Sign On solutions. Various solutions have been investigated at CERN and now, a Web SSO solution using some parts of WS-Federation technology is available. Using the Shibboleth Service Provider module for Apache hosted web sites and Microsoft ADFS as the identity provider linked to Active Directory user, users can now authenticate on any web application using a single authentication platform, providing identity, user information (building, phone...) as well as group membership enabling authorization possibilities. A typical scenario: a CERN user can now authenticate on a Linux/Apache website using Windows Integrated credentials, and his Active Directory group membership can be checked before allowing access to a specific web page

  20. AMSAA Reliability Growth Guide

    National Research Council Canada - National Science Library

    Broemm, William

    2000-01-01

    ... has developed reliability growth methodology for all phases of the process, from planning to tracking to projection. The report presents this methodology and associated reliability growth concepts.

  1. Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety.

    Science.gov (United States)

    Mackinson, Lynn G; Corey, Juliann; Kelly, Veronica; O'Reilly, Kristin P; Stevens, Jennifer P; Desanto-Madeya, Susan; Williams, Donna; O'Donoghue, Sharon C; Foley, Jane

    2018-06-01

    A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants' responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign. ©2018 American Association of Critical-Care Nurses.

  2. NeuroDebian Virtual Machine Deployment Facilitates Trainee-Driven Bedside Neuroimaging Research.

    Science.gov (United States)

    Cohen, Alexander; Kenney-Jung, Daniel; Botha, Hugo; Tillema, Jan-Mendelt

    2017-01-01

    Freely available software, derived from the past 2 decades of neuroimaging research, is significantly more flexible for research purposes than presently available clinical tools. Here, we describe and demonstrate the utility of rapidly deployable analysis software to facilitate trainee-driven translational neuroimaging research. A recipe and video tutorial were created to guide the creation of a NeuroDebian-based virtual computer that conforms to current neuroimaging research standards and can exist within a HIPAA-compliant system. This allows for retrieval of clinical imaging data, conversion to standard file formats, and rapid visualization and quantification of individual patients' cortical and subcortical anatomy. As an example, we apply this pipeline to a pediatric patient's data to illustrate the advantages of research-derived neuroimaging tools in asking quantitative questions "at the bedside." Our goal is to provide a path of entry for trainees to become familiar with common neuroimaging tools and foster an increased interest in translational research.

  3. Bedside resource stewardship in disasters: a provider's dilemma practicing in an ethical gap.

    Science.gov (United States)

    Daniel, Michelle

    2012-01-01

    During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future.

  4. Administrative gatekeeping - a third way between unrestricted patient advocacy and bedside rationing

    DEFF Research Database (Denmark)

    Lauridsen, Sigurd

    2009-01-01

    I shall argue that this dilemma is false, since a third intermediate alternative exists. This alternative, which I term 'administrative gatekeeping', makes it possible for physicians to be involved in rationing while at the same time being genuine advocates of their patients. According to this ideal......, physicians are required to follow fair rules of rationing adopted at higher organizational levels within healthcare systems. At the same time, however, they are prohibited from including considerations of cost in their clinical decisions.......The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside...

  5. Reduction of bioactive substances in stored donor blood: prestorage versus bedside leucofiltration

    DEFF Research Database (Denmark)

    Hammer, J H; Mynster, T; Reimert, C M

    1999-01-01

    Leucocyte filtration has been suggested to improve transfusion products. We studied the effect of prestorage versus bedside leucofiltration on reduction of bioactive substances and leucocyte content in donor blood. Forty-five units of whole blood from healthy blood donors were studied....... Of these units, 9 were stored under standard conditions for 35 d, 9 were leucofiltered after donation and then stored for 35 d, and 3x9 units were stored for 7, 21 and 35 d, respectively, before leucofiltration. Samples were collected from blood units immediately after donation, and before and after...... leucofiltration, and analysed by ELISA and RIA methods for extracellular content of myeloperoxidase (MPO), eosinophil cationic protein (ECP), histamine (HIS) and plasminogen activator inhibitor-1 (PAI-1). Leucocyte content was counted in all samples. In non-filtered blood extracellular MPO, ECP, HIS and PAI-1...

  6. Parental presence on neonatal intensive care unit clinical bedside rounds: randomised trial and focus group discussion

    Science.gov (United States)

    Boswell, Danette; Broom, Margaret; Smith, Judith; Davis, Deborah

    2015-01-01

    Background There are limited data to inform the choice between parental presence at clinical bedside rounds (PPCBR) and non-PPCBR in neonatal intensive care units (NICUs). Methods We performed a single-centre, survey-based, crossed-over randomised trial involving parents of all infants who were admitted to NICU and anticipated to stay >11 days. Parents were randomly assigned using a computer-generated stratified block randomisation protocol to start with PPCBR or non-PPCBR and then crossed over to the other arm after a wash-out period. At the conclusion of each arm, parents completed the ‘NICU Parental Stressor Scale’ (a validated tool) and a satisfaction survey. After completion of the trial, we surveyed all healthcare providers who participated at least in one PPCBR rounding episode. We also offered all participating parents and healthcare providers the opportunity to partake in a focus group discussion regarding PPCBR. Results A total of 72 parents were enrolled in this study, with 63 parents (87%) partially or fully completing the trial. Of the parents who completed the trial, 95% agreed that parents should be allowed to attend clinical bedside rounds. A total of 39 healthcare providers’ surveys were returned and 35 (90%) agreed that parents should be allowed to attend rounds. Nine healthcare providers and 8 parents participated in an interview or focus group, augmenting our understanding of the ways in which PPCBR was beneficial. Conclusions Parents and healthcare providers strongly support PPCBR. NICUs should develop policies allowing PPCBR while mitigating the downsides and concerns of parents and healthcare providers such as decreased education opportunity and confidentiality concerns. Trial registration number Australia and New Zealand Clinical Trials Register number, ACTRN12612000506897. PMID:25711125

  7. A simple bedside test to assess the swallowing dysfunction in Parkinson′s disease

    Directory of Open Access Journals (Sweden)

    S Vinoth Kanna

    2014-01-01

    Full Text Available Background: Swallowing changes are common in Parkinson′s disease (PD. Early identification is essential to avoid complications of aspiration. Objectives: To evaluate the swallowing ability of the PD patients and to correlate it with the indicators of disease progression. Materials and Methods: A total of 100 PD patients (70 males and 30 females aged between 50 years and 70 years with varying stage, duration, and severity were enrolled in a cross-sectional study carried out between January and May 2012. A simple bedside water swallowing test was performed using standard 150 ml of water. Swallowing process was assessed under three categories-swallowing speeds (ml/s, swallowing volume (ml/swallow and swallowing duration (s/swallow. Equal number of age and sex matched controls were also evaluated. Results: All of them completed the task of swallowing. A mean swallowing speed (27.48 ml/s, swallowing volume (28.5 ml/s, and swallowing duration (1.05 s/swallow was established by the control group. The PD patients showed decreased swallowing speed (7.15 ml/s in males and 6.61 ml/s in females, decreased swallowing volume (14.59 ml/swallow and 14 ml/swallow in females, and increased swallowing duration (2.37 s/swallow and 2.42 s/swallow which are statistically significant. There was a significant positive correlation between the severity, duration, and staging of the disease with the swallowing performance and a poor correlation between the subjective reports of dysphagia and the objective performance on water swallow test. Conclusion: The water swallowing test is a simple bedside test to identify the swallowing changes early in PD. It is recommended to do the test in all PD Patients to detect dysphagia early and to intervene appropriately.

  8. Exploration of exposure conditions with a novel wireless detector for bedside digital radiography

    Science.gov (United States)

    Bosmans, Hilde; Nens, Joris; Delzenne, Louis; Marshall, Nicholas; Pauwels, Herman; De Wever, Walter; Oyen, Raymond

    2012-03-01

    We propose, apply and validate an optimization scheme for a new wireless CsI based DR detector in combination with a regular mobile X-ray system for bedside imaging applications. Three different grids were tested in this combination. Signal-difference-to-noise was investigated in two ways, using a 1mm Cu piece in combination with different thicknesses of PMMA and by means of the CDRAD phantom using 10 images per condition and an automated evaluation method. A Figure of Merit (FOM), namely SDNR2/Imparted Energy, was calculated for a large range of exposure conditions, without and with grid in place. Misalignment of the grids was evaluated via the same FOMs. This optimization study was validated with comparative X-ray acquisitions performed on dead bodies. An experienced radiologist scored the quality of several specific aspects for all these exposures. Signal difference to noise ratios measured with the Cu method correlated well with the threshold contrasts from the CDRAD analysis (R2 > 0.9). The analysis showed optimal FOM with detector air kerma rates as typically used in clinical practice. Lower tube voltages provide higher FOM than the higher values but their practical use depends on the limitations of X-ray tubes, linked to patient motion artefacts. The use of high resolution grids should be encouraged, as the FOM increases with 47% at 75kV. These scores from the Visual grading study confirmed the results obtained with the FOM. The switch to (wireless) DR technology for bedside imaging could benefit from devices to improve grid positioning or any scatter reduction technique.

  9. A reliability simulation language for reliability analysis

    International Nuclear Information System (INIS)

    Deans, N.D.; Miller, A.J.; Mann, D.P.

    1986-01-01

    The results of work being undertaken to develop a Reliability Description Language (RDL) which will enable reliability analysts to describe complex reliability problems in a simple, clear and unambiguous way are described. Component and system features can be stated in a formal manner and subsequently used, along with control statements to form a structured program. The program can be compiled and executed on a general-purpose computer or special-purpose simulator. (DG)

  10. Vital Signs-Trucker Safety

    Centers for Disease Control (CDC) Podcasts

    2015-03-03

    This podcast is based on the March 2015 CDC Vital Signs report. In 2012 in the United States, about 317,000 motor vehicle crashes involved a large truck. Twenty-six thousand truck drivers and their passengers were injured in these crashes, and about 700 died. Learn what can be done to help truck drivers stay safe.  Created: 3/3/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 3/3/2015.

  11. knowledge about obstetric danger signs among preg

    African Journals Online (AJOL)

    user

    about knowledge level of pregnant women on obstetric danger signs. The objective of this .... ple size formula for estimating a single population proportion with the ..... subjects mentioned vaginal bleeding as danger sign during pregnancy ...

  12. Signed Young Modules and Simple Specht Modules

    OpenAIRE

    Danz, Susanne; Lim, Kay Jin

    2015-01-01

    By a result of Hemmer, every simple Specht module of a finite symmetric group over a field of odd characteristic is a signed Young module. While Specht modules are parametrized by partitions, indecomposable signed Young modules are parametrized by certain pairs of partitions. The main result of this article establishes the signed Young module labels of simple Specht modules. Along the way we prove a number of results concerning indecomposable signed Young modules that are of independent inter...

  13. Irreducible Specht modules are signed Young modules

    OpenAIRE

    Hemmer, David J.

    2005-01-01

    Recently Donkin defined signed Young modules as a simultaneous generalization of Young and twisted Young modules for the symmetric group. We show that in odd characteristic, if a Specht module $S^\\lambda$ is irreducible, then $S^\\lambda$ is a signed Young module. Thus the set of irreducible Specht modules coincides with the set of irreducible signed Young modules. This provides evidence for our conjecture that the signed Young modules are precisely the class of indecomposable self-dual module...

  14. Dictionaries of African Sign Languages: An Overview

    Science.gov (United States)

    Schmaling, Constanze H.

    2012-01-01

    This article gives an overview of dictionaries of African sign languages that have been published to date most of which have not been widely distributed. After an introduction into the field of sign language lexicography and a discussion of some of the obstacles that authors of sign language dictionaries face in general, I will show problems…

  15. The Legal Recognition of Sign Languages

    Science.gov (United States)

    De Meulder, Maartje

    2015-01-01

    This article provides an analytical overview of the different types of explicit legal recognition of sign languages. Five categories are distinguished: constitutional recognition, recognition by means of general language legislation, recognition by means of a sign language law or act, recognition by means of a sign language law or act including…

  16. Phonological Similarity in American Sign Language.

    Science.gov (United States)

    Hildebrandt, Ursula; Corina, David

    2002-01-01

    Investigates deaf and hearing subjects' ratings of American Sign Language (ASL) signs to assess whether linguistic experience shapes judgments of sign similarity. Findings are consistent with linguistic theories that posit movement and location as core structural elements of syllable structure in ASL. (Author/VWL)

  17. Generating potentially nilpotent full sign patterns

    NARCIS (Netherlands)

    Kim, I.J.; Olesky, D.D.; Shader, B.L.; Driessche, van den P.; Holst, van der H.; Vander Meulen, K.N.

    2009-01-01

    A sign pattern is a matrix with entries in {+,-, 0}. A full sign pattern has no zero entries. The refined inertia of a matrix pattern is defined and techniques are developed for constructing potentially nilpotent full sign patterns. Such patterns are spectrally arbitrary. These techniques can also

  18. Reliability of infarct volumetry: Its relevance and the improvement by a software-assisted approach.

    Science.gov (United States)

    Friedländer, Felix; Bohmann, Ferdinand; Brunkhorst, Max; Chae, Ju-Hee; Devraj, Kavi; Köhler, Yvette; Kraft, Peter; Kuhn, Hannah; Lucaciu, Alexandra; Luger, Sebastian; Pfeilschifter, Waltraud; Sadler, Rebecca; Liesz, Arthur; Scholtyschik, Karolina; Stolz, Leonie; Vutukuri, Rajkumar; Brunkhorst, Robert

    2017-08-01

    Despite the efficacy of neuroprotective approaches in animal models of stroke, their translation has so far failed from bench to bedside. One reason is presumed to be a low quality of preclinical study design, leading to bias and a low a priori power. In this study, we propose that the key read-out of experimental stroke studies, the volume of the ischemic damage as commonly measured by free-handed planimetry of TTC-stained brain sections, is subject to an unrecognized low inter-rater and test-retest reliability with strong implications for statistical power and bias. As an alternative approach, we suggest a simple, open-source, software-assisted method, taking advantage of automatic-thresholding techniques. The validity and the improvement of reliability by an automated method to tMCAO infarct volumetry are demonstrated. In addition, we show the probable consequences of increased reliability for precision, p-values, effect inflation, and power calculation, exemplified by a systematic analysis of experimental stroke studies published in the year 2015. Our study reveals an underappreciated quality problem in translational stroke research and suggests that software-assisted infarct volumetry might help to improve reproducibility and therefore the robustness of bench to bedside translation.

  19. The Triangular Sign, a Useful Diagnostic Marker for Biliary Atresia: A Case Series of Three Irish Infants

    LENUS (Irish Health Repository)

    Smith, A

    2018-06-01

    The triangular cord (TC) sign is the appearance of a triangular shaped echogenic density visualised immediately cranial to the portal vein bifurcation on ultrasonographic examination. Several studies have reported that this ultrasonographic sign is a reliable and helpful marker in identifying Biliary Atresia (BA).

  20. Automatic Road Sign Inventory Using Mobile Mapping Systems

    Science.gov (United States)

    Soilán, M.; Riveiro, B.; Martínez-Sánchez, J.; Arias, P.

    2016-06-01

    The periodic inspection of certain infrastructure features plays a key role for road network safety and preservation, and for developing optimal maintenance planning that minimize the life-cycle cost of the inspected features. Mobile Mapping Systems (MMS) use laser scanner technology in order to collect dense and precise three-dimensional point clouds that gather both geometric and radiometric information of the road network. Furthermore, time-stamped RGB imagery that is synchronized with the MMS trajectory is also available. In this paper a methodology for the automatic detection and classification of road signs from point cloud and imagery data provided by a LYNX Mobile Mapper System is presented. First, road signs are detected in the point cloud. Subsequently, the inventory is enriched with geometrical and contextual data such as orientation or distance to the trajectory. Finally, semantic content is given to the detected road signs. As point cloud resolution is insufficient, RGB imagery is used projecting the 3D points in the corresponding images and analysing the RGB data within the bounding box defined by the projected points. The methodology was tested in urban and road environments in Spain, obtaining global recall results greater than 95%, and F-score greater than 90%. In this way, inventory data is obtained in a fast, reliable manner, and it can be applied to improve the maintenance planning of the road network, or to feed a Spatial Information System (SIS), thus, road sign information can be available to be used in a Smart City context.

  1. Reliability data banks

    International Nuclear Information System (INIS)

    Cannon, A.G.; Bendell, A.

    1991-01-01

    Following an introductory chapter on Reliability, what is it, why it is needed, how it is achieved and measured, the principles of reliability data bases and analysis methodologies are the subject of the next two chapters. Achievements due to the development of data banks are mentioned for different industries in the next chapter, FACTS, a comprehensive information system for industrial safety and reliability data collection in process plants are covered next. CREDO, the Central Reliability Data Organization is described in the next chapter and is indexed separately, as is the chapter on DANTE, the fabrication reliability Data analysis system. Reliability data banks at Electricite de France and IAEA's experience in compiling a generic component reliability data base are also separately indexed. The European reliability data system, ERDS, and the development of a large data bank come next. The last three chapters look at 'Reliability data banks, - friend foe or a waste of time'? and future developments. (UK)

  2. Suncor maintenance and reliability

    Energy Technology Data Exchange (ETDEWEB)

    Little, S. [Suncor Energy, Calgary, AB (Canada)

    2006-07-01

    Fleet maintenance and reliability at Suncor Energy was discussed in this presentation, with reference to Suncor Energy's primary and support equipment fleets. This paper also discussed Suncor Energy's maintenance and reliability standard involving people, processes and technology. An organizational maturity chart that graphed organizational learning against organizational performance was illustrated. The presentation also reviewed the maintenance and reliability framework; maintenance reliability model; the process overview of the maintenance and reliability standard; a process flow chart of maintenance strategies and programs; and an asset reliability improvement process flow chart. An example of an improvement initiative was included, with reference to a shovel reliability review; a dipper trip reliability investigation; bucket related failures by type and frequency; root cause analysis of the reliability process; and additional actions taken. Last, the presentation provided a graph of the results of the improvement initiative and presented the key lessons learned. tabs., figs.

  3. The Accelerator Reliability Forum

    CERN Document Server

    Lüdeke, Andreas; Giachino, R

    2014-01-01

    A high reliability is a very important goal for most particle accelerators. The biennial Accelerator Reliability Workshop covers topics related to the design and operation of particle accelerators with a high reliability. In order to optimize the over-all reliability of an accelerator one needs to gather information on the reliability of many different subsystems. While a biennial workshop can serve as a platform for the exchange of such information, the authors aimed to provide a further channel to allow for a more timely communication: the Particle Accelerator Reliability Forum [1]. This contribution will describe the forum and advertise it’s usage in the community.

  4. Taller-than-wide sign for predicting thyroid microcarcinoma: comparison and combination of two ultrasonographic planes.

    Science.gov (United States)

    Chen, Shun-Ping; Hu, Yuan-Ping; Chen, Bin

    2014-09-01

    The aims of this study were to investigate the accuracy of using the taller-than-wide (TTW) sign in two ultrasonographic planes to predict thyroid microcarcinoma, and to confirm the hypothesis that the presence of a TTW sign in both the transverse and longitudinal ultrasonographic planes strongly suggests thyroid microcarcinoma. Nine hundred forty-two thyroid nodules ≤1 cm were submitted to surgical-histopathologic and ultrasonographic examination. TTW signs were divided into three types based on their detection only in the transverse plane (TTTW type, n = 100), only in the longitudinal plane (LTTW type, n = 61) or in both planes (BTTW type, n = 131). The areas under the receiver operating characteristic curves (A(z)) for the three different TTW signs, as well as for the combination of all TTW signs (ATTW, n = 292), were compared. The results indicated that the A(z) values of the TTTW, LTTW, BTTW and ATTW signs in predicting thyroid microcarcinoma were 0.544, 0.531, 0.627 and 0.702, respectively. The ATTW sign was the most accurate (p 0.05). Therefore, both the LTTW and TTTW signs are reliable markers of thyroid microcarcinoma. The BTTW sign strongly suggests thyroid microcarcinoma. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  5. The Way of the Sign

    DEFF Research Database (Denmark)

    Elias, Camelia

    The Way of the Sign is a book about extraction, about reducing methods of inquiry to the bare bones. It guides students through 10 schools of theory and criticism. The focus is on ‘asking’ each theory to give its best in the simplest way, by making us see what is at stake and how we might respond...... to it. In simple Socratic dialogues, Elias invents scenarios: ‘What is happening?’ Deconstruction asks. And we answer with it: ‘We are buying a mythology.’ ‘How does it make us feel?’ ‘Dumb.’ ‘What is happening?’ Marxism asks. And we answer with it: ‘The rich cheat us.’ ‘How does it make us feel...

  6. Electronic traffic signs: Reflecting upon its transition

    Energy Technology Data Exchange (ETDEWEB)

    Arbaiza Martin, A.E.; Alba, A.L.; Hernando Mazon, A.; Blanch Mico, M.T.

    2016-07-01

    In our days we face a fundamental issue concerning road signs. We may display contents in vertical and horizontal format (static signs, variable message signs, road markings), either on a post, a gantry or a dashboard. And we foresee a coming age where the excellent matrix resolution of painted signs will be truly approached by the resolution of full matrix displays. But we also risk a babel context threatening the universal approach encouraged by international catalogues as the 1968 Convention (ECE/TRANS/196, 2007). And the fundamental risk comes from our decisions regarding how the transition from the contents and formats displayed on static message signs to the ones displayed on electronic signs (in gantries or dashboards) should be. Our work explores this issue specifically, considering the transition from Advance Direction Signs (static message signs, class G, 1 in the 1968 Convention) to what could be termed Advance Location Signs (signs concerning the location of variable events with regards to certain landmarks) developed as an adaptation of the G, 1 class to electronic traffic signs.(Author)

  7. Between the bench, the bedside and the office: The need to build bridges between working neuroscientists and ethicists.

