Sample records for reliable bedside sign

  1. Bedside ultrasound reliability in locating catheter and detecting complications

    Payman Moharamzadeh


    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.

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


    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. Vomiting as a reliable sign of concussion.

    Ledic, Darko; Sosa, Ivan; Linic, Ines Strenja; Cvijanovic, Olga; Kovacevic, Miljenko; Desnica, Andrej; Banicek, Ivanka


    Concussion is the most common type of traumatic brain injury, with headache being the most frequent symptom of mild traumatic brain injury (MTBI) (including dizziness, vomiting, nausea, lack of motor coordination or difficulty balancing). Concussion may be caused by a blow to the head, or by acceleration forces without a direct impact. Often, MTBI occurs as the result of a sports injury. Loss of consciousness is always present, unlike vomiting. Therefore, we hypothesize vomiting to be considered as a cardinal sign of concussion. Stimulation of vomiting centres finally triggers vomiting. Professional boxers and mixed martial arts competitions reluctantly agree with stringent rules and protective clothing. We discuss the issue of further protection for those engaged in these and other sports. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Reliability of subtle (soft) neurological signs in children.

    Vitiello, B; Ricciuti, A J; Stoff, D M; Behar, D; Denckla, M B


    Reliability and stability of neurological "subtle" ("soft") signs were assessed in 54 psychiatric patients and 25 normal children, aged 5-17 years, using the revised Neurological Examination for Subtle Signs (NESS). Acceptable interrater reliability (kappa greater than or equal to 0.50, or intraclass correlation coefficient greater than or equal to 0.70) was found for 40 of the 64 items tested. Test-retest reliability at 2 weeks was unsatisfactory for most of the categorically scored items, including some "classic" subtle signs such as overflows or dysrhythmias. Continuous items, such as time needed to perform 20 consecutive movements, remained mostly stable at retest. A practicing effect was evident only in the graphesthesia test. Overall internal consistency was good (Cronbach's alpha = 0.74). Given the poor stability of overflows and dysrhythmias, researchers and clinicians should rely more on subtle signs that can be assessed on continuous scales.

  5. Risser sign inter-rater and intra-rater agreement: is the Risser sign reliable?

    Reem, Jennifer; Carney, Joseph; Cassidy, Jeffrey [Naval Medical Center San Diego, Department of Orthopaedics, San Diego, CA (United States); Stanley, Mark [Naval Medical Center San Diego, Radiology Department, San Diego, CA (United States); Uniformed Services University of Health Sciences, Bethesda, MD (United States)


    Studies directly evaluating the reliability of the Risser sign are few in number, possess small sample sizes, and offer conflicting results. This study establishes the reliability of the Risser sign on a large sample size in an effort to provide clarification on the subject. Two years' worth of AP pelvis radiographs from patients age 8-20 were downloaded from our institution's digital imaging system. One hundred of these images were selected for inclusion by an independent reviewer whose goal was to capture a spread of radiographs that included all Risser stages. Risser grading occurred in two rounds. In each round, three examiners randomly reviewed the 100 radiographs on three different occasions. The full AP pelvis radiograph was graded in Round 1 while only the iliac apophysis was visible in Round 2. Kappa coefficients and their confidence bounds are reported to indicate intra- and inter-observer reliability. The contrast between the rates of agreement about Risser stages in Rounds 1 versus 2 was assessed by McNemar's test. The signed-rank test was used to evaluate differences in intra-observer values between rounds. Round 1 inter-observer kappa was 0.76. Round 2 inter-observer kappa was 0.51. In Round 1, 63 radiographs showed perfect agreement within the same Risser stage for all observations compared to 44 radiographs with perfect agreement within the same Risser stage in Round 2 (p=0.004). Round 1 intra-observer kappa values were 0.92, 0.86, and 0.88. Round 2 intra-observer kappa values were 0.91, 0.77, and 0.88. Intra-observer value differences between rounds were not significant for two observers (p=0.074, 0.061) but was significant for the third observer (p=0.002). The reliability of the Risser sign is acceptable and can be further improved when other markers of skeletal maturity on the pelvis radiograph are used to assist in grading. (orig.)