    Science.gov (United States)

    Brosnan, Caragh; Cribb, Alan

    2014-12-01

    This paper presents findings from an empirical study that explored the meaning of ethics in the everyday work of neuroscientists. Observation and interviews were carried out in one neuroscience research group that was involved in bench-to-bedside translational research. We focus here specifically on the scientists' perceptions of bioethics. Interviewees were often unfamiliar with bioethics as a discipline, particularly the more junior members of the group. Those who were aware of its existence largely viewed it as something distant from them, and as either too abstract, not relevant or an alien imposition on their work. Some interviewees themselves pointed to the need for better 'bridge building' between ethical principles and real-world examples drawn from scientific practice, and we argue that this space is where a more empirically grounded ethics may be useful in terms of actually engaging scientists at both the bench and the bedside.

  8. Images in pediatrics: the thymic sail sign and thymic wave sign.

    Science.gov (United States)

    Alves, Nuno D; Sousa, Marta

    2013-01-01

    The authors present a radiographic image portraying the "thymic sail sign" and the "thymic wave sign," both normal findings in infant radiographs and present a short description of these signs. These are distinguished from pathologic findings such as the "spinnaker-sail sign" in pneumomediastinum.

  9. Billing and reimbursement for a bedside toxicology service at a tertiary care academic center during its first fiscal year.

    Science.gov (United States)

    Wiegand, Timothy J; Crane, Peter W; Kamali, Michael; Reif, Marilynn; Wratni, Rose; Montante, Ronald; Loveland, Tracey

    2015-03-01

    A bedside toxicology consult service may improve clinical care, facilitate patient clearance and disposition, and result in potential cost savings for poisoning exposures. Despite this, there is scant data regarding economic feasibility for such a service. Previously published information suggests low hourly reimbursement at approximately $26.00/h at the bedside for toxicology consultations. A bedside toxicology consultant service was initiated in 2011. Coverage was available 24 h a day for 50 out of 52 weeks. Bedside rounding on toxicology consult patients was available 6/7 days per week. The practice is associated with >800 bed teaching institution in a large upstate NY region with elements of urban and suburban practice. Demographic and billing data was collected for all patients consulted upon from July 1, 2011 to June 31, 2012. In charges of $514,941 were generated during the period of data collection. Monthly average was $42,912. Net reimbursement of charges was 29 % of overall charges at $147,792. In terms of total encounters, net collection rate in which something was reimbursed or "paid" against charges for that encounter was 82.6 % of all encounters at 999/1,210. Average encounter time for inpatients, including critical care, was 1.05 h, and the average time spent for outpatients was 1.18 h. Reimbursement rates appear higher than previously reported. Revenue generated from reimbursement from toxicology consultation can result in recouping a substantial portion of a toxicologist's salary or potentially fund fellowship positions and salaries or toxicology division infrastructure.

  10. Bedside ROP screening and telemedicine interpretation integrated to a neonatal transport system: Economic aspects and return on investment analysis.

    Science.gov (United States)

    Kovács, Gábor; Somogyvári, Zsolt; Maka, Erika; Nagyjánosi, László

    Peter Cerny Ambulance Service - Premature Eye Rescue Program (PCA-PERP) uses digital retinal imaging (DRI) with remote interpretation in bedside ROP screening, which has advantages over binocular indirect ophthalmoscopy (BIO) in screening of premature newborns. We aimed to demonstrate that PCA-PERP provides good value for the money and to model the cost ramifications of a similar newly launched system. As DRI was demonstrated to have high diagnostic performance, only the costs of bedside DRI-based screening were compared to those of traditional transport and BIO-based screening (cost-minimization analysis). The total costs of investment and maintenance were analyzed with micro-costing method. A ten-year analysis time-horizon and service provider's perspective were applied. From the launch of PCA-PERP up to the end of 2014, 3722 bedside examinations were performed in the PCA covered central region of Hungary. From 2009 to 2014, PCA-PERP saved 92,248km and 3633 staff working hours, with an annual nominal cost-savings ranging from 17,435 to 35,140 Euro. The net present value was 127,847 Euro at the end of 2014, with a payback period of 4.1years and an internal rate of return of 20.8%. Our model presented the NPVs of different scenarios with different initial investments, annual number of transports and average transport distances. PCA-PERP as bedside screening with remote interpretation, when compared to a transport-based screening with BIO, produced better cost-savings from the perspective of the service provider and provided a return on initial investment within five years after the project initiation. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Human Reliability Program Overview

    Energy Technology Data Exchange (ETDEWEB)

    Bodin, Michael

    2012-09-25

    This presentation covers the high points of the Human Reliability Program, including certification/decertification, critical positions, due process, organizational structure, program components, personnel security, an overview of the US DOE reliability program, retirees and academia, and security program integration.

  12. Power electronics reliability analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Mark A.; Atcitty, Stanley

    2009-12-01

    This report provides the DOE and industry with a general process for analyzing power electronics reliability. The analysis can help with understanding the main causes of failures, downtime, and cost and how to reduce them. One approach is to collect field maintenance data and use it directly to calculate reliability metrics related to each cause. Another approach is to model the functional structure of the equipment using a fault tree to derive system reliability from component reliability. Analysis of a fictitious device demonstrates the latter process. Optimization can use the resulting baseline model to decide how to improve reliability and/or lower costs. It is recommended that both electric utilities and equipment manufacturers make provisions to collect and share data in order to lay the groundwork for improving reliability into the future. Reliability analysis helps guide reliability improvements in hardware and software technology including condition monitoring and prognostics and health management.

  13. Reliability of software

    International Nuclear Information System (INIS)

    Kopetz, H.

    1980-01-01

    Common factors and differences in the reliability of hardware and software; reliability increase by means of methods of software redundancy. Maintenance of software for long term operating behavior. (HP) [de

  14. A comparative study of collimation in bedside chest radiography for preterm infants in two teaching hospitals

    International Nuclear Information System (INIS)

    Stollfuss, J.; Schneider, K.; Krüger-Stollfuss, I.

    2015-01-01

    •Potential factors influencing non-optimal image collimation in the setting of bedside chest X-ray in preterm infants were investigated.•A comparable rate of optimal images was observed in two hospitals.•Size, weight or disease severity had no influence on collimation quality.•Unrelated to the years of experience a large variation of the technician in correct collimation was noted (18–86%).•Individualized quality control and education is necessary. Potential factors influencing non-optimal image collimation in the setting of bedside chest X-ray in preterm infants were investigated. A comparable rate of optimal images was observed in two hospitals. Size, weight or disease severity had no influence on collimation quality. Unrelated to the years of experience a large variation of the technician in correct collimation was noted (18–86%). Individualized quality control and education is necessary. Unnecessary exposure of the abdomen, arms or head may lead to a substantial increase of the radiation dose in portable chest X-rays on the neonatal intensive care unit. The objective was to identify potential factors influencing inappropriate exposure of non-thoracic structures in two teaching hospitals. The study analysed 200 consecutive digital chest radiographs in 20 preterm neonates (mean gestation 25 ± 1 weeks). Demographical data, tube settings and exposure parameters were recorded. To grade the collimation, we used a scoring system with a maximum of 12 exposed non-thoracic structures. Length of gestation, age, the radiographer, years of experience in performing X-rays and the number of in situ catheters or lines, were correlated with collimation quality. There was no significant difference between the rates of optimal images obtained in the two hospitals (0.32 vs 0.39, n.s.). Scores showed that most suboptimal images had only mildly reduced image quality (1.40 ± 1.38 vs 1.20 ± 1.43, n.s.). Length of gestation or presence of surgical drains, catheters and

  15. Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects.

    Science.gov (United States)

    Mankes, Russell F; Silver, Charles D

    2013-02-01

    Drugs in wastewater arise from many sources. For health care, these include excretion and direct disposal (bedside wasting). The present study reports on the dispensing and wasting of 15 controlled substances (CS) at two health care facilities in Albany, NY over a nearly two year period. The study considered measures of ecotoxicity, drug metabolism, excretion and disposal of these CS. Potential alternatives to flushing of CS into wastewaters from healthcare facilities are discussed. Drug medication and waste collection records (12,345) included: numbers of drugs dispensed, returned and wasted. Overall, 8528 g of 15 CS were wasted. Three (midazolam, acetaminophen-codeine and fentanyl) accounted for 87.5% of the total wasted. Wasting varied by hospital, 14 CS at the academic medical center hospital and 8 at the surgical care center were wasted. Liquids were more frequently wasted than tablets or pills. Some combination drugs (acetaminophen (APAP)-codeine) were frequently (50% of drug dispensed) wasted while others were less wasted (APAP-hydrocodone-6.3%; APAP-oxycodone-1.3%). The 8 CS judged more hazardous to aquatic life were: APAP-codeine, APAP-hydrocodone, APAP-oxycodone, alprazolam, diazepam, fentanyl, midazolam, and testosterone. Ketamine, morphine, oxycodone and zolpidem were of lesser acute toxicity based on available LC50 values. These CS might provide a therapeutically equivalent alternative to the more environmentally harmful drugs. In health care facilities, professionals dispose of CS by bedside wasting into water or other receptacles. This can be avoided by returning CS to the hospital's pharmacy department, thence to a licensed distributor. Study of this process of drug wasting can identify opportunities for process improvements. We found 3 CS (APAP-codeine, midazolam and testosterone) where ½ to 1/3 of the drug was wasted and 5 others with 30 to 13% wasted. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment

  16. Bedside Ultrasound of Quadriceps to Predict Rehospitalization and Functional Decline in Hospitalized Elders

    Directory of Open Access Journals (Sweden)

    Ana Clara Guerreiro

    2017-07-01

    Full Text Available ObjectiveTo evaluate the capacity of total anterior thigh thickness, quadriceps muscle thickness, and quadriceps contractile index, all measured by bedside ultrasound, to predict rehospitalization, functional decline, and death in elderly patients 3 months after hospital discharge. To evaluate intra and interobserver reproducibility of the dominant thigh evaluation method by point of care ultrasound.MethodsCohort study of patients aged 65 years or more admitted to a medium complexity unit in a teaching hospital in southern Brazil. Comprehensive geriatric assessment and ultrasound evaluation of the dominant thigh of each participant were performed. After 3 months of hospital discharge, telephone contact was made to evaluate the outcomes of rehospitalization or death and functional decline—assessed by the 100 points Barthel scale and defined as a decrease of five or more points.Results100 participants were included. There was no statistically significant difference between intraobserver measurements in the GEE method analysis (p > 0.05, and the mean bias obtained in Bland–Altman plots was close to zero in all four analyses performed, suggesting good intra and interobserver agreement. There was a significant correlation between the echographic measurements (quadriceps thickness and contractile index and gait speed, timed up and go, and handgrip tests. There was a significant association between contractile index (quadriceps thickness over total anterior thigh thickness multiplied by 100 lower than 60% and functional decline (relative risk 1.35; CI 95% 1.10–1.65; p = 0.003 as well as between the thickness of the quadriceps and rehospitalization or death, in both individuals with preserved walking capacity and in bedridden elders (relative risk 1.34; CI 95% 1.02–1.75; p = 0.04.ConclusionThe ultrasonographic method to evaluate thigh thickness was easily applicable and reproducible. The thickness of the quadriceps could

  17. Early bedside detection of ischemia and rejection in liver transplants by microdialysis.

    Science.gov (United States)

    Håugaa, Håkon; Thorgersen, Ebbe B; Pharo, Anne; Boberg, Kirsten M; Foss, Aksel; Line, Pål Dag; Sanengen, Truls; Almaas, Runar; Grindheim, Guro; Pischke, Soeren Erik; Mollnes, Tom Eirik; Tønnessen, Tor Inge

    2012-07-01

    This study was performed to explore whether lactate, pyruvate, glucose, and glycerol levels sampled via microdialysis catheters in the transplanted liver could be used to detect ischemia and/or rejection. The metabolites were measured at the bedside every 1 to 2 hours after the operation for a median of 10 days. Twelve grafts with biopsy-proven rejection and 9 grafts with ischemia were compared to a reference group of 39 grafts with uneventful courses. The median lactate level was significantly higher in both the ischemia group [5.8 mM (interquartile range = 4.0-11.1 mM)] and the rejection group [2.1 mM (interquartile range = 1.9-2.4 mM)] versus the reference group [1.5 mM (interquartile range = 1.1-1.9 mM), P interquartile range = 155-206 μM)] versus the reference group [124 μM (interquartile range = 102-150 μM), P interquartile range = 23.9-156.7) and 138 μM (interquartile range = 26-260 μM)] versus the reference group [11.8 (interquartile range = 10.6-13.6), P interquartile range = 9-24 μM), P = 0.002]. Ischemia was detected with 100% sensitivity and greater than 90% specificity when a positive test was repeated after 1 hour. In 3 cases of hepatic artery thrombosis, ischemia was detected despite normal blood lactate levels. Consecutive pathological measurements for 6 hours were used to diagnose rejection with greater than 80% sensitivity and specificity at a median of 4 days before the activity of alanine aminotransferase, the concentration of bilirubin in serum, or both increased. In conclusion, bedside measurements of intrahepatic lactate and pyruvate levels were used to detect ischemia and rejection earlier than current standard methods could. Discrimination from an uneventful patient course was achieved. Consequently, intrahepatic graft monitoring with microdialysis may lead to the earlier initiation of graft-saving treatment. Copyright © 2012 American Association for the Study of Liver Diseases.

  18. Reliable Design Versus Trust

    Science.gov (United States)

    Berg, Melanie; LaBel, Kenneth A.

    2016-01-01

    This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

  19. Pocket Handbook on Reliability

    Science.gov (United States)

    1975-09-01

    exponencial distributions Weibull distribution, -xtimating reliability, confidence intervals, relia- bility growth, 0. P- curves, Bayesian analysis. 20 A S...introduction for those not familiar with reliability and a good refresher for those who are currently working in the area. LEWIS NERI, CHIEF...includes one or both of the following objectives: a) prediction of the current system reliability, b) projection on the system reliability for someI future

  20. Bedside Heart Type Fatty Acid Binding Protein (H-FABP): Is an Early Predictive Marker of Cardiac Syncope

    International Nuclear Information System (INIS)

    Sonmez, B. M.; Yilmaz, F.; Durdu, T.; Hakbilir, O.; Ongar, M.; Ozturk, D.; Altinbilek, E.; Kavalci, C.; Turhan, T.

    2015-01-01

    Objective: To determine the value of bedside heart-type fatty acid binding protein in diagnosis of cardiac syncope in patients presenting with syncope or presyncope. Methods: The prospective study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, between September 1, 2010, and January 1, 2011, and comprised patients aged over 18 years who presented with syncope or presyncope. Patients presenting to emergency department within 4 hours of syncope or presyncope underwent a bedside heart-type fatty acid binding protein test measurement. SPSS 16 was used for statistical analysis, Results: Of the 100 patients evaluated, 22(22 percent) were diagnosed with cardiac syncope. Of them, 13(59.1 percent) patients had a positive and 9(40.9 percent) had a negative heart-type fatty acid binding protein result. Consequently, the test result was 12.64 times more positive in patients with cardiac syncope compared to those without. Conclusions: Bedside heart-type fatty acid binding protein, particularly at early phase of myocardial injury, reduces diagnostic and therapeutic uncertainity of cardiac origin in syncope patients. (author)

  1. Effects of "minimally invasive curricular surgery" - a pilot intervention study to improve the quality of bedside teaching in medical education.

    Science.gov (United States)

    Raupach, Tobias; Anders, Sven; Pukrop, Tobias; Hasenfuss, Gerd; Harendza, Sigrid

    2009-09-01

    Bedside teaching is an important element of undergraduate medical education. However, the impact of curricular course structure on student outcome needs to be determined. This study assessed changes in fourth-year medical students' evaluations of clinical teaching sessions before and after the introduction of a new course format. The curricular structure of bedside teaching sessions in cardiology was modified without changing the amount of teaching time. Clinical teachers were instructed about the new teaching format and learning objectives. The new format implemented for adult but not paediatric cardiology sessions was piloted with 143 students in winter 2007/08. By computing effect sizes, evaluation results were compared to data obtained from 185 students before the intervention. Significant rating increases were observed for adult cardiology teaching sessions (Cohen's d = 0.66) but not paediatric cardiology sessions (d = 0.22). In addition to improving the structure and organization of the course, the intervention significantly impacted on students' perceptions of their learning outcome regarding practical skills (d = 0.69). Minimal curricular changes combined with basic faculty development measures significantly increase students' perception of learning outcome. Curricular structure needs to be considered when planning bedside teaching sessions in medical undergraduate training.

  2. Principles of Bridge Reliability

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle; Nowak, Andrzej S.

    The paper gives a brief introduction to the basic principles of structural reliability theory and its application to bridge engineering. Fundamental concepts like failure probability and reliability index are introduced. Ultimate as well as serviceability limit states for bridges are formulated......, and as an example the reliability profile and a sensitivity analyses for a corroded reinforced concrete bridge is shown....

  3. Reliability in engineering '87

    International Nuclear Information System (INIS)

    Tuma, M.

    1987-01-01

    The participants heard 51 papers dealing with the reliability of engineering products. Two of the papers were incorporated in INIS, namely ''Reliability comparison of two designs of low pressure regeneration of the 1000 MW unit at the Temelin nuclear power plant'' and ''Use of probability analysis of reliability in designing nuclear power facilities.''(J.B.)

  4. Reliable computer systems.

    Science.gov (United States)

    Wear, L L; Pinkert, J R

    1993-11-01

    In this article, we looked at some decisions that apply to the design of reliable computer systems. We began with a discussion of several terms such as testability, then described some systems that call for highly reliable hardware and software. The article concluded with a discussion of methods that can be used to achieve higher reliability in computer systems. Reliability and fault tolerance in computers probably will continue to grow in importance. As more and more systems are computerized, people will want assurances about the reliability of these systems, and their ability to work properly even when sub-systems fail.

  5. Human factor reliability program

    International Nuclear Information System (INIS)

    Knoblochova, L.

    2017-01-01

    The human factor's reliability program was at Slovenske elektrarne, a.s. (SE) nuclear power plants. introduced as one of the components Initiatives of Excellent Performance in 2011. The initiative's goal was to increase the reliability of both people and facilities, in response to 3 major areas of improvement - Need for improvement of the results, Troubleshooting support, Supporting the achievement of the company's goals. The human agent's reliability program is in practice included: - Tools to prevent human error; - Managerial observation and coaching; - Human factor analysis; -Quick information about the event with a human agent; -Human reliability timeline and performance indicators; - Basic, periodic and extraordinary training in human factor reliability(authors)

  6. Formal faculty observation and assessment of bedside skills for 3rd-year neurology clerks.

    Science.gov (United States)

    Thompson Stone, Robert; Mooney, Christopher; Wexler, Erika; Mink, Jonathan; Post, Jennifer; Jozefowicz, Ralph F

    2016-11-22

    To evaluate the feasibility and utility of instituting a formalized bedside skills evaluation (BSE) for 3rd-year medical students on the neurology clerkship. A neurologic BSE was developed for 3rd - year neurology clerks at the University of Rochester for the 2012-2014 academic years. Faculty directly observed 189 students completing a full history and neurologic examination on real inpatients. Mock grades were calculated utilizing the BSE in the final grade, and number of students with a grade difference was determined when compared to true grade. Correlation was explored between the BSE and clinical scores, National Board of Medical Examiners (NBME) scores, case complexity, and true final grades. A survey was administered to students to assess their clinical skills exposure and the usefulness of the BSE. Faculty completed and submitted a BSE form for 88.3% of students. There was a mock final grade change for 13.2% of students. Correlation coefficients between BSE score and clinical score/NBME score were 0.36 and 0.35, respectively. A statistically significant effect of BSE was found on final clerkship grade (F 2,186 = 31.9, p neurology clerkship was feasible. Low correlation between BSE score and other evaluations indicated a unique measurement to contribute to student grade. Using real patients with differing case complexity did not alter the grade. © 2016 American Academy of Neurology.

  7. Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study

    Directory of Open Access Journals (Sweden)

    de Graaf J

    2009-01-01

    Full Text Available Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

  8. Foucault at the bedside: a critical analysis of empowering a healthy lifestyle.

    Science.gov (United States)

    Devisch, Ignaas; Vanheule, Stijn

    2015-06-01

    Since quite a few years, philosophy is heading towards the bedside of the patient: the practice of philosophy has stepped out of its ivory tower, it seems, to deal with empirical or practical questions. Apart from the advantages, we should keep in mind the importance of a critical analysis of medical or clinical practice as such. If ethics partakes the clinical stage, it runs the risk only to discuss the how question and to forget the more fundamental what or why questions: what are we doing exactly and why is it good for? Starting from the principle of the empowerment of the patient, we will demonstrate how the discourse on empowerment in health care seems to forget a profound reflection upon this principle as such. By rehearsing some basics from the governmentality theory of Michel Foucault and the actualization of it by Nicolas Rose, we will argue how philosophical investigation in medical-ethical evolutions such as empowerment of the patient is still needed to understand what is really going on in today's clinical practice. © 2015 John Wiley & Sons, Ltd.

  9. Simulation as a Central Feature of an Elective Course: Does Simulated Bedside Care Impact Learning?

    Directory of Open Access Journals (Sweden)

    Michael C. Thomas

    2018-05-01

    Full Text Available A three-credit, simulation-based, emergency medicine elective course was designed and offered to doctor of pharmacy students for two years. The primary objective was to determine if there was a difference in exam performance stratified by student simulation experience, namely either as an active observer or as part of bedside clinical care. The secondary objective was to report student satisfaction. Examination performance for simulation-based questions was compared based on the student role (evaluator versus clinical using the Student’s t-test. Summary responses from Likert scale-based student satisfaction responses were collected. A total of 24 students took the course: 12 in each offering. Performance was similar whether the student was assigned to the evaluation team or the clinical team for all of the comparisons (mid-term and final 2015 and 2016, all p-values > 0.05. Students were very satisfied with the course. Of the 19 questions assessing the qualitative aspects of the course, all of the students agreed or strongly agreed to 17 statements, and all of the students were neutral, agreed, or strongly agreed to the remaining two statements. Direct participation and active observation in simulation-based experiences appear to be equally valuable in the learning process, as evidenced by examination performance.

  10. Time-resolved near-infrared technique for bedside monitoring of absolute cerebral blood flow

    Science.gov (United States)

    Diop, Mamadou; Tichauer, Kenneth M.; Elliott, Jonathan T.; Migueis, Mark; Lee, Ting-Yim; St. Lawrence, Keith

    2010-02-01

    A primary focus of neurointensive care is monitoring the injured brain to detect harmful events that can impair cerebral blood flow (CBF). Since current non-invasive bedside methods can only indirectly assess blood flow, the goal of this research was to develop an optical technique for measuring absolute CBF. A time-resolved near-infrared (NIR) apparatus was built and its ability to accurately measure changes in optical properties was demonstrated in tissue-mimicking phantoms. The time-resolved system was combined with a bolus-tracking method for measuring CBF using the dye indocyanine green (ICG) as an intravascular flow tracer. Cerebral blood flow was measured in newborn piglets and for comparison, CBF was concurrently measured using a previously developed continuous-wave NIR method. Measurements were acquired with both techniques under three conditions: normocapnia, hypercapnia and following occlusion of the carotid arteries. Mean CBF values (N = 3) acquired with the TR-NIR system were 31.9 +/- 11.7 ml/100g/min during occlusion, 39.7 +/- 1.6 ml/100g/min at normocapnia, and 58.8 +/- 9.9 ml/100g/min at hypercapnia. Results demonstrate that the developed TR-NIR technique has the sensitivity to measure changes in CBF; however, the CBF measurements were approximately 25% lower than the values obtained with the CW-NIRS technique.

  11. What happens to the pleural space affected by malignant effusion after bedside pleurodesis?

    Science.gov (United States)

    de Araujo, Pedro H X N; Terra, Ricardo M; da Silva Santos, Thiago; Chate, Rodrigo C; de Paiva, Antonio F L; Pêgo-Fernandes, Paulo M

    2018-03-24

    Evaluate radiological characteristics of postpleurodesis pleural space of patients with recurrent malignant pleural effusion(RMPE). Prospective cohort study including patients with RPME treated with bedside pleurodesis. We used CT scans to calculate pleural cavity volume immediately before pleurodesis(iCT) and 30 days after(CT30). Radiological evolution was calculated by the difference between pleural volumes on CT30 and iCT(Δvolume). We categorized initial pleural volume as small(space(≥500 mL) and Δvolume as positive(>254.49 mL), unchanged(≥-268.77-≤ 254.49 mL), or negative(space(62.06%) and 33 large(37.93%). Clinical failure occurred in 7.4% of small space group and in 24.6% of large(P = 0.051, OR4.0(CI:1.098-14.570)). In small space group, 27.77% evolved with positive, 66.66% with unchanged and 5.55% with negative Δvolume. In the large space group these numbers were respectively 21.21%, 27.27%, and 51.51%. There is significant variability on pleural space volume. However, pleural volume remains unchanged in many cases. Besides that, more than half patients with initial large space coursed with relevant reduction. Finally, patients with initial small space presented a greater chance of clinical success. © 2018 Wiley Periodicals, Inc.

  12. Faith-to-faith at the bedside: theological and ethical issues in ecumenical clinical chaplaincy.

    Science.gov (United States)

    Mellon, Brad F

    2003-04-01

    Chaplains who serve in a clinical context often minister to patients representing a wide variety of faiths. In order to offer the best pastoral care possible, the chaplain should first possess a set of personal theological convictions as a foundation for ministry. Second, he or she needs to be sensitive to the beliefs and practices of the patients. Third, it is vital to develop a relationship of acceptance and trust not only with patients under their care, but also with family members and caregivers as well. At times, situations will arise that are purely religious or theological. In a clinical setting, however, the questions and problems that arise more often are both theological and ethical. It is beneficial for the chaplain to be involved in an ethics committee, where the specifics of each case can be discussed, and staff can offer counsel to patients and their families. This study examines issues that chaplains face at the bedside, such as terminal care, life-prolonging treatments, dementia, persistent vegetative state, and euthanasia-assisted suicide. We will discover that those who are involved in clinical pastoral ministry will be called upon to be a comforter, mediator, educator, ethicist, and counselor.

  13. Evaluation of Four Bedside Test Systems for Card Performance, Handling and Safety.

    Science.gov (United States)

    Giebel, Felix; Picker, Susanne M; Gathof, Birgit S

    2008-01-01

    SUMMARY: OBJECTIVE: Pretransfusion ABO compatibility testing is a simple and required precaution against ABO-incompatible transfusion, which is one of the greatest threats in transfusion medicine. While distinct agglutination is most important for correct test interpretation, protection against infectious diseases and ease of handling are crucial for accurate test performance. Therefore, the aim of this study was to evaluate differences in test card design, handling, and user safety. DESIGN: Four different bedside test cards with pre-applied antibodies were evaluated by 100 medical students using packed red blood cells of different ABO blood groups. Criteria of evaluation were: agglutination, labelling, handling, and safety regarding possible user injuries. Criteria were rated subjectively according to German school notes ranging from 1 = very good to 6 = very bad/insufficient. RESULTS: Overall, all cards received very good/good marks. The ABO blood group was identified correctly in all cases. Three cards (no. 1, no. 3, no. 4) received statistically significant (p labelling (1.5 vs. 2.2-2.4), handling (1.9-2.0 vs. 2.5), and user safety (2.5 vs. 3.4). Analysis of card self-explanation revealed no remarkable differences. CONCLUSION: Despite good performance of all card systems tested, the best results when including all criteria evaluated were obtained with card no. 4 (particularly concerning clear agglutination), followed by cards no. 2, no. 1, and no. 3.

  14. When families cannot "let go": ethical decision-making at the bedside.

    Science.gov (United States)

    Thomas, J E; Latimer, E J

    1989-09-01

    Shared decision-making at the bedside is now a regular feature of medical practice. When disagreements arise between a patient and family members caregivers sometimes find themselves caught in a complex tangle of human relationships that strains monochrome ethical thinking. The patient's expressed wishes are often compromised for the sake of the family's needs. Conversely, a unilateral appeal for patient autonomy may prove insensitive to the hurt and the needs of the family. We describe a relatively unsuccessful attempt by a patient's caregivers to buy time to maximize the interests of the patient and her family and discuss the way in which the family dynamics militated against the rather obvious solution of promoting the patient's right to refuse treatment. The purpose of this article is not to evoke sympathy for health care professionals in dealing with such conflicts but rather to heighten awareness of the issues at stake and to stimulate thinking about ways and means to bring about a more favourable outcome than the one described here.

  15. Driving Organizational Change From the Bedside: The AACN Clinical Scene Investigator Academy.

    Science.gov (United States)

    Lacey, Susan R; Goodyear-Bruch, Caryl; Olney, Adrienne; Hanson, Dave; Altman, Marian S; Varn-Davis, Natasha S; Brinker, Debbie; Lavandero, Ramón; Cox, Karen S

    2017-08-01

    Staff nurses are pivotal in leading change related to quality improvement efforts, although many lack skills to steer change from the bedside. The American Association of Critical-Care Nurses (AACN) staff nurse leadership program, Clinical Scene Investigator (CSI) Academy, teaches and empowers staff nurses in leadership skills and change concepts to translate evidence into practice affecting patient outcomes. To describe the curriculum of the AACN CSI Academy that provides staff nurses with the leadership skills required to create unit-based change projects that positively impact patient/family outcomes. The curriculum of the Academy included leadership topics, communication, change concepts, quality improvement methods, project management, and data management and analysis. Each team of participants collected project data to show improvements in patient care. The program evaluation used many data sources to assess the program effectiveness, relating to the professional growth of the participant nurses. The participants assessed project patient outcomes, sustainability, and spread. The first cohort of CSI participants included 164 direct care nurses from 42 hospitals in 6 cities. They rated the Academy highly in the program evaluation, and they reported that the Academy contributed to their professional development. The individual hospital quality improvement projects resulted in positive patient and estimated fiscal outcomes that were generally sustained 1 year after the program. With the skills, tools, and support obtained from participation in the CSI Academy, staff nurses can make substantial contributions to their organizations in clinical and possibly fiscal outcomes. ©2017 American Association of Critical-Care Nurses.

  16. Misleading signs in acute vertigo.

    Science.gov (United States)

    Lance, Sean; Mossman, Stuart Scott

    2018-04-01

    The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them. © 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.

  17. A tour in sign language

    CERN Document Server

    François Briard

    2016-01-01

    In early May, CERN welcomed a group of deaf children for a tour of Microcosm and a Fun with Physics demonstration.   On 4 May, around ten children from the Centre pour enfants sourds de Montbrillant (Montbrillant Centre for Deaf Children), a public school funded by the Office médico-pédagogique du canton de Genève, took a guided tour of the Microcosm exhibition and were treated to a Fun with Physics demonstration. The tour guides’ explanations were interpreted into sign language in real time by a professional interpreter who accompanied the children, and the pace and content were adapted to maximise the interaction with the children. This visit demonstrates CERN’s commitment to remaining as widely accessible as possible. To this end, most of CERN’s visit sites offer reduced-mobility access. In the past few months, CERN has also welcomed children suffering from xeroderma pigmentosum (a genetic disorder causing extreme sensiti...

  18. Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients.

    Science.gov (United States)

    Killingsworth, Christopher D; Taylor, Steven M; Patterson, Mark A; Weinberg, Jordan A; McGwin, Gerald; Melton, Sherry M; Reiff, Donald A; Kerby, Jeffrey D; Rue, Loring W; Jordan, William D; Passman, Marc A

    2010-05-01

    Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population. Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients. After a defined lead-in phase to allow dissemination of techniques, the algorithm was prospectively implemented on January 1, 2008. Data were collected for 1 year using accepted reporting standards and a quality assurance review performed based on intent-to-treat at 6, 12, and 18 months. As defined in the prospectively implemented algorithm, 109 patients met criteria for IVUS-directed bedside IVC filter placement. Technical feasibility was 98.1%. Only 2 patients had inadequate IVUS visualization for bedside filter placement and required subsequent placement in the endovascular suite. Technical success, defined as proper deployment in an infrarenal position, was achieved in 104 of the remaining 107 patients (97.2%). The filter was permanent in 21 (19.6%) and retrievable in 86 (80.3%). The single-puncture technique was used in 101 (94.4%), with additional dual access required in 6 (5.6%). Periprocedural complications were rare but included malpositioning requiring retrieval and repositioning in three patients, filter tilt >/=15 degrees in two, and arteriovenous fistula in one. The 30-day mortality rate for the bedside group was 5.5%, with no filter-related deaths. Successful placement of IVC filters using IVUS-guided imaging at the bedside in critically ill patients can be established through an evidence-based prospectively

  19. An electronic dictionary of Danish Sign Language

    DEFF Research Database (Denmark)

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas

    2008-01-01

    Compiling sign language dictionaries has in the last 15 years changed from most often being simply collecting and presenting signs for a given gloss in the surrounding vocal language to being a complicated lexicographic task including all parts of linguistic analysis, i.e. phonology, phonetics......, morphology, syntax and semantics. In this presentation we will give a short overview of the Danish Sign Language dictionary project. We will further focus on lemma selection and some of the problems connected with lemmatisation....

  20. Persistence of external signs in Pacific herring Clupea pallasii Valenciennes with ichthyophoniasis

    Science.gov (United States)

    Hart, Lucas M.; Conway, Carla M.; Elliott, Diane G.; Hershberger, Paul K.

    2016-01-01

    The progression of external signs of Ichthyophonus infection in Pacific herring Clupea pallasii Valenciennes was highly variable and asynchronous after intraperitoneal injection with pure parasite preparations; however, external signs generally persisted through the end of the study (429 days post-exposure). Observed signs included papules, erosions and ulcers. The prevalence of external signs plateaued 35 days post-exposure and persisted in 73–79% of exposed individuals through the end of the first experiment (147 days post-exposure). Among a second group of infected herring, external signs completely resolved in only 10% of the fish after 429 days. The onset of mortality preceded the appearance of external signs. Histological examination of infected skin and skeletal muscle tissues indicated an apparent affinity of the parasite for host red muscle. Host responses consisted primarily of granulomatous inflammation, fibrosis and necrosis in the skeletal muscle and other tissues. The persistence and asynchrony of external signs and host response indicated that they were neither a precursor to host mortality nor did they provide reliable metrics for hindcasting on the date of exposure. However, the long-term persistence of clinical signs in Pacific herring may be useful in ascertaining the population-level impacts of ichthyophoniasis in regularly observed populations.

  1. Significance of satellite sign and spot sign in predicting hematoma expansion in spontaneous intracerebral hemorrhage.

    Science.gov (United States)

    Yu, Zhiyuan; Zheng, Jun; Ali, Hasan; Guo, Rui; Li, Mou; Wang, Xiaoze; Ma, Lu; Li, Hao; You, Chao

    2017-11-01

    Hematoma expansion is related to poor outcome in spontaneous intracerebral hemorrhage (ICH). Recently, a non-enhanced computed tomography (CT) based finding, termed the 'satellite sign', was reported to be a novel predictor for poor outcome in spontaneous ICH. However, it is still unclear whether the presence of the satellite sign is related to hematoma expansion. Initial computed tomography angiography (CTA) was conducted within 6h after ictus. Satellite sign on non-enhanced CT and spot sign on CTA were detected by two independent reviewers. The sensitivity and specificity of both satellite sign and spot sign were calculated. Receiver-operator analysis was conducted to evaluate their predictive accuracy for hematoma expansion. This study included 153 patients. Satellite sign was detected in 58 (37.91%) patients and spot sign was detected in 38 (24.84%) patients. Among 37 patients with hematoma expansion, 22 (59.46%) had satellite sign and 23 (62.16%) had spot sign. The sensitivity and specificity of satellite sign for prediction of hematoma expansion were 59.46% and 68.97%, respectively. The sensitivity and specificity of spot sign were 62.16% and 87.07%, respectively. The area under the curve (AUC) of satellite sign was 0.642 and the AUC of spot sign was 0.746. (P=0.157) CONCLUSION: Our results suggest that the satellite sign is an independent predictor for hematoma expansion in spontaneous ICH. Although spot sign has the higher predictive accuracy, satellite sign is still an acceptable predictor for hematoma expansion when CTA is unavailable. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Gesture, sign, and language: The coming of age of sign language and gesture studies.

    Science.gov (United States)

    Goldin-Meadow, Susan; Brentari, Diane

    2017-01-01

    How does sign language compare with gesture, on the one hand, and spoken language on the other? Sign was once viewed as nothing more than a system of pictorial gestures without linguistic structure. More recently, researchers have argued that sign is no different from spoken language, with all of the same linguistic structures. The pendulum is currently swinging back toward the view that sign is gestural, or at least has gestural components. The goal of this review is to elucidate the relationships among sign language, gesture, and spoken language. We do so by taking a close look not only at how sign has been studied over the past 50 years, but also at how the spontaneous gestures that accompany speech have been studied. We conclude that signers gesture just as speakers do. Both produce imagistic gestures along with more categorical signs or words. Because at present it is difficult to tell where sign stops and gesture begins, we suggest that sign should not be compared with speech alone but should be compared with speech-plus-gesture. Although it might be easier (and, in some cases, preferable) to blur the distinction between sign and gesture, we argue that distinguishing between sign (or speech) and gesture is essential to predict certain types of learning and allows us to understand the conditions under which gesture takes on properties of sign, and speech takes on properties of gesture. We end by calling for new technology that may help us better calibrate the borders between sign and gesture.

  3. Reliability and safety engineering

    CERN Document Server

    Verma, Ajit Kumar; Karanki, Durga Rao

    2016-01-01

    Reliability and safety are core issues that must be addressed throughout the life cycle of engineering systems. Reliability and Safety Engineering presents an overview of the basic concepts, together with simple and practical illustrations. The authors present reliability terminology in various engineering fields, viz.,electronics engineering, software engineering, mechanical engineering, structural engineering and power systems engineering. The book describes the latest applications in the area of probabilistic safety assessment, such as technical specification optimization, risk monitoring and risk informed in-service inspection. Reliability and safety studies must, inevitably, deal with uncertainty, so the book includes uncertainty propagation methods: Monte Carlo simulation, fuzzy arithmetic, Dempster-Shafer theory and probability bounds. Reliability and Safety Engineering also highlights advances in system reliability and safety assessment including dynamic system modeling and uncertainty management. Cas...

  4. Towards overcoming the Monte Carlo sign problem with tensor networks

    Directory of Open Access Journals (Sweden)

    Bañuls Mari Carmen

    2017-01-01

    Full Text Available The study of lattice gauge theories with Monte Carlo simulations is hindered by the infamous sign problem that appears under certain circumstances, in particular at non-zero chemical potential. So far, there is no universal method to overcome this problem. However, recent years brought a new class of non-perturbative Hamiltonian techniques named tensor networks, where the sign problem is absent. In previous work, we have demonstrated that this approach, in particular matrix product states in 1+1 dimensions, can be used to perform precise calculations in a lattice gauge theory, the massless and massive Schwinger model. We have computed the mass spectrum of this theory, its thermal properties and real-time dynamics. In this work, we review these results and we extend our calculations to the case of two flavours and non-zero chemical potential. We are able to reliably reproduce known analytical results for this model, thus demonstrating that tensor networks can tackle the sign problem of a lattice gauge theory at finite density.

  5. Reward uncertainty enhances incentive salience attribution as sign-tracking

    Science.gov (United States)

    Anselme, Patrick; Robinson, Mike J. F.; Berridge, Kent C.

    2014-01-01

    Conditioned stimuli (CSs) come to act as motivational magnets following repeated association with unconditioned stimuli (UCSs) such as sucrose rewards. By traditional views, the more reliably predictive a Pavlovian CS-UCS association, the more the CS becomes attractive. However, in some cases, less predictability might equal more motivation. Here we examined the effect of introducing uncertainty in CS-UCS association on CS strength as an attractive motivation magnet. In the present study, Experiment 1 assessed the effects of Pavlovian predictability versus uncertainty about reward probability and/or reward magnitude on the acquisition and expression of sign-tracking (ST) and goal-tracking (GT) responses in an autoshaping procedure. Results suggested that uncertainty produced strongest incentive salience expressed as sign-tracking. Experiment 2 examined whether a within-individual temporal shift from certainty to uncertainty conditions could produce a stronger CS motivational magnet when uncertainty began, and found that sign-tracking still increased after the shift. Overall, our results support earlier reports that ST responses become more pronounced in the presence of uncertainty regarding CS-UCS associations, especially when uncertainty combines both probability and magnitude. These results suggest that Pavlovian uncertainty, although diluting predictability, is still able to enhance the incentive motivational power of particular CSs. PMID:23078951

  6. Segmentation of British Sign Language (BSL): Mind the gap!

    OpenAIRE

    Orfanidou, E.; McQueen, J.; Adam, R.; Morgan, G.

    2015-01-01

    This study asks how users of British Sign Language (BSL) recognize individual signs in connected sign sequences. We examined whether this is achieved through modality-specific or modality-general segmentation procedures. A modality-specific feature of signed languages is that, during continuous signing, there are salient transitions between sign locations. We used the sign-spotting task to ask if and how BSL signers use these transitions in segmentation. A total of 96 real BSL signs were prec...

  7. Human reliability analysis

    International Nuclear Information System (INIS)

    Dougherty, E.M.; Fragola, J.R.

    1988-01-01

    The authors present a treatment of human reliability analysis incorporating an introduction to probabilistic risk assessment for nuclear power generating stations. They treat the subject according to the framework established for general systems theory. Draws upon reliability analysis, psychology, human factors engineering, and statistics, integrating elements of these fields within a systems framework. Provides a history of human reliability analysis, and includes examples of the application of the systems approach

  8. Reliability of electronic systems

    International Nuclear Information System (INIS)

    Roca, Jose L.

    2001-01-01

    Reliability techniques have been developed subsequently as a need of the diverse engineering disciplines, nevertheless they are not few those that think they have been work a lot on reliability before the same word was used in the current context. Military, space and nuclear industries were the first ones that have been involved in this topic, however not only in these environments it is that it has been carried out this small great revolution in benefit of the increase of the reliability figures of the products of those industries, but rather it has extended to the whole industry. The fact of the massive production, characteristic of the current industries, drove four decades ago, to the fall of the reliability of its products, on one hand, because the massively itself and, for other, to the recently discovered and even not stabilized industrial techniques. Industry should be changed according to those two new requirements, creating products of medium complexity and assuring an enough reliability appropriated to production costs and controls. Reliability began to be integral part of the manufactured product. Facing this philosophy, the book describes reliability techniques applied to electronics systems and provides a coherent and rigorous framework for these diverse activities providing a unifying scientific basis for the entire subject. It consists of eight chapters plus a lot of statistical tables and an extensive annotated bibliography. Chapters embrace the following topics: 1- Introduction to Reliability; 2- Basic Mathematical Concepts; 3- Catastrophic Failure Models; 4-Parametric Failure Models; 5- Systems Reliability; 6- Reliability in Design and Project; 7- Reliability Tests; 8- Software Reliability. This book is in Spanish language and has a potentially diverse audience as a text book from academic to industrial courses. (author)

  9. Operational safety reliability research

    International Nuclear Information System (INIS)

    Hall, R.E.; Boccio, J.L.