  6. The role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis.

    Kumar, Arun; Debata, Pradeep Kumar; Ranjan, Amitabh; Gaind, Rajani


    To evaluate the role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis in children using reagent strips. This prospective, single blinded study was conducted in the Department of Pediatrics of VMMC & Safdarjung Hospital, New Delhi in collaboration with the Department of Microbiology of VMMC & Safdarjung Hospital, New Delhi, over a period of 15 mo (August 2009 to Nov 2010). Seventy-five children aged 3 mo to 12 y admitted in the pediatric ward with suspected diagnosis of acute meningitis were included. All enroled patients underwent lumbar puncture. CSF samples were taken and divided in 2 parts for laboratory evaluation and rapid strip analysis. The sensitivity, specificity, positive predictive value and the negative predictive values of the reagent strips for the diagnosis of bacterial meningitis were calculated. Accuracy of the reagent strips was established using kappa statistics. Latex agglutination for antigen detection and microbiological culture were also done. Highly significant association was observed between CSF examination in routine laboratory method and dipstick method. The number of laboratory values that correlated were- for cells 71(94.63%), for protein 68 (90.67%), for glucose 68(90.67%) out of total 75 cases. The sensitivity and specificity of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. The positive predictive and negative predictive values of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. Staphylococcus aureus was found to be the most common organism isolated (50%). Thus reagent strip analysis is a very rapid, reliable and effective method for diagnosis of acute bacterial meningitis in children. Staphylococcus aureus was the most common organism isolated.

  7. Bedside thoracic ultrasonography of the fourth intercostal space reliably determines safe removal of tube thoracostomy after traumatic injury.

    Kwan, Rita O; Miraflor, Emily; Yeung, Louise; Strumwasser, Aaron; Victorino, Gregory P


    Thoracic ultrasonography is more sensitive than chest radiography (CXR) in detecting pneumothorax; however, the role of ultrasonography to determine resolution of pneumothorax after thoracostomy tube placement for traumatic injury remains unclear. We hypothesized that ultrasonography can be used to determine pneumothorax resolution and facilitate efficient thoracostomy tube removal. We sought to compare the ability of thoracic ultrasonography at the second through fifth intercostal space (ICS) to detect pneumothorax with that of CXR and determine which ICS maximizes the positive and negative predictive value of thoracic ultrasonography for detecting clinically relevant pneumothorax resolution. A prospective, blinded clinical study of trauma patients requiring tube thoracostomy placement was performed at a university-based urban trauma center. A surgeon performed daily thoracic ultrasonographies consisting of midclavicular lung evaluation for pleural sliding in ICS 2 through 5. Ultrasonography findings were compared with findings on concurrently obtained portable CXR. Of the patients, 33 underwent 119 ultrasonographies, 109 of which had concomitant portable CXR results for comparison. Ultrasonography of ICS 4 or 5 was better than ICS 2 and 3 at detecting a pneumothorax, with a positive predictive value of 100% and a negative predictive value of 92%. The positive and negative predictive values for ICS 2 were 46% and 93% and for ICS 3 were 63% and 92%, respectively. Bedside, surgeon-performed, thoracic ultrasonography of ICS 4 for pneumothorax can safely and efficiently determine clinical resolution of traumatic pneumothorax and aid in the timely removal of thoracostomy tubes. Diagnostic study, level II.

  8. Diagnosing Diabetic Foot Osteomyelitis in Patients Without Signs of Soft Tissue Infection by Coupling Hybrid 67Ga SPECT/CT With Bedside Percutaneous Bone Puncture

    Aslangul, Elisabeth; M’Bemba, Jocelyne; Caillat-Vigneron, Nadine; Coignard, Sophie; Larger, Etienne; Boitard, Christian; Lipsky, Benjamin A.


    OBJECTIVE Successful treatment of osteomyelitis is more likely with accurate diagnosis and identification of the causative pathogens. This typically requires obtaining a specimen of bone, usually by image-guided biopsy. We sought to develop a simpler bedside method for definitively diagnosing osteomyelitis. RESEARCH DESIGN AND METHODS Over 2 years, we enrolled consecutive patients presenting to our diabetic foot clinic with a foot ulcer and clinically suspected osteomyelitis but without soft ...