    1986-01-01

    Operating reactor events such as the TMI accident and the Salem automatic-trip failures raised the concern that during a plant's operating lifetime the reliability of systems could degrade from the design level that was considered in the licensing process. To address this concern, NRC is sponsoring the Operational Safety Reliability Research project. The objectives of this project are to identify the essential tasks of a reliability program and to evaluate the effectiveness and attributes of such a reliability program applicable to maintaining an acceptable level of safety during the operating lifetime at the plant

  10. Circuit design for reliability

    CERN Document Server

    Cao, Yu; Wirth, Gilson

    2015-01-01

    This book presents physical understanding, modeling and simulation, on-chip characterization, layout solutions, and design techniques that are effective to enhance the reliability of various circuit units.  The authors provide readers with techniques for state of the art and future technologies, ranging from technology modeling, fault detection and analysis, circuit hardening, and reliability management. Provides comprehensive review on various reliability mechanisms at sub-45nm nodes; Describes practical modeling and characterization techniques for reliability; Includes thorough presentation of robust design techniques for major VLSI design units; Promotes physical understanding with first-principle simulations.

  11. Signs, dispositions, and semiotic scaffolding.

    Science.gov (United States)

    Fernández, Eliseo

    2015-12-01

    In theoretical work we distinguish living beings from inanimate objects on the basis of some paramount attributes, such as agency and autonomy. These abstract features are not directly accessible to our scrutiny, but we surmise their nature through observation of the purpose-oriented behavior of organisms. I intend to show that organismal purposefulness springs from the intrinsic, constitutive kind of finality that is the hallmark of all semiotic transactions. To this aim I develop a dispositionalist account of organismal causation based on a distinction between two kinds of causal dispositions: fixed (efficient) dispositions and traveling dispositions. Fixed dispositions are rigidly attached to physical structures and processes; these are the dispositions regularly invoked in current discussions of causal explanation. Traveling dispositions are able to move freely from one location to another by becoming embodied into suitable supporting media. I introduce these notions to articulate a view of semiosis I deem best suited to the life sciences, and contend that sign tokens are vehicles of traveling dispositions. This account places the origin of purposive behavior at the interaction of physical and semiotic causation. To properly motivate the discussion I briefly review some recent developments in the philosophy of science concerning various forms of causation invoked by scientists across disciplines to frame explanations and make predictions. The ensuing discussion gives particular prominence to mechanistic (as distinct from mechanicist) explanatory accounts of biological phenomena. This review is followed by a brief characterization of a "nomological machine," a comprehensive schema introduced and developed by Nancy Cartwright with the goal of explaining causal mechanisms in a general setting. By capitalizing on this model's heuristic virtues I seek to formulate a compelling view of the interactions between physical and semiotic causation at play in semiotic

  12. Historical Development of Hong Kong Sign Language

    Science.gov (United States)

    Sze, Felix; Lo, Connie; Lo, Lisa; Chu, Kenny

    2013-01-01

    This article traces the origins of Hong Kong Sign Language (hereafter HKSL) and its subsequent development in relation to the establishment of Deaf education in Hong Kong after World War II. We begin with a detailed description of the history of Deaf education with a particular focus on the role of sign language in such development. We then…

  13. Research Ethics in Sign Language Communities

    Science.gov (United States)

    Harris, Raychelle; Holmes, Heidi M.; Mertens, Donna M.

    2009-01-01

    Codes of ethics exist for most professional associations whose members do research on, for, or with sign language communities. However, these ethical codes are silent regarding the need to frame research ethics from a cultural standpoint, an issue of particular salience for sign language communities. Scholars who write from the perspective of…

  14. Visual cortex entrains to sign language.

    Science.gov (United States)

    Brookshire, Geoffrey; Lu, Jenny; Nusbaum, Howard C; Goldin-Meadow, Susan; Casasanto, Daniel

    2017-06-13

    Despite immense variability across languages, people can learn to understand any human language, spoken or signed. What neural mechanisms allow people to comprehend language across sensory modalities? When people listen to speech, electrophysiological oscillations in auditory cortex entrain to slow ([Formula: see text]8 Hz) fluctuations in the acoustic envelope. Entrainment to the speech envelope may reflect mechanisms specialized for auditory perception. Alternatively, flexible entrainment may be a general-purpose cortical mechanism that optimizes sensitivity to rhythmic information regardless of modality. Here, we test these proposals by examining cortical coherence to visual information in sign language. First, we develop a metric to quantify visual change over time. We find quasiperiodic fluctuations in sign language, characterized by lower frequencies than fluctuations in speech. Next, we test for entrainment of neural oscillations to visual change in sign language, using electroencephalography (EEG) in fluent speakers of American Sign Language (ASL) as they watch videos in ASL. We find significant cortical entrainment to visual oscillations in sign language sign is strongest over occipital and parietal cortex, in contrast to speech, where coherence is strongest over the auditory cortex. Nonsigners also show coherence to sign language, but entrainment at frontal sites is reduced relative to fluent signers. These results demonstrate that flexible cortical entrainment to language does not depend on neural processes that are specific to auditory speech perception. Low-frequency oscillatory entrainment may reflect a general cortical mechanism that maximizes sensitivity to informational peaks in time-varying signals.

  15. Phonological Awareness for American Sign Language

    Science.gov (United States)

    Corina, David P.; Hafer, Sarah; Welch, Kearnan

    2014-01-01

    This paper examines the concept of phonological awareness (PA) as it relates to the processing of American Sign Language (ASL). We present data from a recently developed test of PA for ASL and examine whether sign language experience impacts the use of metalinguistic routines necessary for completion of our task. Our data show that deaf signers…

  16. Signs of Alcohol Abuse and Addiction

    Science.gov (United States)

    ... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Alcohol Facts » Signs of Alcohol Abuse and Addiction Signs of Alcohol Abuse and Addiction Listen ©istock. ...

  17. Signs of Cocaine Abuse and Addiction

    Science.gov (United States)

    ... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Cocaine (Coke, Crack) Facts » Signs of Cocaine Use and Addiction Signs of Cocaine Use and Addiction Listen ©istock. ...

  18. Signs of Painkiller Abuse and Addiction

    Science.gov (United States)

    ... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Pain Medicine (Oxy, Vike) Facts » Signs of Pain Medicine Abuse and Addiction Signs of Pain Medicine Abuse and Addiction Listen © ...

  19. Signs of Heroin Abuse and Addiction

    Science.gov (United States)

    ... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Heroin (Smack, Junk) Facts » Signs of Heroin Use and Addiction Signs of Heroin Use and Addiction Listen Heroin ...

  20. Signs of Marijuana Abuse and Addiction

    Science.gov (United States)

    ... Used Drugs in the Past Drug Use Prevention Phone Numbers and Websites Search Share You are here Home » Drugs That People Abuse » Marijuana (Weed, Pot) Facts » Signs of Marijuana Use and Addiction Signs of Marijuana Use and Addiction Listen ©istock. ...

  1. Sign Detection Theory and Its Applications.

    Science.gov (United States)

    Heine, M. H.

    1984-01-01

    Offers characterization of sign-transmission which is more general than conventional signal-transmission theory. Concepts and terminology, formal description of individual communications process, reconciliation with classical signal-detection theory, applications of sign-detection formalism to information retrieval on MEDLINE database, and a…

  2. Signs: een wetenschappelijk tijdschrift in transatlantisch perspectief

    Directory of Open Access Journals (Sweden)

    Ieme van der Poel

    1997-06-01

    Full Text Available Het Amerikaanse feministische tijdschrift Signs is een belangrijke bron voor de receptie van het Franse feminisme in Amerika. Bovendien geeft het een indruk van het verschil tussen de academische, Amerikaanse vrouwenstudies enerzijds, en de literair en politiek getinte Franse vrouwenbeweging anderzijds. Ieme van der Poel analyseert de jaargangen van Signs tussen 1975 en 1981 vanuit deze gezichtspunten.

  3. Smartphone Based Traffic Sign Inventory and Assessment.

    Science.gov (United States)

    2016-01-01

    Road signs are an important part of the infrastructure and are needed to ensure smooth and : safe traffic flow. Faded, occluded, damaged or vandalized signs can confuse or misinform : drivers and lead to unsafe driving behavior. E.g. if a driver is n...

  4. CDC Vital Signs-Preventing Stroke Deaths

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the September 2017 CDC Vital Signs report. Each year, more than 140,000 people die and many survivors face disability. Eighty percent of strokes are preventable. Learn the signs of stroke and how to prevent them.

  5. 23 CFR 750.707 - Nonconforming signs.

    Science.gov (United States)

    2010-04-01

    ... was lawfully erected but does not comply with the provisions of State law or State regulations passed... affected by the State law or regulations. For example, paper signs nailed to trees, abandoned signs and the... abandonment or discontinuance. Where a State establishes a period of more than one (1) year as a reasonable...

  6. Infant Sign Training and Functional Analysis

    Science.gov (United States)

    Normand, Matthew P.; Machado, Mychal A.; Hustyi, Kristin M.; Morley, Allison J.

    2011-01-01

    We taught manual signs to typically developing infants using a reversal design and caregiver-nominated stimuli. We delivered the stimuli on a time-based schedule during baseline. During the intervention, we used progressive prompting and reinforcement, described by Thompson et al. (2004, 2007), to establish mands. Following sign training, we…

  7. CDC Vital Signs: Progress on Childhood Obesity

    Science.gov (United States)

    ... VitalSigns – Childhood Obesity [PSA – 0:60 seconds] VitalSigns – Obesidad en niños: [PODCAST – 1:15 minutes] Childhood Overweight ... Prevention and Control MedlinePlus – Obesity in Children MedlinePlus – Obesidad en niños Top of Page Get Email Updates ...

  8. Words Recognized as Units: Systematic Signs.

    Science.gov (United States)

    Carlin, John

    1997-01-01

    This historical article proposes that students with deafness in the early grades should be taught easy and familiar words by appropriate sign-language gestures on the fingers and by writing, and that the simple rules of grammar should be explained in the signs in the order of the words. (CR)

  9. Tritium in Exit Signs | RadTown USA | US EPA

    Science.gov (United States)

    2017-08-07

    Many exit signs contain tritium to light the sign without batteries or electricity. Using tritium in exit signs allows the sign to remain lit if the power goes out. Tritium is most dangerous when it is inhaled or swallowed. Never tamper with a tritium exit sign. If a tritium exit sign is broken, leave the area immediately and notify the building maintenance staff.

  10. Sharing Vital Signs between mobile phone applications.

    Science.gov (United States)

    Karlen, Walter; Dumont, Guy A; Scheffer, Cornie

    2014-01-01

    We propose a communication library, ShareVitalSigns, for the standardized exchange of vital sign information between health applications running on mobile platforms. The library allows an application to request one or multiple vital signs from independent measurement applications on the Android OS. Compatible measurement applications are automatically detected and can be launched from within the requesting application, simplifying the work flow for the user and reducing typing errors. Data is shared between applications using intents, a passive data structure available on Android OS. The library is accompanied by a test application which serves as a demonstrator. The secure exchange of vital sign information using a standardized library like ShareVitalSigns will facilitate the integration of measurement applications into diagnostic and other high level health monitoring applications and reduce errors due to manual entry of information.

  11. Road Signs for UV-Completion

    CERN Document Server

    Dvali, Gia; Gomez, Cesar

    2012-01-01

    We confront the concepts of Wilsonian UV-completion versus self-completion by Classicalization in theories with derivatively-coupled scalars. We observe that the information about the UV-completion road is encoded in the sign of the derivative terms. We note that the sign of the derivative couplings for which there is no consistent Wilsonian UV-completion is the one that allows for consistent classicalons. This is an indication that for such a sign the vertex must be treated as fundamental and the theory self-protects against potential inconsistencies, such as superluminality, via self-completion by classicalization. Applying this reasoning to the UV-completion of the Standard Model, we see that the information about the Higgs versus classicalization is encoded in the sign of the scattering amplitude of longitudinal W-bosons. Negative sign excludes Higgs or any other weakly-coupled Wilsonian physics.

  12. Eigen-Gradients for Traffic Sign Recognition

    Directory of Open Access Journals (Sweden)

    Sheila Esmeralda Gonzalez-Reyna

    2013-01-01

    Full Text Available Traffic sign detection and recognition systems include a variety of applications like autonomous driving, road sign inventory, and driver support systems. Machine learning algorithms provide useful tools for traffic sign identification tasks. However, classification algorithms depend on the preprocessing stage to obtain high accuracy rates. This paper proposes a road sign characterization method based on oriented gradient maps and the Karhunen-Loeve transform in order to improve classification performance. Dimensionality reduction may be important for portable applications on resource constrained devices like FPGAs; therefore, our approach focuses on achieving a good classification accuracy by using a reduced amount of attributes compared to some state-of-the-art methods. The proposed method was tested using German Traffic Sign Recognition Benchmark, reaching a dimensionality reduction of 99.3% and a classification accuracy of 95.9% with a Multi-Layer Perceptron.

  13. Brain networks predict metabolism, diagnosis and prognosis at the bedside in disorders of consciousness.

    Science.gov (United States)

    Chennu, Srivas; Annen, Jitka; Wannez, Sarah; Thibaut, Aurore; Chatelle, Camille; Cassol, Helena; Martens, Géraldine; Schnakers, Caroline; Gosseries, Olivia; Menon, David; Laureys, Steven

    2017-08-01

    Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging. Using graph theory, we visualize and quantify spectral connectivity estimated from electroencephalography as a dense brain network. Our findings demonstrate that key quantitative metrics of these networks correlate with the continuum of behavioural recovery in patients, ranging from those diagnosed as unresponsive, through those who have emerged from minimally conscious, to the fully conscious locked-in syndrome. In particular, a network metric indexing the presence of densely interconnected central hubs of connectivity discriminated behavioural consciousness with accuracy comparable to that achieved by expert assessment with positron emission tomography. We also show that this metric correlates strongly with brain metabolism. Further, with classification analysis, we predict the behavioural diagnosis, brain metabolism and 1-year clinical outcome of individual patients. Finally, we demonstrate that assessments of brain networks show robust connectivity in patients diagnosed as unresponsive by clinical consensus, but later rediagnosed as minimally conscious with the Coma Recovery Scale-Revised. Classification analysis of their brain network identified each of these misdiagnosed patients as minimally conscious, corroborating their behavioural diagnoses. If deployed at the bedside in the clinical context, such network measurements could complement systematic behavioural assessment and help reduce the high misdiagnosis rate reported

  14. Bedside identification of patients at risk for PVC-induced cardiomyopathy: Is ECG useful?

    Science.gov (United States)

    Garster, Noelle C; Henrikson, Charles A

    2017-07-01

    Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10% of total beats. Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4% (n = 1,128), 3.5% (n = 32), 4.3% (n = 25), and 16.6% (n = 55), respectively, which represent statistically significant differences (P ECG for ≥10% PVC Holter burden was 58%. Negative predictive value for 0 PVCs on ECG was 98%. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72% and 93.6%, respectively, when utilizing a positive ECG result as one PVC or more, and 44% and 98.9%, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden. © 2017 Wiley Periodicals, Inc.

  15. The auditory oddball paradigm revised to improve bedside detection of consciousness in behaviorally unresponsive patients.

    Science.gov (United States)

    Morlet, Dominique; Ruby, Perrine; André-Obadia, Nathalie; Fischer, Catherine

    2017-11-01

    Active paradigms requiring subjects to engage in a mental task on request have been developed to detect consciousness in behaviorally unresponsive patients. Using auditory ERPs, the active condition consists in orienting patient's attention toward oddball stimuli. In comparison with passive listening, larger P300 in the active condition identifies voluntary processes. However, contrast between these two conditions is usually too weak to be detected at the individual level. To improve test sensitivity, we propose as a control condition to actively divert the subject's attention from the auditory stimuli with a mental imagery task that has been demonstrated to be within the grasp of the targeted patients: navigate in one's home. Twenty healthy subjects were presented with a two-tone oddball paradigm in the three following condition: (a) passive listening, (b) mental imagery, (c) silent counting of deviant stimuli. Mental imagery proved to be more efficient than passive listening to lessen P300 response to deviant tones as compared with the active counting condition. An effect of attention manipulation (oriented vs. diverted) was observed in 19/20 subjects, of whom 18 showed the expected P300 effect and 1 showed an effect restricted to the N2 component. The only subject showing no effect also proved insufficient engagement in the tasks. Our study demonstrated the efficiency of diverting attention using mental imagery to improve the sensitivity of the active oddball paradigm. Using recorded instructions and requiring a small number of electrodes, the test was designed to be conveniently and economically used at the patient's bedside. © 2017 Society for Psychophysiological Research.

  16. EEG in children, in the laboratory or at the patient's bedside.

    Science.gov (United States)

    Kaminska, A; Cheliout-Heraut, F; Eisermann, M; Touzery de Villepin, A; Lamblin, M D

    2015-03-01

    In pediatrics, EEG recordings are performed on patients from the neonatal period up to young adults. This means adapting techniques to many different conditions, concerning not only the patient's age, the need for asepsis and the patient's behavior, but also the environment (e.g. in the laboratory, at the patient's bedside, or in the neonatal intensive care unit [NICU]). Technical requirements depend on age, indication and the type of examination; in infancy, there should be a minimum of 12 EEG electrodes, ECG and respiration recording. In epileptology, surface EMG is also necessary to characterize the type of seizures and refine the diagnosis of epilepsy syndrome, on which physicians will base their treatment choice. The role of the EEG technician is essential because the quality of the recording, its analysis and conclusion will depend on the quality of the technical set-up and the interaction with the child. Sleep is a systematic part of the study up to the age of 5 years for several reasons: sleep EEG yields information on brain maturation; the EEG tracing during wakefulness can contain too many artefacts; and some grapho-elements, key to the diagnosis, only appear during sleep. The time of the examination must be chosen according to the child's usual nap times, possibly after sleep deprivation. Grapho-elements and spatio-temporal organization of the EEG vary with age, and normal variants and unusual aspects are quite wide for any given age; this is why a physician experienced in pediatric EEG should perform the interpretation. This chapter concerns EEG performed in infants, children and adolescents, its technical aspects according to age and indications (general pediatrics, emergency, epilepsy). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. The predictive diagnostic value of serial daily bedside ultrasonography for severe dengue in Indonesian adults.

    Directory of Open Access Journals (Sweden)

    Meta Michels

    Full Text Available BACKGROUND: Identification of dengue patients at risk for progressing to severe disease is difficult. Significant plasma leakage is a hallmark of severe dengue infection which can suddenly lead to hypovolemic shock around the time of defervescence. We hypothesized that the detection of subclinical plasma leakage may identify those at risk for severe dengue. The aim of the study was to determine the predictive diagnostic value of serial ultrasonography for severe dengue. METHODOLOGY/PRINCIPAL FINDINGS: Daily bedside ultrasounds were performed with a handheld ultrasound device in a prospective cohort of adult Indonesians with dengue. Timing, localization and relation to dengue severity of the ultrasonography findings were determined, as well as the relation with serial hematocrit and albumin values. The severity of dengue was retrospectively determined by WHO 2009 criteria. A total of 66 patients with proven dengue infection were included in the study of whom 11 developed severe dengue. Presence of subclinical plasma leakage at enrollment had a positive predictive value of 35% and a negative predictive value of 90% for severe dengue. At enrollment, 55% of severe dengue cases already had subclinical plasma leakage, which increased to 91% during the subsequent days. Gallbladder wall edema was more pronounced in severe than in non-severe dengue patients and often preceded ascites/pleural effusion. Serial hematocrit and albumin measurements failed to identify plasma leakage and patients at risk for severe dengue. CONCLUSIONS/SIGNIFICANCE: Serial ultrasonography, in contrast to existing markers such as hematocrit, may better identify patients at risk for development of severe dengue. Patients with evidence of subclinical plasma leakage and/or an edematous gallbladder wall by ultrasonography merit intensive monitoring for development of complications.

  18. Sociolinguistic Variation and Change in British Sign Language Number Signs: Evidence of Leveling?

    Science.gov (United States)

    Stamp, Rose; Schembri, Adam; Fenlon, Jordan; Rentelis, Ramas

    2015-01-01

    This article presents findings from the first major study to investigate lexical variation and change in British Sign Language (BSL) number signs. As part of the BSL Corpus Project, number sign variants were elicited from 249 deaf signers from eight sites throughout the UK. Age, school location, and language background were found to be significant…

  19. Information structure in Russian Sign Language and Sign Language of the Netherlands

    NARCIS (Netherlands)

    Kimmelman, V.

    2014-01-01

    This dissertation explores Information Structure in two sign languages: Sign Language of the Netherlands and Russian Sign Language. Based on corpus data and elicitation tasks we show how topic and focus are expressed in these languages. In particular, we show that topics can be marked syntactically

  20. Signed Language Working Memory Capacity of Signed Language Interpreters and Deaf Signers

    Science.gov (United States)

    Wang, Jihong; Napier, Jemina

    2013-01-01

    This study investigated the effects of hearing status and age of signed language acquisition on signed language working memory capacity. Professional Auslan (Australian sign language)/English interpreters (hearing native signers and hearing nonnative signers) and deaf Auslan signers (deaf native signers and deaf nonnative signers) completed an…

  1. AUTOMATIC ROAD SIGN INVENTORY USING MOBILE MAPPING SYSTEMS

    Directory of Open Access Journals (Sweden)

    M. Soilán

    2016-06-01

    Full Text Available The periodic inspection of certain infrastructure features plays a key role for road network safety and preservation, and for developing optimal maintenance planning that minimize the life-cycle cost of the inspected features. Mobile Mapping Systems (MMS use laser scanner technology in order to collect dense and precise three-dimensional point clouds that gather both geometric and radiometric information of the road network. Furthermore, time-stamped RGB imagery that is synchronized with the MMS trajectory is also available. In this paper a methodology for the automatic detection and classification of road signs from point cloud and imagery data provided by a LYNX Mobile Mapper System is presented. First, road signs are detected in the point cloud. Subsequently, the inventory is enriched with geometrical and contextual data such as orientation or distance to the trajectory. Finally, semantic content is given to the detected road signs. As point cloud resolution is insufficient, RGB imagery is used projecting the 3D points in the corresponding images and analysing the RGB data within the bounding box defined by the projected points. The methodology was tested in urban and road environments in Spain, obtaining global recall results greater than 95%, and F-score greater than 90%. In this way, inventory data is obtained in a fast, reliable manner, and it can be applied to improve the maintenance planning of the road network, or to feed a Spatial Information System (SIS, thus, road sign information can be available to be used in a Smart City context.

  2. Hawaii Electric System Reliability

    Energy Technology Data Exchange (ETDEWEB)

    Loose, Verne William [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Silva Monroy, Cesar Augusto [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2012-08-01

    This report addresses Hawaii electric system reliability issues; greater emphasis is placed on short-term reliability but resource adequacy is reviewed in reference to electric consumers’ views of reliability “worth” and the reserve capacity required to deliver that value. The report begins with a description of the Hawaii electric system to the extent permitted by publicly available data. Electrical engineering literature in the area of electric reliability is researched and briefly reviewed. North American Electric Reliability Corporation standards and measures for generation and transmission are reviewed and identified as to their appropriateness for various portions of the electric grid and for application in Hawaii. Analysis of frequency data supplied by the State of Hawaii Public Utilities Commission is presented together with comparison and contrast of performance of each of the systems for two years, 2010 and 2011. Literature tracing the development of reliability economics is reviewed and referenced. A method is explained for integrating system cost with outage cost to determine the optimal resource adequacy given customers’ views of the value contributed by reliable electric supply. The report concludes with findings and recommendations for reliability in the State of Hawaii.

  3. Hawaii electric system reliability.

    Energy Technology Data Exchange (ETDEWEB)

    Silva Monroy, Cesar Augusto; Loose, Verne William

    2012-09-01

    This report addresses Hawaii electric system reliability issues; greater emphasis is placed on short-term reliability but resource adequacy is reviewed in reference to electric consumers' views of reliability %E2%80%9Cworth%E2%80%9D and the reserve capacity required to deliver that value. The report begins with a description of the Hawaii electric system to the extent permitted by publicly available data. Electrical engineering literature in the area of electric reliability is researched and briefly reviewed. North American Electric Reliability Corporation standards and measures for generation and transmission are reviewed and identified as to their appropriateness for various portions of the electric grid and for application in Hawaii. Analysis of frequency data supplied by the State of Hawaii Public Utilities Commission is presented together with comparison and contrast of performance of each of the systems for two years, 2010 and 2011. Literature tracing the development of reliability economics is reviewed and referenced. A method is explained for integrating system cost with outage cost to determine the optimal resource adequacy given customers' views of the value contributed by reliable electric supply. The report concludes with findings and recommendations for reliability in the State of Hawaii.

  4. Improving machinery reliability

    CERN Document Server

    Bloch, Heinz P

    1998-01-01

    This totally revised, updated and expanded edition provides proven techniques and procedures that extend machinery life, reduce maintenance costs, and achieve optimum machinery reliability. This essential text clearly describes the reliability improvement and failure avoidance steps practiced by best-of-class process plants in the U.S. and Europe.

  5. LED system reliability

    NARCIS (Netherlands)

    Driel, W.D. van; Yuan, C.A.; Koh, S.; Zhang, G.Q.

    2011-01-01

    This paper presents our effort to predict the system reliability of Solid State Lighting (SSL) applications. A SSL system is composed of a LED engine with micro-electronic driver(s) that supplies power to the optic design. Knowledge of system level reliability is not only a challenging scientific

  6. Integrated system reliability analysis

    DEFF Research Database (Denmark)

    Gintautas, Tomas; Sørensen, John Dalsgaard

    Specific targets: 1) The report shall describe the state of the art of reliability and risk-based assessment of wind turbine components. 2) Development of methodology for reliability and risk-based assessment of the wind turbine at system level. 3) Describe quantitative and qualitative measures...

  7. Reliability of neural encoding

    DEFF Research Database (Denmark)

    Alstrøm, Preben; Beierholm, Ulrik; Nielsen, Carsten Dahl

    2002-01-01

    The reliability with which a neuron is able to create the same firing pattern when presented with the same stimulus is of critical importance to the understanding of neuronal information processing. We show that reliability is closely related to the process of phaselocking. Experimental results f...

  8. The 'pre-erosive' radiologic signs of rheumatoid arthritis in soft tissue radiography of the hands

    International Nuclear Information System (INIS)

    Maekelae, P.; Virtama, P.

    1978-01-01

    Soft tissue radiography of the hands using the mammographic immersion technique was performed on 119 patients, having definite or classical rheumatoid arthritis, and on 123 controls of matching age, sex, and professional distribution. A total of 7744 finger joints and carpal borders were investigated for joint swelling, periarticular edema, pre-erosive and erosive bone changes, joint space narrowing, and osteoarthritic joint margin spurs. Slight joint swelling and pre-erosive bone changes were found in connection with osteoarthritic joint changes in elderly control patients. Periarticular edema and moderate to massive joint swelling were quite reliable signs for synovitis. The incidence of pre-erosive bone signs was significantly greater in the rheumatoid arthritis group than in the control group, especially in patients less than 60 years old. These signs can be regarded as suggestive of rheumatoid arthritis; probability diagnosis could be performed using these signs and the Bayesian approach. (orig.) [de

  9. 'pre-erosive' radiologic signs of rheumatoid arthritis in soft tissue radiography of the hands

    Energy Technology Data Exchange (ETDEWEB)

    Maekelae, P; Virtama, P [Turku Univ. (Finland). Dept. of Diagnostic Radiology

    1978-01-01

    Soft tissue radiography of the hands using the mammographic immersion technique was performed on 119 patients, having definite or classical rheumatoid arthritis, and on 123 controls of matching age, sex, and professional distribution. A total of 7744 finger joints and carpal borders were investigated for joint swelling, periarticular edema, pre-erosive and erosive bone changes, joint space narrowing, and osteoarthritic joint margin spurs. Slight joint swelling and pre-erosive bone changes were found in connection with osteoarthritic joint changes in elderly control patients. Periarticular edema and moderate to massive joint swelling were quite reliable signs for synovitis. The incidence of pre-erosive bone signs was significantly greater in the rheumatoid arthritis group than in the control group, especially in patients less than 60 years old. These signs can be regarded as suggestive of rheumatoid arthritis; probability diagnosis could be performed using these signs and the Bayesian approach.

  10. Signs of Life on Venus

    Science.gov (United States)

    Ksanfomality, L.

    2012-04-01

    The search for "habitable zones" in extrasolar planetary systems is based on the premise of "normal" physical conditions in a habitable zone, i.e. pressure, temperature range, and atmospheric composition similar to those on the Earth. However, one should not exclude completely the possibility of the existence of life at relatively high temperatures, despite the fact that at the first glance it seems impossible. The planet Venus with its dense, hot (735 K), oxigenless CO2 - atmosphere and high 92 bar-pressure at the surface could be the natural laboratory for the studies of this type. Amid exoplanets, celestial bodies with the physical conditions similar to the Venusian can be met. The only existing data of actual close-in observations of Venus' surface are the results of a series of missions of the soviet VENERA landers which took place the 1970's and 80's in the atmosphere and on the surface of Venus. For 36 and 29 years since these missions, respectively, I repeatedly returned to the obtained images of the Venus' surface in order to reveal on them any unusual objects observed in the real conditions of Venus. The new analysis of the Venus' panoramas was based on the search of unusual elements in two ways. Since the efficiency of the VENERA landers maintained for a long time they produced a large number of primary television panoramas during the lander's work. Thus, one can try to detect: (a) any differences in successive images (appearance or disappearance of parts of the image or change of their shape), and understand what these changes are related to (e.g., wind), and whether they are related to hypothetical habitability of a planet. Another sign (b) of the wanted object is their morphological peculiarities which distinguishes them from the ordinary surface details. The results of VENERA-9 (1975) and VENERA -13 (1982) are of the main interest. A few relatively large objects ranging from a decimeter to half meter and with unusual morphology were observed in some

  11. Design reliability engineering

    International Nuclear Information System (INIS)

    Buden, D.; Hunt, R.N.M.

    1989-01-01

    Improved design techniques are needed to achieve high reliability at minimum cost. This is especially true of space systems where lifetimes of many years without maintenance are needed and severe mass limitations exist. Reliability must be designed into these systems from the start. Techniques are now being explored to structure a formal design process that will be more complete and less expensive. The intent is to integrate the best features of design, reliability analysis, and expert systems to design highly reliable systems to meet stressing needs. Taken into account are the large uncertainties that exist in materials, design models, and fabrication techniques. Expert systems are a convenient method to integrate into the design process a complete definition of all elements that should be considered and an opportunity to integrate the design process with reliability, safety, test engineering, maintenance and operator training. 1 fig

  12. Bayesian methods in reliability

    Science.gov (United States)

    Sander, P.; Badoux, R.

    1991-11-01

    The present proceedings from a course on Bayesian methods in reliability encompasses Bayesian statistical methods and their computational implementation, models for analyzing censored data from nonrepairable systems, the traits of repairable systems and growth models, the use of expert judgment, and a review of the problem of forecasting software reliability. Specific issues addressed include the use of Bayesian methods to estimate the leak rate of a gas pipeline, approximate analyses under great prior uncertainty, reliability estimation techniques, and a nonhomogeneous Poisson process. Also addressed are the calibration sets and seed variables of expert judgment systems for risk assessment, experimental illustrations of the use of expert judgment for reliability testing, and analyses of the predictive quality of software-reliability growth models such as the Weibull order statistics.

  13. Clinical Implications of Cluster Analysis-Based Classification of Acute Decompensated Heart Failure and Correlation with Bedside Hemodynamic Profiles.

    Directory of Open Access Journals (Sweden)

    Tariq Ahmad

    Full Text Available Classification of acute decompensated heart failure (ADHF is based on subjective criteria that crudely capture disease heterogeneity. Improved phenotyping of the syndrome may help improve therapeutic strategies.To derive cluster analysis-based groupings for patients hospitalized with ADHF, and compare their prognostic performance to hemodynamic classifications derived at the bedside.We performed a cluster analysis on baseline clinical variables and PAC measurements of 172 ADHF patients from the ESCAPE trial. Employing regression techniques, we examined associations between clusters and clinically determined hemodynamic profiles (warm/cold/wet/dry. We assessed association with clinical outcomes using Cox proportional hazards models. Likelihood ratio tests were used to compare the prognostic value of cluster data to that of hemodynamic data.We identified four advanced HF clusters: 1 male Caucasians with ischemic cardiomyopathy, multiple comorbidities, lowest B-type natriuretic peptide (BNP levels; 2 females with non-ischemic cardiomyopathy, few comorbidities, most favorable hemodynamics; 3 young African American males with non-ischemic cardiomyopathy, most adverse hemodynamics, advanced disease; and 4 older Caucasians with ischemic cardiomyopathy, concomitant renal insufficiency, highest BNP levels. There was no association between clusters and bedside-derived hemodynamic profiles (p = 0.70. For all adverse clinical outcomes, Cluster 4 had the highest risk, and Cluster 2, the lowest. Compared to Cluster 4, Clusters 1-3 had 45-70% lower risk of all-cause mortality. Clusters were significantly associated with clinical outcomes, whereas hemodynamic profiles were not.By clustering patients with similar objective variables, we identified four clinically relevant phenotypes of ADHF patients, with no discernable relationship to hemodynamic profiles, but distinct associations with adverse outcomes. Our analysis suggests that ADHF classification using

  14. Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients’ Families in the United States

    Directory of Open Access Journals (Sweden)

    Anup C. Katheria

    2018-04-01

    Full Text Available BackgroundWhile delayed umbilical cord clamping in preterm infants has shown to improve long-term neurological outcomes, infants who are thought to need resuscitation do not receive delayed cord clamping even though they may benefit the most. A mobile resuscitation platform allows infants to be resuscitated at the mother’s bedside with the cord intact. The newborn is supplied with placental blood during the resuscitation in view of the mother. The objective of the study is to assess the usability and acceptability of mobile resuscitation platform, LifeStart trolley, among the infants’ parents and perinatal providers.MethodsA resuscitation platform was present during every delivery that required advanced neonatal providers for high-risk deliveries. Perinatal providers and parents of the infants were given a questionnaire shortly after the delivery.Results60 neonatal subjects were placed on the trolley. The majority of deliveries were high risk for meconium-stained amniotic fluid (43%, and non-reassuring fetal heart rate (45%. About 50% of neonatal providers felt that there were some concerns regarding access to the baby. No parents were uncomfortable with the bedside neonatal interventions, and most parents perceived that communication was improved because of the proximity to the care team.ConclusionBedside resuscitation with umbilical cord intact through the use of a mobile resuscitation trolley is feasible, safe, and effective, but about half of the perinatal providers expressed concerns. Logistical issues such as improved space management and/or delivery setup should be considered in centers planning to perform neonatal resuscitation with an intact cord.

  15. Hand-carried ultrasound performed at bedside in cardiology inpatient setting – a comparative study with comprehensive echocardiography

    Directory of Open Access Journals (Sweden)

    Ramires Jose F

    2004-11-01

    Full Text Available Abstract Background Hand-carried ultrasound (HCU devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE, in cardiology inpatient setting. Methods We studied 44 consecutive patients (mean age 54 ± 18 years, 25 men who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training and considered as the gold standard. Results There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58. There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85, aortic regurgitation (kappa = 0.89, and tricuspid regurgitation (Kappa = 0.74. A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters. Conclusion Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.

  16. Percutaneous catheter drainage of thoracic fluid: the usefulness and safety of bedside trocar placement under ultrasound guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon [Seoul Medical Center, Seoul (Korea, Republic of)

    2006-07-15

    The author wanted to evaluate the usefulness and safety of the trocar technique for US-guided bedside catheter placement into thoracic fluid collections, and this technique has generally been reserved for the larger or superficial fluid collections. 42 drainage procedures were performed in 38 patients at the bedside. The patients were positioned supine or semi-upright. A drainage catheter system with a stylet and cannula assembly was used and all of the catheters were inserted using the trocar technique. The procedures consisted of drainage of empyema (n=14), malignant effusion (n=13), lung abscess (n=3), massive transudate (n=8), hemothorax (n=2) and chest wall hematoma (n=2). The clinical results were classified as successful (complete and partially successful), failure or undetermined. The medical records and images were retrospectively reviewed to evaluate the success rate, the complications and the procedure time. Technical success was achieved in all of the 42 procedures. With using the trocar technique, all the catheters were placed into even the small collections without significant complications. Drainage was successful in 36 (85.7%) of the 42 procedures. The average volume of thoracic fluid that was aspirated manually at the time of catheter placement was 420 mL (range: 35 to 1470 mL). The procedure time was less than 10 minutes from US-localization to complete catheter placement in all of the procedures. The trocar technique under US guidance can be an efficient and safe alternative to the Seldinger or guide-wire exchange technique for bedside catheter placement in the critically ill or hemodynamically unstable patients.

  17. Validation of a new bedside echoscopic heart examination resulting in an improvement in echo-lab workflow.

    Science.gov (United States)

    Réant, Patricia; Dijos, Marina; Arsac, Florence; Mignot, Aude; Cadenaule, Fabienne; Aumiaux, Annette; Jimenez, Christine; Dufau, Marilyne; Prévost, Alain; Pillois, Xavier; Fort, Patrick; Roudaut, Raymond; Lafitte, Stéphane

    2011-03-01

    In daily cardiology practice, porters are usually required to transfer inpatients who need an echocardiogram to the echocardiographic department (echo-lab). To assess echo-lab personnel workflow and patient transfer delay by comparing the use of a new, ultraportable, echoscopic, pocket-sized device at the bedside with patient transfer to the echo-lab for conventional transthoracic echocardiography, in patients needing pericardial control after cardiac invasive procedures. After validation of echoscopic capabilities for pericardial effusion, left ventricular function and mitral regurgitation grade compared with conventional echocardiography, we evaluated echo-lab personnel workflow and time to perform bedside echoscopy for pericardial control evaluation after invasive cardiac procedures. This strategy was compared with conventional evaluation at the echo-lab, in terms of personnel workflow, and patients' transfer, waiting and examination times. Concordance between echoscopy and conventional echocardiography for evaluation of pericardial effusion was good (0.97; kappa value 0.86). For left ventricular systolic function and mitral regurgitation evaluations, concordances were 0.96 (kappa value 0.90) and 0.96 (kappa value 0.86), respectively. In the second part of the study, the mean total time required in the bedside echoscopy group was 20.3±5.4 mins vs. 66.0±16.4 mins in the conventional echo-lab group (pporters in 100% of cases; 69% of patients needed a wheelchair. The use of miniaturized echoscopic tools for pericardial control after invasive cardiac procedures was feasible and accurate, allowing improvement in echo-lab workflow and avoiding patient waiting time and transfer. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  18. Case Study: Zutphen : Estimates of levee system reliability

    NARCIS (Netherlands)

    Roscoe, K.; Kothuis, Baukje; Kok, Matthijs

    2017-01-01

    Estimates of levee system reliability can conflict with experience and intuition. For example, a very high failure probability may be computed while no evidence of failure has been observed, or a very low failure probability when signs of failure have been detected.

  19. From bench to bedside: successful translational nanomedicine: highlights of the Third Annual Meeting of the American Academy of Nanomedicine.

    Science.gov (United States)

    Wei, Chiming; Liu, Nanhai; Xu, Pingyi; Heller, Mike; Tomalia, Donald A; Haynie, Donald T; Chang, Esther H; Wang, Kuan; Lee, Yoon-Sik; Lyubchenko, Yuri L; Bawa, Raj; Tian, Ryan; Hanes, Justin; Pun, Suzie; Meiners, Jens-Christian; Guo, Peixuan

    2007-12-01

    The Third Annual Meeting of the American Academy of Nanomedicine (AANM) was held at the University of California San Diego, in San Diego, California during September 7-8, 2007. The meeting was focused on successful translational nanomedicine: from bench to bedside. There were four keynote lectures and eight scientific symposiums in this meeting. The researchers and investigators reported the results and process of current nanomedicine research and approaches to clinical applications. The meeting provided exciting information for nanomedicine clinical-related researches and strategy for further development of nanomedicine research which will be benefits to clinical practice.

  20. The Phonetics of Head and Body Movement in the Realization of American Sign Language Signs.

    Science.gov (United States)

    Tyrone, Martha E; Mauk, Claude E

    2016-01-01

    Because the primary articulators for sign languages are the hands, sign phonology and phonetics have focused mainly on them and treated other articulators as passive targets. However, there is abundant research on the role of nonmanual articulators in sign language grammar and prosody. The current study examines how hand and head/body movements are coordinated to realize phonetic targets. Kinematic data were collected from 5 deaf American Sign Language (ASL) signers to allow the analysis of movements of the hands, head and body during signing. In particular, we examine how the chin, forehead and torso move during the production of ASL signs at those three phonological locations. Our findings suggest that for signs with a lexical movement toward the head, the forehead and chin move to facilitate convergence with the hand. By comparison, the torso does not move to facilitate convergence with the hand for signs located at the torso. These results imply that the nonmanual articulators serve a phonetic as well as a grammatical or prosodic role in sign languages. Future models of sign phonetics and phonology should take into consideration the movements of the nonmanual articulators in the realization of signs. © 2016 S. Karger AG, Basel.

  1. Sign rules for anisotropic quantum spin systems

    International Nuclear Information System (INIS)

    Bishop, R. F.; Farnell, D. J. J.; Parkinson, J. B.

    2000-01-01

    We present exact ''sign rules'' for various spin-s anisotropic spin-lattice models. It is shown that, after a simple transformation which utilizes these sign rules, the ground-state wave function of the transformed Hamiltonian is positive definite. Using these results exact statements for various expectation values of off-diagonal operators are presented, and transitions in the behavior of these expectation values are observed at particular values of the anisotropy. Furthermore, the importance of such sign rules in variational calculations and quantum Monte Carlo calculations is emphasized. This is illustrated by a simple variational treatment of a one-dimensional anisotropic spin model

  2. Reliability of construction materials

    International Nuclear Information System (INIS)

    Merz, H.

    1976-01-01

    One can also speak of reliability with respect to materials. While for reliability of components the MTBF (mean time between failures) is regarded as the main criterium, this is replaced with regard to materials by possible failure mechanisms like physical/chemical reaction mechanisms, disturbances of physical or chemical equilibrium, or other interactions or changes of system. The main tasks of the reliability analysis of materials therefore is the prediction of the various failure reasons, the identification of interactions, and the development of nondestructive testing methods. (RW) [de

  3. Structural Reliability Methods

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager; Madsen, H. O.

    The structural reliability methods quantitatively treat the uncertainty of predicting the behaviour and properties of a structure given the uncertain properties of its geometry, materials, and the actions it is supposed to withstand. This book addresses the probabilistic methods for evaluation...... of structural reliability, including the theoretical basis for these methods. Partial safety factor codes under current practice are briefly introduced and discussed. A probabilistic code format for obtaining a formal reliability evaluation system that catches the most essential features of the nature...... of the uncertainties and their interplay is the developed, step-by-step. The concepts presented are illustrated by numerous examples throughout the text....