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

    Zhenyu Mei


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

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


    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.

  11. Comparing portable computers with bedside computers when administering medications using bedside medication verification.

    Ludwig-Beymer, Patti; Williams, Phillip; Stimac, Ellen


    This research examined bedside medication verification administration in 2 adult critical care units, using portable computers and permanent bedside computers. There were no differences in the number of near-miss errors, the time to administer the medications, or nurse perception of ease of medication administration, care of patients, or reliability of technology. The percentage of medications scanned was significantly higher with the use of permanent bedside computers, and nurses using permanent bedside computers were more likely to agree that the computer was always available.

  12. Update on bedside ultrasound (US) diagnosis of acute cholecystitis (AC).

    Zenobii, Maria Francesca; Accogli, Esterita; Domanico, Andrea; Arienti, Vincenzo


    Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy's sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.

  13. Physical Dysfunction and Nonorganic Signs in Patients With Chronic Neck Pain : Exploratory Study Into Interobserver Reliability and Construct Validity

    Jorritsma, Wim; Dijkstra, Pieter U.; Knol -de Vries, Grietje; Geertzen, Jan H. B.; Reneman, Michiel F.


    STUDY DESIGN: Repeated-measurement design. OBJECTIVES: To explore interobserver reliability of the modified physical dysfunction severity (mPDS) as a measure for impairment of the cervical spine and the modified cervical nonorganic signs (mcNOS) as a measure for behavioral signs, and to explore cons

  14. Validity and reliability of the Japanese version of the Newest Vital Sign: a preliminary study.

    Takamichi Kogure

    Full Text Available Health literacy (HL refers to the ability to obtain, process, and understand basic health information and services, and is thus needed to make appropriate health decisions. The Newest Vital Sign (NVS is comprised of 6 questions about an ice cream nutrition label and assesses HL numeracy skills. We developed a Japanese version of the NVS (NVS-J and evaluated the validity and reliability of the NVS-J in patients with chronic pain. The translation of the original NVS into Japanese was achieved as per the published guidelines. An observational study was subsequently performed to evaluate the validity and reliability of the NVS-J in 43 Japanese patients suffering from chronic pain. Factor analysis with promax rotation, using the Kaiser criterion (eigenvalues ≥1.0, and a scree plot revealed that the main component of the NVS-J consists of three determinative factors, and each factor consists of two NVS-J items. The criterion-related validity of the total NVS-J score was significantly correlated with the total score of Ishikawa et al.'s self-rated HL Questionnaire, the clinical global assessment of comprehensive HL level, cognitive function, and the Brinkman index. In addition, Cronbach's coefficient for the total score of the NVS-J was adequate (alpha = 0.72. This study demonstrated that the NVS-J has good validity and reliability. Further, the NVS-J consists of three determinative factors: "basic numeracy ability," "complex numeracy ability," and "serious-minded ability." These three HL abilities comprise a 3-step hierarchical structure. Adequate HL should be promoted in chronic pain patients to enable coping, improve functioning, and increase activities of daily living (ADLs and quality of life (QOL.

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

    Makdissi, Michael; Davis, Gavin


    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.

  16. Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement

    Dayana P. Rosa


    Full Text Available Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic, and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval.

  17. Reliability of measuring pectoralis minor muscle resting length in subjects with and without signs of shoulder impingement

    Rosa, Dayana P.; Borstad, John D.; Pires, Elisa D.; Camargo, Paula R.