  4. Reliability and mechanical design

    International Nuclear Information System (INIS)

    Lemaire, Maurice

    1997-01-01

    A lot of results in mechanical design are obtained from a modelisation of physical reality and from a numerical solution which would lead to the evaluation of needs and resources. The goal of the reliability analysis is to evaluate the confidence which it is possible to grant to the chosen design through the calculation of a probability of failure linked to the retained scenario. Two types of analysis are proposed: the sensitivity analysis and the reliability analysis. Approximate methods are applicable to problems related to reliability, availability, maintainability and safety (RAMS)

  5. RTE - 2013 Reliability Report

    International Nuclear Information System (INIS)

    Denis, Anne-Marie

    2014-01-01

    RTE publishes a yearly reliability report based on a standard model to facilitate comparisons and highlight long-term trends. The 2013 report is not only stating the facts of the Significant System Events (ESS), but it moreover underlines the main elements dealing with the reliability of the electrical power system. It highlights the various elements which contribute to present and future reliability and provides an overview of the interaction between the various stakeholders of the Electrical Power System on the scale of the European Interconnected Network. (author)

  6. Mini-Mental Parkinson: First Validation Study of a New Bedside Test Constructed for Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    F. Mahieux

    1995-01-01

    Full Text Available We have developed a brief screening test aimed at identifying cognitive disorders in Parkinson’s disease. The Mini-Mental Parkinson derives from the Mini-Mental State Examination of Folstein. It includes seven ordered subsections, with a total score of 32. A pilot study was conducted in 50 community-dwelling parkinsonian patients, in order to establish its metrological qualities. Comparisons were made with a neuropsychological battery including several tests widely used in the assessment of specific cognitive disorders in Parkinson’s disease. The correlations between the Mini-Mental Parkinson and each component of this battery were substantial, especially for the performance subtests of the WAIS-R (r = 0.62 to 0.72, the Stroop test (r = 0.65 the 15-objects test (r = 0.64, the word fluency (r = 0.63 and the Odd Man Out test (r = 0.61. The validity of each subtest of the Mini-Mental Parkinson was adequate except for one, based on a word choice, which requires a modification in French before definitive use. The test-retest reliability was high (r = 0.84. There was a significant difference in the mean scores in cases with confusional event (22.4, even without current signs of dementia, compared with patients with no such history (27.2. In conclusion, this brief test is suitable for assessment of parkinsonian patients.

  7. Performance of pile supported sign structures : [brief].

    Science.gov (United States)

    2015-05-01

    Sign structures in Wisconsin are typically supported by drilled shaft foundations or spread : footing foundations. However, when the soil conditions are not suitable to be supported on : drilled shafts or spread footings, a group of piles could suppo...

  8. Ebola (Ebola Virus Disease): Signs and Symptoms

    Science.gov (United States)

    ... Exposure Communication Resources Videos Audio Infographics & Illustrations Factsheets Posters Virus Ecology Graphic Signs and Symptoms Recommend on ... site? Adobe PDF file Microsoft PowerPoint file Microsoft Word file Microsoft Excel file Audio/Video file Apple ...

  9. CDC Vital Signs: Asthma in the US

    Science.gov (United States)

    ... gov . Vital Signs Topics Covered Alcohol Antibiotic Resistance Cancer Cardiovascular Diseases Diseases & Conditions Food Safety Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity ...

  10. CDC Vital Signs: HIV Care Saves Lives

    Science.gov (United States)

    ... gov . Vital Signs Topics Covered Alcohol Antibiotic Resistance Cancer Cardiovascular Diseases Diseases & Conditions Food Safety Healthcare-associated Infections Healthy Living HIV / AIDS Injury, Violence & Safety Motor Vehicle Safety Obesity ...

  11. Vital Signs-Preventing Norovirus Outbreaks

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the June 2014 CDC Vital Signs report. Norovirus infects about 20 million Americans each year. Learn how to protect yourself and your family from this very contagious, potentially serious illness.

  12. Symbol signing design for older drivers

    Science.gov (United States)

    1997-07-01

    This project evaluated the effectiveness of symbol traffic signs for young, middle-aged and elderly drivers. Daytime legibility distance and comprehension of 85 symbols in the Manual on Uniform Traffic Control Devices (MUTCD) were measured. Legibilit...

  13. Photometric requirements for portable changeable message signs.

    Science.gov (United States)

    2001-09-01

    This project reviewed the performance of pchangeable message signs (PCMSs) and developed photometric standards to establish performance requirements. In addition, researchers developed photometric test methods and recommended them for use in evaluati...

  14. Vital Signs-Alcohol Poisoning Deaths

    Centers for Disease Control (CDC) Podcasts

    This podcast is based on the January 2015 CDC Vital Signs report. In the United States, an average of six people die every day from alcohol poisoning. Learn what you can do to prevent binge drinking and alcohol poisoning.

  15. 27 CFR 6.102 - Outside signs.

    Science.gov (United States)

    2010-04-01

    ... OF THE TREASURY LIQUORS âTIED-HOUSEâ Exceptions § 6.102 Outside signs. The act by an industry member... advertising matter about the product or the industry member which is permanently inscribed or securely affixed...

  16. Hazard sign comprehension among illiterate adults

    African Journals Online (AJOL)

    KATEVG

    Hazard signs have been considered an effective mode of transferring safety .... United Kingdom and the United States of America, indicating that hazard ..... primary providers of these programmes (Occupational Health and Safety Act 1993).

  17. Mental Illness in Children: Know the Signs

    Science.gov (United States)

    ... how you can help. By Mayo Clinic Staff Mental illness in children can be hard for parents to ... help they need. Understand the warning signs of mental illness in children and how you can help your ...

  18. Water Breaking: Understand This Sign of Labor

    Science.gov (United States)

    Healthy Lifestyle Labor and delivery, postpartum care Water breaking worries? Prepare yourself for childbirth by getting the facts about this important sign of labor. By Mayo Clinic Staff If you're ...

  19. Computing health quality measures using Informatics for Integrating Biology and the Bedside.

    Science.gov (United States)

    Klann, Jeffrey G; Murphy, Shawn N

    2013-04-19

    The Health Quality Measures Format (HQMF) is a Health Level 7 (HL7) standard for expressing computable Clinical Quality Measures (CQMs). Creating tools to process HQMF queries in clinical databases will become increasingly important as the United States moves forward with its Health Information Technology Strategic Plan to Stages 2 and 3 of the Meaningful Use incentive program (MU2 and MU3). Informatics for Integrating Biology and the Bedside (i2b2) is one of the analytical databases used as part of the Office of the National Coordinator (ONC)'s Query Health platform to move toward this goal. Our goal is to integrate i2b2 with the Query Health HQMF architecture, to prepare for other HQMF use-cases (such as MU2 and MU3), and to articulate the functional overlap between i2b2 and HQMF. Therefore, we analyze the structure of HQMF, and then we apply this understanding to HQMF computation on the i2b2 clinical analytical database platform. Specifically, we develop a translator between two query languages, HQMF and i2b2, so that the i2b2 platform can compute HQMF queries. We use the HQMF structure of queries for aggregate reporting, which define clinical data elements and the temporal and logical relationships between them. We use the i2b2 XML format, which allows flexible querying of a complex clinical data repository in an easy-to-understand domain-specific language. The translator can represent nearly any i2b2-XML query as HQMF and execute in i2b2 nearly any HQMF query expressible in i2b2-XML. This translator is part of the freely available reference implementation of the QueryHealth initiative. We analyze limitations of the conversion and find it covers many, but not all, of the complex temporal and logical operators required by quality measures. HQMF is an expressive language for defining quality measures, and it will be important to understand and implement for CQM computation, in both meaningful use and population health. However, its current form might allow

  20. Design and evaluation of a mobile bedside PET/SPECT imaging system

    Science.gov (United States)

    Studenski, Matthew Thomas

    Patients confined to an intensive care unit, the emergency room, or a surgical suite are managed without nuclear medicine procedures such as positron emission tomography (PET) or single photon emission computed tomography (SPECT). These studies have diagnostic value which can greatly benefit the physician's treatment of the patient but require that the patient is moved to a scanner. This dissertation examines the feasibility of an economical PET/SPECT system that can be brought to the bedside of an immobile patient for imaging. We chose to focus on cardiac SPECT imaging including perfusion imaging using 99mTc tracers and viability imaging using 18F tracers first because of problems arising from positioning a detector beneath a patient's bed, a requirement for the opposed detector orientation in PET imaging. Second, SPECT imaging acquiring over the anterior 180 degrees of the patient results in reduced attenuation effects due to the heart's location in the anterior portion of the body. Four studies were done to assess the clinical feasibility of the mobile system; 1) the performance of the system was evaluated in SPECT mode at both 140 keV (99mTc tracers) and 511 keV (positron emitting tracers), 2) a dynamic cardiac phantom was used to develop and test image acquisition and processing methods for the system at both energies, 3) a high energy pinhole collimator was designed to reduce the effects of high energy photon penetration through the parallel hole collimator, and 4) we estimated the radiation dose to persons that would be in the vicinity of a patient to ensure that the effective dose is below the regulatory limit. With these studies, we show that the mobile system provides an economical means of bringing nuclear medicine to an immobile patient while staying below the regulatory dose limit to other persons. The system performed well at both 140 keV and 511 keV and provided viable images of a phantom myocardium at both energies. The system does not achieve the

  1. Evaluating the informatics for integrating biology and the bedside system for clinical research

    Directory of Open Access Journals (Sweden)

    Meystre Stéphane M

    2009-10-01

    Full Text Available Abstract Background Selecting patient cohorts is a critical, iterative, and often time-consuming aspect of studies involving human subjects; informatics tools for helping streamline the process have been identified as important infrastructure components for enabling clinical and translational research. We describe the evaluation of a free and open source cohort selection tool from the Informatics for Integrating Biology and the Bedside (i2b2 group: the i2b2 hive. Methods Our evaluation included the usability and functionality of the i2b2 hive using several real world examples of research data requests received electronically at the University of Utah Health Sciences Center between 2006 - 2008. The hive server component and the visual query tool application were evaluated for their suitability as a cohort selection tool on the basis of the types of data elements requested, as well as the effort required to fulfill each research data request using the i2b2 hive alone. Results We found the i2b2 hive to be suitable for obtaining estimates of cohort sizes and generating research cohorts based on simple inclusion/exclusion criteria, which consisted of about 44% of the clinical research data requests sampled at our institution. Data requests that relied on post-coordinated clinical concepts, aggregate values of clinical findings, or temporal conditions in their inclusion/exclusion criteria could not be fulfilled using the i2b2 hive alone, and required one or more intermediate data steps in the form of pre- or post-processing, modifications to the hive metadata, etc. Conclusion The i2b2 hive was found to be a useful cohort-selection tool for fulfilling common types of requests for research data, and especially in the estimation of initial cohort sizes. For another institution that might want to use the i2b2 hive for clinical research, we recommend that the institution would need to have structured, coded clinical data and metadata available that can be

  2. Mission and Sustainability of Informatics for Integrating Biology and the Bedside (i2b2).

    Science.gov (United States)

    Murphy, Shawn; Wilcox, Adam

    2014-01-01

    A visible example of a successfully disseminated research project in the healthcare space is Informatics for Integrating Biology and the Bedside, or i2b2. The project serves to provide the software that can allow a researcher to do direct, self-serve queries against the electronic healthcare data form a hospital. The goals of these queries are to find cohorts of patients that fit specific profiles, while providing for patient privacy and discretion. Sustaining this resource and keeping its direction has always been a challenge, but ever more so as the ten year National Centers for Biomedical Computing (NCBCs) sunset their funding. Building on the i2b2 structures has helped the dissemination plans for grants leveraging it because it is a disseminated national resource. While this has not directly increased the support of i2b2 internally, it has increased the ability of institutions to leverage the resource and generally leads to increased institutional support. The successful development, use, and dissemination i2b2 has been significant in clinical research and informatics. Its evolution has been from a local research data infrastructure to one disseminated more broadly than any other product of the National Centers for Biomedical Computing, and an infrastructure spawning larger investments than were originally used to create it. Throughout this, there were two main lessons about the benefits of dissemination: that people have great creativity in utilizing a resource in different ways and that broader system use can make the system more robust. One option for long-term sustainability of the central authority would be to translate the function to an industry partner. Another option currently being pursued is to create a foundation that would be a central authority for the project. Over the past 10 years, i2b2 has risen to be an important staple in the toolkit of health care researchers. There are now over 110 hospitals that use i2b2 for research. This open

  3. Sign patterns of J-orthogonal matrices

    Czech Academy of Sciences Publication Activity Database

    Hall, F.J.; Li, Z.; Parnass, C.; Rozložník, Miroslav

    2017-01-01

    Roč. 5, č. 1 (2017), s. 225-241 ISSN 2300-7451 Institutional support: RVO:67985840 Keywords : G-matrix * J-orthogonal matrix * sign pattern matrix * sign patterns that allow J-orthogonality Subject RIV: BA - General Mathematics OBOR OECD: Applied mathematics https://www.degruyter.com/view/j/spma.2017.5.issue-1/spma-2017-0016/spma-2017-0016.xml?format=INT

  4. Sign patterns of J-orthogonal matrices

    Czech Academy of Sciences Publication Activity Database

    Hall, F.J.; Li, Z.; Parnass, C.; Rozložník, Miroslav

    2017-01-01

    Roč. 5, č. 1 (2017), s. 225-241 ISSN 2300-7451 Institutional support: RVO:67985840 Keywords : G-matrix * J-orthogonal matrix * sign pattern matrix * sign patterns that allow J-orthogonality Subject RIV: BA - General Mathematics OBOR OECD: Applied mathematics https://www.degruyter.com/view/j/spma.2017.5.issue-1/spma-2017-0016/spma-2017-0016. xml ?format=INT

  5. Spontaneous neonatal pneumomediastinum: the "spinnaker sail" sign.

    Science.gov (United States)

    Lawal, T A; Glüer, S; Reismann, M; Dördelmann, M; Schirg, E; Ure, B

    2009-02-01

    Spontaneous pneumomediastinum is a rare condition in the newborn, not associated with identifiable trauma or mechanical ventilation. It is diagnosed by a combination of physical examination and confirmatory chest radiograph, with various recognized signs identifiable in this condition. We report the case of a male neonate, who had pneumomediastinum confirmed by the presence of a wind blown spinnaker sail sign and was managed conservatively. We also reviewed the literature.

  6. Being and Sign in the "Enneads"

    Science.gov (United States)

    Tomulet, Daniel

    2010-01-01

    The intention of this work is to show that Plotinus' metaphysics, his theory of Intellect, can be interpreted as a philosophy of the sign. The fact that Plotinus describes Intellect, the world of real beings, as a sign or a trace of the One is well-known, and we use this aspect in our work. However, what is even more important from our perspective…

  7. Central structure preservation of the reversal sign

    International Nuclear Information System (INIS)

    Chen, C.J.

    1999-01-01

    We report serial changes of central structure preservation of the reversal sign in a case of child abuse. The serial CT images show that the relatively spared attenuation at the basal ganglia, thalami, and posterior fossa develops before the occurrence of transtentorial herniation. This finding makes the theory that central preservation of the reversal sign is due to pressure relief after transtentorial herniation less convincible. (orig.)

  8. Sign rank versus Vapnik-Chervonenkis dimension

    Science.gov (United States)

    Alon, N.; Moran, Sh; Yehudayoff, A.

    2017-12-01

    This work studies the maximum possible sign rank of sign (N × N)-matrices with a given Vapnik-Chervonenkis dimension d. For d=1, this maximum is three. For d=2, this maximum is \\widetilde{\\Theta}(N1/2). For d >2, similar but slightly less accurate statements hold. The lower bounds improve on previous ones by Ben-David et al., and the upper bounds are novel. The lower bounds are obtained by probabilistic constructions, using a theorem of Warren in real algebraic topology. The upper bounds are obtained using a result of Welzl about spanning trees with low stabbing number, and using the moment curve. The upper bound technique is also used to: (i) provide estimates on the number of classes of a given Vapnik-Chervonenkis dimension, and the number of maximum classes of a given Vapnik-Chervonenkis dimension--answering a question of Frankl from 1989, and (ii) design an efficient algorithm that provides an O(N/log(N)) multiplicative approximation for the sign rank. We also observe a general connection between sign rank and spectral gaps which is based on Forster's argument. Consider the adjacency (N × N)-matrix of a Δ-regular graph with a second eigenvalue of absolute value λ and Δ ≤ N/2. We show that the sign rank of the signed version of this matrix is at least Δ/λ. We use this connection to prove the existence of a maximum class C\\subseteq\\{+/- 1\\}^N with Vapnik-Chervonenkis dimension 2 and sign rank \\widetilde{\\Theta}(N1/2). This answers a question of Ben-David et al. regarding the sign rank of large Vapnik-Chervonenkis classes. We also describe limitations of this approach, in the spirit of the Alon-Boppana theorem. We further describe connections to communication complexity, geometry, learning theory, and combinatorics. Bibliography: 69 titles.

  9. Central structure preservation of the reversal sign

    Energy Technology Data Exchange (ETDEWEB)

    Chen, C.J. [Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei (Taiwan)

    1999-12-01

    We report serial changes of central structure preservation of the reversal sign in a case of child abuse. The serial CT images show that the relatively spared attenuation at the basal ganglia, thalami, and posterior fossa develops before the occurrence of transtentorial herniation. This finding makes the theory that central preservation of the reversal sign is due to pressure relief after transtentorial herniation less convincible. (orig.)

  10. Approach to reliability assessment

    International Nuclear Information System (INIS)

    Green, A.E.; Bourne, A.J.

    1975-01-01

    Experience has shown that reliability assessments can play an important role in the early design and subsequent operation of technological systems where reliability is at a premium. The approaches to and techniques for such assessments, which have been outlined in the paper, have been successfully applied in variety of applications ranging from individual equipments to large and complex systems. The general approach involves the logical and systematic establishment of the purpose, performance requirements and reliability criteria of systems. This is followed by an appraisal of likely system achievment based on the understanding of different types of variational behavior. A fundamental reliability model emerges from the correlation between the appropriate Q and H functions for performance requirement and achievement. This model may cover the complete spectrum of performance behavior in all the system dimensions

  11. The rating reliability calculator

    Directory of Open Access Journals (Sweden)

    Solomon David J

    2004-04-01

    Full Text Available Abstract Background Rating scales form an important means of gathering evaluation data. Since important decisions are often based on these evaluations, determining the reliability of rating data can be critical. Most commonly used methods of estimating reliability require a complete set of ratings i.e. every subject being rated must be rated by each judge. Over fifty years ago Ebel described an algorithm for estimating the reliability of ratings based on incomplete data. While his article has been widely cited over the years, software based on the algorithm is not readily available. This paper describes an easy-to-use Web-based utility for estimating the reliability of ratings based on incomplete data using Ebel's algorithm. Methods The program is available public use on our server and the source code is freely available under GNU General Public License. The utility is written in PHP, a common open source imbedded scripting language. The rating data can be entered in a convenient format on the user's personal computer that the program will upload to the server for calculating the reliability and other statistics describing the ratings. Results When the program is run it displays the reliability, number of subject rated, harmonic mean number of judges rating each subject, the mean and standard deviation of the averaged ratings per subject. The program also displays the mean, standard deviation and number of ratings for each subject rated. Additionally the program will estimate the reliability of an average of a number of ratings for each subject via the Spearman-Brown prophecy formula. Conclusion This simple web-based program provides a convenient means of estimating the reliability of rating data without the need to conduct special studies in order to provide complete rating data. I would welcome other researchers revising and enhancing the program.

  12. Structural systems reliability analysis

    International Nuclear Information System (INIS)

    Frangopol, D.

    1975-01-01

    For an exact evaluation of the reliability of a structure it appears necessary to determine the distribution densities of the loads and resistances and to calculate the correlation coefficients between loads and between resistances. These statistical characteristics can be obtained only on the basis of a long activity period. In case that such studies are missing the statistical properties formulated here give upper and lower bounds of the reliability. (orig./HP) [de

  13. Reliability and maintainability

    International Nuclear Information System (INIS)

    1994-01-01

    Several communications in this conference are concerned with nuclear plant reliability and maintainability; their titles are: maintenance optimization of stand-by Diesels of 900 MW nuclear power plants; CLAIRE: an event-based simulation tool for software testing; reliability as one important issue within the periodic safety review of nuclear power plants; design of nuclear building ventilation by the means of functional analysis; operation characteristic analysis for a power industry plant park, as a function of influence parameters

  14. Reliability data book

    International Nuclear Information System (INIS)

    Bento, J.P.; Boerje, S.; Ericsson, G.; Hasler, A.; Lyden, C.O.; Wallin, L.; Poern, K.; Aakerlund, O.

    1985-01-01

    The main objective for the report is to improve failure data for reliability calculations as parts of safety analyses for Swedish nuclear power plants. The work is based primarily on evaluations of failure reports as well as information provided by the operation and maintenance staff of each plant. In the report are presented charts of reliability data for: pumps, valves, control rods/rod drives, electrical components, and instruments. (L.E.)

  15. History of metaphoric signs in radiology

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Stephen R., E-mail: bakersr@umdnj.edu; Noorelahi, Yasser M., E-mail: dr.ynoorelahi@gmail.com; Ghosh, Shanchita, E-mail: Ghoshs1@umdnj.edu; Yang, Lily C., E-mail: yangclily@gmail.com; Kasper, David J., E-mail: dkasp86@gmail.com

    2013-09-15

    Purpose: To survey the nearly 100 year history of metaphoric sign naming in radiology describing the pace of their overall accumulation in the radiology canon, their specific rates of growth by modality and subspecialty and the characteristics of the referents to which the signs are attached. Materials and methods: A comprehensive list of metaphoric signs was compiled from a search of articles in several major English language radiology journals, from a roster compiled in a monograph on the subject published in 1984 and from a search of several databases to find signs published in the first half of the 20th century. Results: The growth of radiological metaphorical signs naming was slow for several decades after the first one was published in 1918. It then increased rapidly until the 1980s encompassing all modalities and subspecialties. Recently the practice has shown a marked and steady decline. Conclusion: Metaphoric sign naming was a frequently reported contribution to the radiological literature in the second half of the 20th century corresponding with Radiology's growth as a descriptive discipline. Its decline since then may be a consequence of Radiology's evolution into a more analytic, data-driven field of inquiry.

  16. History of metaphoric signs in radiology

    International Nuclear Information System (INIS)

    Baker, Stephen R.; Noorelahi, Yasser M.; Ghosh, Shanchita; Yang, Lily C.; Kasper, David J.

    2013-01-01

    Purpose: To survey the nearly 100 year history of metaphoric sign naming in radiology describing the pace of their overall accumulation in the radiology canon, their specific rates of growth by modality and subspecialty and the characteristics of the referents to which the signs are attached. Materials and methods: A comprehensive list of metaphoric signs was compiled from a search of articles in several major English language radiology journals, from a roster compiled in a monograph on the subject published in 1984 and from a search of several databases to find signs published in the first half of the 20th century. Results: The growth of radiological metaphorical signs naming was slow for several decades after the first one was published in 1918. It then increased rapidly until the 1980s encompassing all modalities and subspecialties. Recently the practice has shown a marked and steady decline. Conclusion: Metaphoric sign naming was a frequently reported contribution to the radiological literature in the second half of the 20th century corresponding with Radiology's growth as a descriptive discipline. Its decline since then may be a consequence of Radiology's evolution into a more analytic, data-driven field of inquiry

  17. On the temporal dynamics of sign production: An ERP study in Catalan Sign Language (LSC).

    Science.gov (United States)

    Baus, Cristina; Costa, Albert

    2015-06-03

    This study investigates the temporal dynamics of sign production and how particular aspects of the signed modality influence the early stages of lexical access. To that end, we explored the electrophysiological correlates associated to sign frequency and iconicity in a picture signing task in a group of bimodal bilinguals. Moreover, a subset of the same participants was tested in the same task but naming the pictures instead. Our results revealed that both frequency and iconicity influenced lexical access in sign production. At the ERP level, iconicity effects originated very early in the course of signing (while absent in the spoken modality), suggesting a stronger activation of the semantic properties for iconic signs. Moreover, frequency effects were modulated by iconicity, suggesting that lexical access in signed language is determined by the iconic properties of the signs. These results support the idea that lexical access is sensitive to the same phenomena in word and sign production, but its time-course is modulated by particular aspects of the modality in which a lexical item will be finally articulated. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Face and content validity of Xperience™ Team Trainer: bed-side assistant training simulator for robotic surgery.

    Science.gov (United States)

    Sessa, Luca; Perrenot, Cyril; Xu, Song; Hubert, Jacques; Bresler, Laurent; Brunaud, Laurent; Perez, Manuela

    2018-03-01

    In robotic surgery, the coordination between the console-side surgeon and bed-side assistant is crucial, more than in standard surgery or laparoscopy where the surgical team works in close contact. Xperience™ Team Trainer (XTT) is a new optional component for the dv-Trainer ® platform and simulates the patient-side working environment. We present preliminary results for face, content, and the workload imposed regarding the use of the XTT virtual reality platform for the psychomotor and communication skills training of the bed-side assistant in robot-assisted surgery. Participants were categorized into "Beginners" and "Experts". They tested a series of exercises (Pick & Place Laparoscopic Demo, Pick & Place 2 and Team Match Board 1) and completed face validity questionnaires. "Experts" assessed content validity on another questionnaire. All the participants completed a NASA Task Load Index questionnaire to assess the workload imposed by XTT. Twenty-one consenting participants were included (12 "Beginners" and 9 "Experts"). XTT was shown to possess face and content validity, as evidenced by the rankings given on the simulator's ease of use and realism parameters and on the simulator's usefulness for training. Eight out of nine "Experts" judged the visualization of metrics after the exercises useful. However, face validity has shown some weaknesses regarding interactions and instruments. Reasonable workload parameters were registered. XTT demonstrated excellent face and content validity with acceptable workload parameters. XTT could become a useful tool for robotic surgery team training.

  19. Role of bedside index for severity of acute pancreatitis (bisap score in predicting outcome in acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Shahnawaz Bashir Bhat

    2015-12-01

    Full Text Available Objective: To investigate the role of Bedside index for severity of acute pancreatitis (BISAP score in predicting the outcome of acute pancreatitis. Methods: This single hospital based prospective study included fifty patients of acute pancreatitis admitted within 48 hours of onset of symptoms, who were divided into two groups according to admission BISAP score. BISAP score 3 (severe acute pancreatitis. The ability of BISAP score to predict mortality, morbidity and hospital stay in acute pancreatitis patients was analyzed. Results: A BISAP score of >3 was associated with increased risk of development of transient organ failure, persistent organ failure and pancreatic necrosis (Statistically significant. Mortality in group with BISAP and #8805;3 was 23.5% (4 patients which was statistically higher than group with BISAP score and #706;3 (0 patients (p=0.019.The mean duration of hospital stay of patients in group with BISAP score < 3 was 7.58 +/- 4.04 days and in group with BISAP score and #8805;3 was 15.35 +/- 1.66.(p=0.02. Conclusion: Bedside index for severity in acute pancreatitis (BISAP score, at admission is an excellent score in predicting the mortality, morbidity and hospital stay and hence management protocol in patients admitted with acute pancreatitis. [J Contemp Med 2015; 5(4.000: 215-220

  20. Transnasal endoscopic evaluation of swallowing: a bedside technique to evaluate ability to swallow pureed diets in elderly patients with dysphagia.

    Science.gov (United States)

    Sakamoto, Torao; Horiuchi, Akira; Nakayama, Yoshiko

    2013-08-01

    Endoscopic evaluation of swallowing (EES) is not commonly used by gastroenterologists to evaluate swallowing in patients with dysphagia. To use transnasal endoscopy to identify factors predicting successful or failed swallowing of pureed foods in elderly patients with dysphagia. EES of pureed foods was performed by a gastroenterologist using a small-calibre transnasal endoscope. Factors related to successful versus unsuccessful swallowing of pureed foods were analyzed with regard to age, comorbid diseases, swallowing activity, saliva pooling, vallecular residues, pharyngeal residues and airway penetration⁄aspiration. Unsuccessful swallowing was defined in patients who could not eat pureed foods at bedside during hospitalization. Logistic regression analysis was used to identify independent predictors of swallowing of pureed foods. During a six-year period, 458 consecutive patients (mean age 80 years [range 39 to 97 years]) were considered for the study, including 285 (62%) men. Saliva pooling, vallecular residues, pharyngeal residues and penetration⁄aspiration were found in 240 (52%), 73 (16%), 226 (49%) and 232 patients (51%), respectively. Overall, 247 patients (54%) failed to swallow pureed foods. Multivariate logistic regression analysis demonstrated that the presence of pharyngeal residues (OR 6.0) and saliva pooling (OR 4.6) occurred significantly more frequently in patients who failed to swallow pureed foods. Pharyngeal residues and saliva pooling predicted impaired swallowing of pureed foods. Transnasal EES performed by a gastroenterologist provided a unique bedside method of assessing the ability to swallow pureed foods in elderly patients with dysphagia.

  1. [Conventional radiology, digital radiology with photostimulable phosphor, laser digitalization of thoracic radiographic films at the bedside. A comparative study].

    Science.gov (United States)

    Miceli, M; Stamati, R; Burci, P; Guidarelli, G; Sartoni Galloni, S

    1992-10-01

    The bedside chest images obtained with conventional radiology and with "on line" and "off line" digital modalities were compared to evaluate the respective capabilities in visualizing chest anatomical structures. Seventy patients were submitted to bedside chest examinations with a portable unit; both a conventional film and a digital system (PCR Graphics 1, Philips) with photostimulable phosphor imaging plate were fitted in the radiographic cassette. The former was digitized using an "off line" laser beam unit (FD 2000, Dupont); the latter was subsequently postprocessed by modifying contrast, optical density and spatial frequencies. Thus, 4 different viewing modalities were obtained for each examination: a) conventional radiography; b) standard digital radiography; c) postprocessed digital radiography; d) digitized conventional radiography. Detectability rates of chest anatomical structures were analyzed by 4 independent radiologists on the different images and expressed by a score 1-4. The values were always higher with digital modalities than with the conventional one and the differences were statistically significant (Student's t-test modified by Bonferroni). In particular, the greatest difference was found between c) and a) in retrocardiac lung parenchyma and in skeletal structures, in favour of c). Concerning the comparative adequacy of the various digital modalities, higher detectability rates of chest anatomical structures were obtained with c), but also with b), than with d).

  2. Multidisciplinary System Reliability Analysis

    Science.gov (United States)

    Mahadevan, Sankaran; Han, Song; Chamis, Christos C. (Technical Monitor)

    2001-01-01

    The objective of this study is to develop a new methodology for estimating the reliability of engineering systems that encompass multiple disciplines. The methodology is formulated in the context of the NESSUS probabilistic structural analysis code, developed under the leadership of NASA Glenn Research Center. The NESSUS code has been successfully applied to the reliability estimation of a variety of structural engineering systems. This study examines whether the features of NESSUS could be used to investigate the reliability of systems in other disciplines such as heat transfer, fluid mechanics, electrical circuits etc., without considerable programming effort specific to each discipline. In this study, the mechanical equivalence between system behavior models in different disciplines are investigated to achieve this objective. A new methodology is presented for the analysis of heat transfer, fluid flow, and electrical circuit problems using the structural analysis routines within NESSUS, by utilizing the equivalence between the computational quantities in different disciplines. This technique is integrated with the fast probability integration and system reliability techniques within the NESSUS code, to successfully compute the system reliability of multidisciplinary systems. Traditional as well as progressive failure analysis methods for system reliability estimation are demonstrated, through a numerical example of a heat exchanger system involving failure modes in structural, heat transfer and fluid flow disciplines.

  3. Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study.

    Science.gov (United States)

    Lytle, Jamie; Mwatha, Catherine; Davis, Karen K

    2014-01-01

    Sleep deprivation in hospitalized patients is common and can have serious detrimental effects on recovery from illness. Lavender aromatherapy has improved sleep in a variety of clinical settings, but the effect has not been tested in the intermediate care unit. To determine the effect of inhalation of 100% lavender oil on patients' vital signs and perceived quality of sleep in an intermediate care unit. A randomized controlled pilot study was conducted in 50 patients. Control patients received usual care. The treatment group had 3 mL of 100% pure lavender oil in a glass jar in place at the bedside from 10 pm until 6 am. Vital signs were recorded at intervals throughout the night. At 6 am all patients completed the Richard Campbell Sleep Questionnaire to assess quality of sleep. Blood pressure was significantly lower between midnight and 4 am in the treatment group than in the control group (P = .03) According to the overall mean change score in blood pressure between the baseline and 6 am measurements, the treatment group had a decrease in blood pressure and the control group had an increase; however, the difference between the 2 groups was not significant (P = .12). Mean overall sleep score was higher in the intervention group (48.25) than in the control group (40.10), but the difference was not significant. Lavender aromatherapy may be an effective way to improve sleep in an intermediate care unit.

  4. Analysis and Application of Reliability

    International Nuclear Information System (INIS)

    Jeong, Hae Seong; Park, Dong Ho; Kim, Jae Ju

    1999-05-01

    This book tells of analysis and application of reliability, which includes definition, importance and historical background of reliability, function of reliability and failure rate, life distribution and assumption of reliability, reliability of unrepaired system, reliability of repairable system, sampling test of reliability, failure analysis like failure analysis by FEMA and FTA, and cases, accelerated life testing such as basic conception, acceleration and acceleration factor, and analysis of accelerated life testing data, maintenance policy about alternation and inspection.

  5. Psychometric properties of a sign language version of the Mini International Neuropsychiatric Interview (MINI).

    Science.gov (United States)

    Øhre, Beate; Saltnes, Hege; von Tetzchner, Stephen; Falkum, Erik

    2014-05-22

    There is a need for psychiatric assessment instruments that enable reliable diagnoses in persons with hearing loss who have sign language as their primary language. The objective of this study was to assess the validity of the Norwegian Sign Language (NSL) version of the Mini International Neuropsychiatric Interview (MINI). The MINI was translated into NSL. Forty-one signing patients consecutively referred to two specialised psychiatric units were assessed with a diagnostic interview by clinical experts and with the MINI. Inter-rater reliability was assessed with Cohen's kappa and "observed agreement". There was 65% agreement between MINI diagnoses and clinical expert diagnoses. Kappa values indicated fair to moderate agreement, and observed agreement was above 76% for all diagnoses. The MINI diagnosed more co-morbid conditions than did the clinical expert interview (mean diagnoses: 1.9 versus 1.2). Kappa values indicated moderate to substantial agreement, and "observed agreement" was above 88%. The NSL version performs similarly to other MINI versions and demonstrates adequate reliability and validity as a diagnostic instrument for assessing mental disorders in persons who have sign language as their primary and preferred language.

  6. Psychometric properties of a sign language version of the Mini International Neuropsychiatric Interview (MINI)

    Science.gov (United States)

    2014-01-01

    Background There is a need for psychiatric assessment instruments that enable reliable diagnoses in persons with hearing loss who have sign language as their primary language. The objective of this study was to assess the validity of the Norwegian Sign Language (NSL) version of the Mini International Neuropsychiatric Interview (MINI). Methods The MINI was translated into NSL. Forty-one signing patients consecutively referred to two specialised psychiatric units were assessed with a diagnostic interview by clinical experts and with the MINI. Inter-rater reliability was assessed with Cohen’s kappa and “observed agreement”. Results There was 65% agreement between MINI diagnoses and clinical expert diagnoses. Kappa values indicated fair to moderate agreement, and observed agreement was above 76% for all diagnoses. The MINI diagnosed more co-morbid conditions than did the clinical expert interview (mean diagnoses: 1.9 versus 1.2). Kappa values indicated moderate to substantial agreement, and “observed agreement” was above 88%. Conclusion The NSL version performs similarly to other MINI versions and demonstrates adequate reliability and validity as a diagnostic instrument for assessing mental disorders in persons who have sign language as their primary and preferred language. PMID:24886297

  7. Sign Language Echolalia in Deaf Children with Autism Spectrum Disorder

    Science.gov (United States)

    Shield, Aaron; Cooley, Frances; Meier, Richard P.

    2017-01-01

    Purpose: We present the first study of echolalia in deaf, signing children with autism spectrum disorder (ASD). We investigate the nature and prevalence of sign echolalia in native-signing children with ASD, the relationship between sign echolalia and receptive language, and potential modality differences between sign and speech. Method: Seventeen…

  8. PET/CT manifestation of the meniscus sign of ulcerating gastric carcinoma

    International Nuclear Information System (INIS)

    Bahk, Yong Whee

    2007-01-01

    Meniscus-like presentation of ulcerating gastric carcinoma on upper gastrointestinal series radiograph was first described in 1921 by Carman and has since been known as a useful differential diagnostic sign in radiology. In 1982 using then newly introduced computed tomography (CT) Widder and Mueller revisited the meniscus sign. Their study was primarily focused on a dynamic assessment of the demonstrability of the meniscus sign that largely depends on the judgment and technical skill of examiner, especially graded compression and patient positioning. One year earlier Balfe et al. assessed the diagnostic reliability of gastric wall thickening as observed on CT scan in adenocarcinoma, lymphoma and leiomyosarcoma and concluded that it is not a reliable finding. In contrast, however, Lee et al. recently emphasized that the wall thickness measurement on CT of exophytic carcinoma, myoma and ulcers was a useful diagnostic means. Thus, it appears that gastric wall thickening or mucosal heave-up is by itself not as reliable as the meniscus sign. The electronic search of world literature failed to disclose earlier report of this sign demonstrated by 18 F-FDG positron emission tomography and computed tomography (PET/CT). The present communication documents 18 F-FDG PET/CT finding of the meniscus sign as encountered in a case of ulcerating gastric carcinoma, the histological diagnosis of which was moderately differentiated tubular adenocarcinoma. Unlike most gastric tumors without ulceration that tend to unimpressively accumulate 18 F-FDG the present case of Borrmann type III gastric carcinoma demonstrated markedly increased 18 F-FDG uptake

  9. Edema is not a reliable diagnostic sign to exclude small brain metastases.

    Directory of Open Access Journals (Sweden)

    Tanja Schneider

    Full Text Available No prior systematic study on the extent of vasogenic edema (VE in patients with brain metastases (BM exists. Here, we aim to determine 1 the general volumetric relationship between BM and VE, 2 a threshold diameter above which a BM shows VE, and 3 the influence of the primary tumor and location of the BM in order to improve diagnostic processes and understanding of edema formation. This single center, retrospective study includes 173 untreated patients with histologically proven BM. Semi-manual segmentation of 1416 BM on contrast-enhanced T1-weighted images and of 865 VE on fluid-attenuated inversion recovery/T2-weighted images was conducted. Statistical analyses were performed using a paired-samples t-test, linear regression/generalized mixed-effects model, and receiver-operating characteristic (ROC curve controlling for the possible effect of non-uniformly distributed metastases among patients. For BM with non-confluent edema (n = 545, there was a statistically significant positive correlation between the volumes of the BM and the VE (P < 0.001. The optimal threshold for edema formation was a diameter of 9.4 mm for all BM. The primary tumors as interaction term in multivariate analysis had a significant influence on VE formation whereas location had not. Hence VE development is dependent on the volume of the underlying BM and the site of the primary neoplasm, but not from the location of the BM.

  10. Predicting Fluid Responsiveness Using Bedside Ultrasound Measurements of the Inferior Vena Cava and Physician Gestalt in the Emergency Department of an Urban Public Hospital in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Hendry Robert Sawe

    Full Text Available Bedside inferior vena cava (IVC ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation.This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician's impression of patient volume status and cause of hypotension. Bedside ultrasound CI measurements were performed at baseline and after each 500mL of fluid. Receiver operating characteristic (ROC curve analysis was performed to characterize the relationship between CI and Physician gestalt, and the change in mean arterial pressure (MAP.We enrolled 364 patients, 52% male, mean age 36 years. Indications for fluid resuscitation were haemorrhage (54%, dehydration (30%, and sepsis (17%. Receiver operating characteristic curve analysis found optimal CI cut-off values of 45%, 52% and 53% to predict a MAP rise of 5, 8 and 10 mmHg per litre of fluid, respectively. The sensitivity and specificity of CI of 50% for predicting a 10mmHg increase in MAP per litre were 88% (95%CI 81-93% and 73% (95%CI 67-79%, respectively, area under the curve (AUC = 0.85 (0.81-0.89. The sensitivity and specificity of physician gestalt estimate of volume depletion severity were 68% (95%CI 60-75% and 86% (95%CI 80-90%, respectively, AUC = 0.83 (95% CI: 0.79-0.87. Those with a baseline CI ≥ 50% (51% of patients had a 2.8-fold greater fluid responsiveness than those with a baseline CI<50% (p<0.0001.Ultrasound measurement of the CI can predict blood pressure response among patients requiring intravenous fluid resuscitation and may be useful in early identification of patients who will benefit most from volume resuscitation, and those who will likely require other interventions.

  11. Repetitions in French Belgian Sign Language (LSFB) and Flemish Sign Language (VGT) narratives and conversations

    OpenAIRE

    Notarrigo, Ingrid; Meurant, Laurence; Van Herreweghe, Mieke; Vermeerbergen, Myriam

    2016-01-01

    Repetition was described in the nineties by a limited number of sign linguists: Vermeerbergen & De Vriendt (1994) looked at a small corpus of VGT data, Fisher & Janis (1990) analysed “verb sandwiches” in ASL and Pinsonneault (1994) “verb echos” in Quebec Sign Language. More recently the same phenomenon has been the focus of research in a growing number of signed languages, including American (Nunes and de Quadros 2008), Hong Kong (Sze 2008), Russian (Shamaro 2008), Polish (Flilipczak and Most...

  12. On the System of Place Name Signs in Estonian Sign Language

    Directory of Open Access Journals (Sweden)

    Liina Paales

    2011-05-01

    Full Text Available A place name sign is a linguistic-cultural marker that includes both memory and landscape. The author regards toponymic signs in Estonian Sign Language as representations of images held by the Estonian Deaf community: they reflect the geographical place, the period, the relationships of the Deaf community with hearing community, and the common and distinguishing features of the two cultures perceived by community's members. Name signs represent an element of signlore, which includes various types of creative linguistic play. There are stories hidden behind the place name signs that reveal the etymological origin of place name signs and reflect the community's memory. The purpose of this article is twofold. Firstly, it aims to introduce Estonian place name signs as Deaf signlore forms, analyse their structure and specify the main formation methods. Secondly, it interprets place-denoting signs in the light of understanding the foundations of Estonian Sign Language, Estonian Deaf education and education history, the traditions of local Deaf communities, and also of the cultural and local traditions of the dominant hearing communities. Both perspectives - linguistic and folkloristic - are represented in the current article.

  13. Safety and reliability criteria

    International Nuclear Information System (INIS)

    O'Neil, R.

    1978-01-01

    Nuclear power plants and, in particular, reactor pressure boundary components have unique reliability requirements, in that usually no significant redundancy is possible, and a single failure can give rise to possible widespread core damage and fission product release. Reliability may be required for availability or safety reasons, but in the case of the pressure boundary and certain other systems safety may dominate. Possible Safety and Reliability (S and R) criteria are proposed which would produce acceptable reactor design. Without some S and R requirement the designer has no way of knowing how far he must go in analysing his system or component, or whether his proposed solution is likely to gain acceptance. The paper shows how reliability targets for given components and systems can be individually considered against the derived S and R criteria at the design and construction stage. Since in the case of nuclear pressure boundary components there is often very little direct experience on which to base reliability studies, relevant non-nuclear experience is examined. (author)

  14. Proposed reliability cost model

    Science.gov (United States)

    Delionback, L. M.