    Background: Pectoralis minor adaptive shortening may change scapula resting position and scapular kinematics during arm elevation. A reliable and clinically feasible method for measuring pectoralis minor length will be useful for clinical decision making when evaluating and treating individuals with shoulder pain and dysfunction. Objectives: To evaluate intrarater, interrater, and between-day reliability of a pectoralis minor (PM) muscle length measurement in subjects with and without signs of shoulder impingement. Method: A convenience sample of 100 individuals (50 asymptomatic and 50 symptomatic) participated in this study. Intra- and interrater reliability of the measurement was estimated in 50 individuals (25 asymptomatic and 25 symptomatic), and between-day reliability of the measurement repeated over an interval of 7 days was estimated in an independent sample of 50 additional participants. Pectoralis minor length was measured using a flexible tape measure with subjects standing. Results: Intraclass correlation coefficients (ICC3,k) for intrarater and interrater reliability ranged from 0.86-0.97 and 0.95 for between-day reliability in both groups. Standard error of measurements (SEM) ranged from 0.30-0.42 cm, 0.70-0.84 cm, and 0.40-0.41 cm for intrarater, interrater, and between-day reliability, respectively, across the sample. The minimal detectable change (MDC) for between-day measurements ranged from 1.13-1.14 cm for both groups. Conclusions: In asymptomatic individuals and in those with signs of shoulder impingement, a single rater or pair of raters can measure pectoralis minor muscle length using a tape measure with very good reliability. This measurement can also be reliably used by the same rater over a seven day interval. PMID:26982455

  18. Is scar tenderness a reliable sign of scar complications in labor?

    Isha Gutgutia


    Full Text Available Background: Cesarean section has come a long way from being a risky & restrictive surgery to one that is safe and quick. Due to a rise in the rates of primary caesarean section globally, repeat cesarean section has also become very common. The chief concern during labor with scarred uteri is that of scar rupture which can have devastating fetal and maternal consequences, including mortality. Several studies monitoring for the features of scar rupture like abnormal cardiotocography (CTG, severe abdominal pain persisting between contractions, acute onset scar tenderness, hematuria or abnormal vaginal bleeding, maternal tachycardia or shock, cessation of uterine activity and loss of station of the presenting part exist with the exception of scar tenderness which has not been evaluated separately in any study. The present prospective observational study was undertaken in a tertiary care hospital to evaluate the sensitivity and specificity of scar tenderness as a sign of scar complications in labor. Methods: 78 women with one previous cesarean delivery in spontaneous labor at term undergoing trial of scar were monitored for progress of labor and observed for vaginal bleeding, scar tenderness, maternal pulse and blood pressure every 30 minutes. Scar tenderness was elicited by pressing below and behind the pubic symphysis in between uterine contractions while engaging the woman in conversation and noting for a visible wince. Fetal heart rate auscultation was done as per protocol. Trial of scar was terminated for scar tenderness, unexplained maternal tachycardia, fresh vaginal bleeding, fetal heart rate abnormalities and non-progress of labor. Results: The sensitivity and specificity of scar tenderness as a predictor of scar complications was 92.3% and 3.8%, while accuracy was 33.3%. The likelihood ratio of a positive sign of scar tenderness being associated with scar complications in labour is 1.48. Maternal tachycardia was not a significant predictor

  19. A Tool to Assess the Signs and Symptoms of Catheter-Associated Urinary Tract Infection: Development and Reliability.

    Blodgett, Tom J; Gardner, Sue E; Blodgett, Nicole P; Peterson, Lisa V; Pietraszak, Melissa


    The purpose of this pilot study was to determine the inter-rater reliability of four clinical manifestations of catheter-associated urinary tract infections (CAUTI) among hospitalized adults with short-term indwelling urinary catheters using a tool developed for this purpose: the CAUTI Assessment Profile (CAP). Study participants included 30 non-pregnant English-speaking adults, recruited from two community hospitals. Three nurses assessed each participant for fever, suprapubic tenderness, flank tenderness, and delirium using standardized techniques. Based on the generalized Kappa statistic and 95% confidence intervals, there was evidence of strong inter-rater reliability for fever (K = 1.00, 0.793-1.207), suprapubic tenderness (K = 0.39, 0.185-0.598), and delirium (K = 0.58, 0.379-0.792), but not for flank tenderness (K = 0.29, -0.036 to 0.617). This study provides preliminary evidence that the CAP can be used to consistently identify these clinical signs and symptoms of CAUTI in hospitalized adults. © The Author(s) 2014.