    1973-01-01

    The research investigations which were involved in the study include: cost analysis/allocation, reliability and product assurance, forecasting methodology, systems analysis, and model-building. This is a classic example of an interdisciplinary problem, since the model-building requirements include the need for understanding and communication between technical disciplines on one hand, and the financial/accounting skill categories on the other. The systems approach is utilized within this context to establish a clearer and more objective relationship between reliability assurance and the subcategories (or subelements) that provide, or reenforce, the reliability assurance for a system. Subcategories are further subdivided as illustrated by a tree diagram. The reliability assurance elements can be seen to be potential alternative strategies, or approaches, depending on the specific goals/objectives of the trade studies. The scope was limited to the establishment of a proposed reliability cost-model format. The model format/approach is dependent upon the use of a series of subsystem-oriented CER's and sometimes possible CTR's, in devising a suitable cost-effective policy.

  15. Know Stroke: Know the Signs, Act in Time Video

    Medline Plus

    Full Text Available ... Seeing. Trouble Walking. Know Stroke, Know the Signs, Act in Time. Announcer: Most people know what to ... but you need to know the signs and act in time. Here are the signs to look ...

  16. Path optimization method for the sign problem

    Directory of Open Access Journals (Sweden)

    Ohnishi Akira

    2018-01-01

    Full Text Available We propose a path optimization method (POM to evade the sign problem in the Monte-Carlo calculations for complex actions. Among many approaches to the sign problem, the Lefschetz-thimble path-integral method and the complex Langevin method are promising and extensively discussed. In these methods, real field variables are complexified and the integration manifold is determined by the flow equations or stochastically sampled. When we have singular points of the action or multiple critical points near the original integral surface, however, we have a risk to encounter the residual and global sign problems or the singular drift term problem. One of the ways to avoid the singular points is to optimize the integration path which is designed not to hit the singular points of the Boltzmann weight. By specifying the one-dimensional integration-path as z = t +if(t(f ϵ R and by optimizing f(t to enhance the average phase factor, we demonstrate that we can avoid the sign problem in a one-variable toy model for which the complex Langevin method is found to fail. In this proceedings, we propose POM and discuss how we can avoid the sign problem in a toy model. We also discuss the possibility to utilize the neural network to optimize the path.

  17. Traffic signs recognition for driving assistance

    Science.gov (United States)

    Sai Sangram Reddy, Yatham; Karthik, Devareddy; Rana, Nikunj; Jasmine Pemeena Priyadarsini, M.; Rajini, G. K.; Naseera, Shaik

    2017-11-01

    In the current circumstances with the innovative headway, we must be able to provide assistance to the driving in recognising the traffic signs on the roads. At present time, many reviews are being directed moving in the direction of the usage of a keen Traffic Systems. One field of this exploration is driving support systems, and many reviews are being directed to create frameworks which distinguish and perceive street signs in front of the vehicle, and afterward utilize the data to advise the driver or to even control the vehicle by implementing this system on self-driving vehicles. In this paper we propose a method to detect the traffic sign board in a frame using HAAR cascading and then identifying the sign on it. The output may be either given out in voice or can be displayed as per the driver’s convenience. Each of the Traffic Sign is recognised using a database of images of symbols used to train the KNN classifier using open CV libraries.

  18. An experimental vital signs detection radar using low-IF heterodyne architecture and single-sideband transmission

    DEFF Research Database (Denmark)

    Jensen, Brian Sveistrup; Johansen, Tom Keinicke; Yan, Lei

    2013-01-01

    In this paper an experimental X-band radar system, called DTU-VISDAM, developed for the detection and monitoring of human vital signs is described. The DTU-VISDAM radar exploits a low intermediate frequency (IF) heterodyne RF front-end architecture and single-sideband (SSB) transmission for easier...... and more reliable extraction of the vital signs. The hardware implementation of the proposed low-IF RF front-end architecture and associated IF circuitry is discussed. Furthermore, the signal processing and calibration steps necessary to extract the vital signs information measured on a human subject...

  19. Common signs and symptoms in hypothyroidism in central part of iran

    International Nuclear Information System (INIS)

    Jabbari, A.; Besharat, S.; Razavianzadeh, N.; Moetabar, M.

    2008-01-01

    This study was designed to evaluate the common signs and symptoms of hypothyroidism in persons with clinical diagnosis of hypothyroidism that was confirmed with laboratory tests. This descriptive cross-sectional study was done during 13 months in medical centers of Shahrood city, in central part of Iran. All cases with probable diagnosis of hypothyroidism based on the signs and symptoms, referred to health care services were included in the study. Radioimmunoassay tests and thyroid hormones evaluation were done. Demographic data and signs were recorded through interview. Data were entered in the computer and analyzed by SPSS software. Patients who completed questionnaires (n=50) were interviewed three times during this period. Female/male ratio was 6/1. The most common signs were cold intolerance (95%), weight gain and menorrhagia. The most common symptoms were edema (80%) and pallor (60%). The severe disease was seen in 4%. Mild type was the most common presentation of hypothyroidism (60%). The most common signs and symptoms of hypothyroidism in the central part of Iran (Shahrood city), that is one of the iodine deficient areas in Iran; were different from other studies. Socio-demographic and nutritional status, illiteracy level and personal self-care are among the probable causes. Unfortunately, concomitance of some of the signs and symptoms are not diagnostic for hypothyroidism. It seems that strong clinical suspicious and laboratory confirmation are the only reliable methods for hypothyroidism diagnosis. (author)

  20. Acute ureterolithiasis: Incidence of secondary signs on unenhanced helical CT and influence on patient management

    Energy Technology Data Exchange (ETDEWEB)

    Ege, G. E-mail: gurkanege@yahoo.com; Akman, H.; Kuzucu, K.; Yildiz, S

    2003-12-01

    AIM: The purpose of this study was to determine the incidence of secondary signs associated with ureteral stones on unenhanced helical computed tomography (CT) of patients with acute renal colic, and to correlate these with patient management and outcome. MATERIALS AND METHODS: One hundred and ten patients with ureterolithiasis were evaluated prospectively for the secondary signs of obstruction on unenhanced helical CT. Our attention was focused primarily on the presence or absence of seven secondary signs on unenhanced helical CT, including hydronephrosis, unilateral renal enlargement, perinephric oedema, unilateral absence of the white pyramid, hydroureter, periureteral oedema and lateroconal fascial thickening. RESULTS: Of the 110 patients, 91 (82.7%) had hydroureter, 88 (80%) had hydronephrosis, 65 (59%) had periureteric oedema and 63 (57.2%) had unilateral renal enlargement. Ninety stones passed spontaneously and 21 required intervention. CONCLUSION: Secondary signs of urinary tract obstruction are useful and supportive findings in interpretation of the CT examination. In our experience, the most reliable signs indicating ureteral obstruction are hydroureter, hydronephrosis, periureteral oedema and unilateral renal enlargement, respectively. In addition, stones larger than 6 mm, located within the proximal two thirds of the ureter, and seen associated with five or more the secondary signs of obstruction, are more likely to require endoscopic removal and/or lithotripsy.

  1. Reliability Centered Maintenance - Methodologies

    Science.gov (United States)

    Kammerer, Catherine C.

    2009-01-01

    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  2. Issues in cognitive reliability

    International Nuclear Information System (INIS)

    Woods, D.D.; Hitchler, M.J.; Rumancik, J.A.

    1984-01-01

    This chapter examines some problems in current methods to assess reactor operator reliability at cognitive tasks and discusses new approaches to solve these problems. The two types of human failures are errors in the execution of an intention and errors in the formation/selection of an intention. Topics considered include the types of description, error correction, cognitive performance and response time, the speed-accuracy tradeoff function, function based task analysis, and cognitive task analysis. One problem of human reliability analysis (HRA) techniques in general is the question of what are the units of behavior whose reliability are to be determined. A second problem for HRA is that people often detect and correct their errors. The use of function based analysis, which maps the problem space for plant control, is recommended

  3. Web-Based Evidence Based Practice Educational Intervention to Improve EBP Competence among BSN-Prepared Pediatric Bedside Nurses: A Mixed Methods Pilot Study

    Science.gov (United States)

    Laibhen-Parkes, Natasha

    2014-01-01

    For pediatric nurses, their competence in EBP is critical for providing high-quality care and maximizing patient outcomes. The purpose of this pilot study was to assess and refine a Web-based EBP educational intervention focused on improving EBP beliefs and competence in BSN-prepared pediatric bedside nurses, and to examine the feasibility,…

  4. Family bedside orientations: An innovative peer support model to enhance a culture of family-centred care at the Stollery Children's Hospital.

    Science.gov (United States)

    Wodinski, Lindsay M; Mattson McCrady, Heather M; Oswald, Christie M; Lyste, Nicole J M; Forbes, Karen L L

    2017-10-01

    This paper presents family bedside orientations, an innovative bedside peer support model for families of paediatric patients piloted in one unit at the Stollery Children's Hospital in Edmonton, Alberta. The model invites family members of former patients back to the hospital as volunteer peer mentors responsible for meeting one-on-one with current inpatient families to provide a listening presence, discuss patient safety practices and encourage families to participate in their child's care. Using qualitative and quantitative data collection methods, the model was evaluated over 1 year (December 2014 to December 2015). Data sources included peer mentor field notes (from 163 visits) detailing the number of family bedside orientations completed by peer mentors and how they interacted with families, as well as post-visit family (n=35) surveys, Hospital-Child Inpatient Experience Survey data, peer mentor (n=6) questionnaires, focus groups with unit staff (n=10) and interviews with members of the project leadership team (n=5). Our findings indicated that family bedside orientations became an established practice in the pilot unit and positively impacted family care experiences. We attribute these successes to championing and support from unit staff and our multidisciplinary project leadership team. We discuss how our team addressed family privacy and confidentiality while introducing peer mentors in the unit. We also highlight strategies used to integrate peer mentors as part of the staff team and enhance peer support culture in the pilot unit. Practical considerations for implementing this model in other paediatric environments are provided.

  5. Lack of concordance between a rapid bedside and conventional laboratory method of cardiac troponin testing: impact on risk stratification of patients suspected of acute coronary syndrome.

    NARCIS (Netherlands)

    Cramer, G.E.; Kievit, P.C.; Brouwer, M.A.; Keijzer, M.H. de; Luijten, H.E.; Verheugt, F.W.A.

    2007-01-01

    OBJECTIVES: This study was designed to test the usefulness of a bedside assay as compared to a laboratory method of troponin testing to predict adverse cardiac outcome of chest pain patients. METHODS: We studied 358 ER visits of patients suspected of a non ST-elevation acute coronary syndrome. cTnI

  6. [Value of bedside echocardiography in diagnosis and risk assessment of in-hospital death for patients with Stanford type A aortic dissection].

    Science.gov (United States)

    Wang, H J; Xiao, Z Y; Gu, G R; Xue, Y; Shao, M; Deng, Z; Tao, Z G; Yao, C L; Tong, C Y

    2017-11-24

    Objective: To investigate the value of bedside echocardiography in diagnosis and risk assessment of in-hospital death of patients with Stanford type A aortic dissection. Methods: The clinical data of 229 patients with Stanford type A aortic dissection diagnosed by CT angiography in Zhongshan Hospital affiliated to Fudan University between January 2009 and January 2016 were retrospectively analyzed. The patients were divided into survival group(191 cases)and non-survival group(38 cases)according to presence or absence of in-hospital death. The bedside echocardiography features were analyzed, and influence factors of in-hospital death were determined by multivariate logistic regression analysis. Results: (1) Compared with the survival group, the non-survival group had lower surgery rate (60.52%(23/38) vs. 85.34%(163/191), P 0.05). (2) The bedside echocardiography results showed that prevalence of aortic valve involvement(65.79%(25/38) vs.34.03%(65/191), P 0.05). (3) The multivariate logistic regression analysis showed that aortic valve involvement( OR =3.275, 95% CI 1.290-8.313, P risk factors for in-hospital death in patients with Stanford type A aortic dissection. Conclusions: Bedside echocardiography has significant diagnostic value for Stanford type A aortic dissection. Aortic valve involvement, enlargement of aortic root diameter and without surgery are independent risk factors for patients with Stanford type A aortic dissection.

  7. [SPECIFIC DIAGNOSTIC SIGNIFICANCE OF "RIPPLE SIGN" OF MEDIAL FEMORAL CONDYLE UNDER ARTHROSCOPE IN MEDIAL LONGITUDINAL MENISCAL TEARS].

    Science.gov (United States)

    Ren Shiyou; Sun, Limang; Chen, Guofei; Jiang, Changqing; Zhang, Xintao; Zhang Wentao

    2015-01-01

    To investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. Between June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. The positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign" , 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". The "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.

  8. Reliability issues in PACS

    Science.gov (United States)

    Taira, Ricky K.; Chan, Kelby K.; Stewart, Brent K.; Weinberg, Wolfram S.

    1991-07-01

    Reliability is an increasing concern when moving PACS from the experimental laboratory to the clinical environment. Any system downtime may seriously affect patient care. The authors report on the several classes of errors encountered during the pre-clinical release of the PACS during the past several months and present the solutions implemented to handle them. The reliability issues discussed include: (1) environmental precautions, (2) database backups, (3) monitor routines of critical resources and processes, (4) hardware redundancy (networks, archives), and (5) development of a PACS quality control program.

  9. Reliability Parts Derating Guidelines

    Science.gov (United States)

    1982-06-01

    226-30, October 1974. 66 I, 26. "Reliability of GAAS Injection Lasers", De Loach , B. C., Jr., 1973 IEEE/OSA Conference on Laser Engineering and...Vol. R-23, No. 4, 226-30, October 1974. 28. "Reliability of GAAS Injection Lasers", De Loach , B. C., Jr., 1973 IEEE/OSA Conference on Laser...opnatien ot 󈨊 deg C, mounted on a 4-inach square 0.250~ inch thick al~loy alum~nusi panel.. This mounting technique should be L~ ken into cunoidur~tiou

  10. Reliability and validity of the de Morton Mobility Index in individuals with sub-acute stroke.

    Science.gov (United States)

    Braun, Tobias; Marks, Detlef; Thiel, Christian; Grüneberg, Christian

    2018-02-04

    To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke. This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke. The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n = 109) and reliability (n = 51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p = 0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92-0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident. These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum. Implications for Rehabilitation The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke. The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity. The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points. The lack of any floor or ceiling effects on hospital admission indicates

  11. Accuracy of bedside glucose measurement from three glucometers in critically ill patients.

    NARCIS (Netherlands)

    Hoedemaekers, C.W.E.; Klein Gunnewiek, J.M.T.; Prinsen, M.A.; Willems, J.L.; Hoeven, J.G. van der

    2008-01-01

    OBJECTIVE: Implementation of strict glucose control in most intensive care units has resulted in increased use of point-of-care glucose devices in the intensive care unit. The aim of this study was to determine the reliability of point-of-care testing glucose meters among critically ill patients

  12. A comparison of Google Glass and traditional video vantage points for bedside procedural skill assessment.

    Science.gov (United States)

    Evans, Heather L; O'Shea, Dylan J; Morris, Amy E; Keys, Kari A; Wright, Andrew S; Schaad, Douglas C; Ilgen, Jonathan S

    2016-02-01

    This pilot study assessed the feasibility of using first person (1P) video recording with Google Glass (GG) to assess procedural skills, as compared with traditional third person (3P) video. We hypothesized that raters reviewing 1P videos would visualize more procedural steps with greater inter-rater reliability than 3P rating vantages. Seven subjects performed simulated internal jugular catheter insertions. Procedures were recorded by both Google Glass and an observer's head-mounted camera. Videos were assessed by 3 expert raters using a task-specific checklist (CL) and both an additive- and summative-global rating scale (GRS). Mean scores were compared by t-tests. Inter-rater reliabilities were calculated using intraclass correlation coefficients. The 1P vantage was associated with a significantly higher mean CL score than the 3P vantage (7.9 vs 6.9, P = .02). Mean GRS scores were not significantly different. Mean inter-rater reliabilities for the CL, additive-GRS, and summative-GRS were similar between vantages. 1P vantage recordings may improve visualization of tasks for behaviorally anchored instruments (eg, CLs), whereas maintaining similar global ratings and inter-rater reliability when compared with conventional 3P vantage recordings. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. [Information technology in learning sign language].

    Science.gov (United States)

    Hernández, Cesar; Pulido, Jose L; Arias, Jorge E

    2015-01-01

    To develop a technological tool that improves the initial learning of sign language in hearing impaired children. The development of this research was conducted in three phases: the lifting of requirements, design and development of the proposed device, and validation and evaluation device. Through the use of information technology and with the advice of special education professionals, we were able to develop an electronic device that facilitates the learning of sign language in deaf children. This is formed mainly by a graphic touch screen, a voice synthesizer, and a voice recognition system. Validation was performed with the deaf children in the Filadelfia School of the city of Bogotá. A learning methodology was established that improves learning times through a small, portable, lightweight, and educational technological prototype. Tests showed the effectiveness of this prototype, achieving a 32 % reduction in the initial learning time for sign language in deaf children.

  14. A Sign Language Screen Reader for Deaf

    Science.gov (United States)

    El Ghoul, Oussama; Jemni, Mohamed

    Screen reader technology has appeared first to allow blind and people with reading difficulties to use computer and to access to the digital information. Until now, this technology is exploited mainly to help blind community. During our work with deaf people, we noticed that a screen reader can facilitate the manipulation of computers and the reading of textual information. In this paper, we propose a novel screen reader dedicated to deaf. The output of the reader is a visual translation of the text to sign language. The screen reader is composed by two essential modules: the first one is designed to capture the activities of users (mouse and keyboard events). For this purpose, we adopted Microsoft MSAA application programming interfaces. The second module, which is in classical screen readers a text to speech engine (TTS), is replaced by a novel text to sign (TTSign) engine. This module converts text into sign language animation based on avatar technology.

  15. Signs in neuroradiology: A pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Kizilca, Ozgur; Oztek, Alp; Kesimal, Ugur; Senol, Utku [Dept. of Radiology, Akdeniz University Faculty of Medicine, Antalya (Turkmenistan)

    2017-11-15

    One of the major problems radiologists face in everyday practice is to decide the correct diagnosis, or at least narrow down the list of possibilities. In this context, indicative evidences (signs) are useful to recognize pathologies, and also to narrow the list of differential diagnoses. Despite classically being described for a single disease, or a closely related family of disorders, most indications are not restricted exclusively to their traditional definition. Therefore, using signs for prognosis requires knowledge of the mechanism of their appearance, and which pathologies they are observed in. In this study, we demonstrate some of the more common and useful neuroradiologic signs with relevant images, and discuss their use in differential diagnosis.

  16. The "double panda" sign in Leigh disease.

    Science.gov (United States)

    Sonam, Kothari; Bindu, P S; Gayathri, Narayanappa; Khan, Nahid Akhtar; Govindaraju, C; Arvinda, Hanumanthapura R; Nagappa, Madhu; Sinha, Sanjib; Thangaraj, K; Taly, Arun B

    2014-07-01

    Although the "face of the giant panda" sign on magnetic resonance imaging (MRI) is traditionally considered to be characteristic of Wilson disease, it has also been reported in other metabolic disorders. This study describes the characteristic "giant panda" sign on MRI in a child with Leigh disease. The diagnosis was based on the history of neurological regression; examination findings of oculomotor abnormalities, hypotonia, and dystonia; raised serum lactate levels; and characteristic brain stem and basal ganglia signal changes on MRI. The midbrain and pontine tegmental signal changes were consistent with the "face of the giant panda and her cub" sign. In addition to Wilson disease, metabolic disorders such as Leigh disease should also be considered in the differential diagnosis of this rare imaging finding. © The Author(s) 2013.

  17. English Shop Signs and Brand Names

    Directory of Open Access Journals (Sweden)

    Parvaneh Khosravizadeh

    2016-07-01

    Full Text Available The present study tries to investigate the people’s attitude to the use of English words in TV commercials, brand-naming and shop signs in Iran and specifically in Tehran where due to the fact that it is the capital, more English might be used for the sake of foreigners. The widespread use of English shop signs and English brand names for recently produced goodsdrove the researchers to investigate peoples’ attitude as consumers from two aspects of age and education. To reach the research goal, a questionnaire was devised and distributed to 100 people at random selection probing their attitudes while considering two factors of age and education. The result of the research will mostly benefit sociolinguists and business marketers.Keywords: age, education, advertising, brand-naming, shop signs, globalization

  18. Classic Peripheral Signs of Subacute Bacterial Endocarditis

    Directory of Open Access Journals (Sweden)

    Yooyoung Chong

    2016-10-01

    Full Text Available A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.

  19. Classic Peripheral Signs of Subacute Bacterial Endocarditis

    Science.gov (United States)

    Chong, Yooyoung; Han, Sung Joon; Rhee, Youn Ju; Kang, Shin Kwang; Yu, Jae Hyeon; Na, Myung Hoon

    2016-01-01

    A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance. PMID:27734006

  20. A sequent calculus for signed interval logic

    DEFF Research Database (Denmark)

    Rasmussen, Thomas Marthedal

    2001-01-01

    We propose and discuss a complete sequent calculus formulation for Signed Interval Logic (SIL) with the chief purpose of improving proof support for SIL in practice. The main theoretical result is a simple characterization of the limit between decidability and undecidability of quantifier-free SIL....... We present a mechanization of SIL in the generic proof assistant Isabelle and consider techniques for automated reasoning. Many of the results and ideas of this report are also applicable to traditional (non-signed) interval logic and, hence, to Duration Calculus....