  20. Bedside Blood Glucose Monitoring in Hospitals

    American Diabetes Association


    Bedside Blood Glucose Monitoring in Hospitals American Diabetes Association The modern management of hospitalized patients with diabetes includes capillary blood glucose determinations at the bedside...

  1. Bedside ocular ultrasound.

    Roque, Pedro J; Hatch, Nicholas; Barr, Laurel; Wu, Teresa S


    Many ocular emergencies are difficult to diagnose in the emergency setting with conventional physical examination tools. Additionally, persistent efforts to re-examine the eye may be deleterious to a patient's overall condition. Ultrasound is an important tool because it affords physicians a rapid, portable, accurate, and dynamic tool for evaluation of a variety of ocular and orbital diseases. The importance of understanding orbital anatomy, with attention to the firm attachment points of the various layers of the eye, cannot be understated. This article describes the relevant eye anatomy, delves into the ultrasound technique, and illustrates a variety of orbital pathologies detectable by bedside ultrasound.

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

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


    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. Migraine patients consistently show abnormal vestibular bedside tests

    Eliana Teixeira Maranhão


    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.

  4. The Bedside Sherlock Holmes

    Fitzgerald, Faith T.; Tierney, Lawrence M.


    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. PMID:7135953

  5. The bedside Sherlock Holmes.

    Fitzgerald, F T; Tierney, L M


    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.

  6. A large web-based observer reliability study of early ischaemic signs on computed tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS.

    Joanna M Wardlaw

    Full Text Available BACKGROUND: Early signs of ischaemic stroke on computerised tomography (CT scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. METHODOLOGY AND PRINCIPAL FINDINGS: We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. CONCLUSIONS: Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis.

  7. A Large Web-Based Observer Reliability Study of Early Ischaemic Signs on Computed Tomography. The Acute Cerebral CT Evaluation of Stroke Study (ACCESS)

    Wardlaw, Joanna M.; von Kummer, Rüdiger; Farrall, Andrew J.; Chappell, Francesca M.; Hill, Michael; Perry, David


    Background Early signs of ischaemic stroke on computerised tomography (CT) scanning are subtle but CT is the most widely available diagnostic test for stroke. Scoring methods that code for the extent of brain ischaemia may improve stroke diagnosis and quantification of the impact of ischaemia. Methodology and Principal Findings We showed CT scans from patients with acute ischaemic stroke (n = 32, with different patient characteristics and ischaemia signs) to doctors in stroke-related specialties world-wide over the web. CT scans were shown twice, randomly and blindly. Observers entered their scan readings, including early ischaemic signs by three scoring methods, into the web database. We compared observers' scorings to a reference standard neuroradiologist using area under receiver operator characteristic curve (AUC) analysis, Cronbach's alpha and logistic regression to determine the effect of scales, patient, scan and observer variables on detection of early ischaemic changes. Amongst 258 readers representing 33 nationalities and six specialties, the AUCs comparing readers with the reference standard detection of ischaemic signs were similar for all scales and both occasions. Being a neuroradiologist, slower scan reading, more pronounced ischaemic signs and later time to CT all improved detection of early ischaemic signs and agreement on the rating scales. Scan quality, stroke severity and number of years of training did not affect agreement. Conclusions Large-scale observer reliability studies are possible using web-based tools and inform routine practice. Slower scan reading and use of CT infarct rating scales improve detection of acute ischaemic signs and should be encouraged to improve stroke diagnosis. PMID:21209901

  8. Delay-bounded semi-reliable vital sign transmission protocol for mobile telemedicine over a CDMA 1x EV-DO network.

    Lee, Tong H; Yoo, Sun K


    The reliable and instant transmission of vital signs is important for remote time-critical patient care through a telemedicine system. However, sometimes the reliability and instantaneity conditions cannot be satisfied simultaneously under a high-noise mobile network, because they are reciprocal to each other. In this paper, the vital sign transmission protocol (VSTP) running over a CDMA 1x EVDO (Code Division Multiple Access 1x Evolution Data Only) mobile network is proposed to comply with both the reliability and instantaneity requirements. The switching buffer management scheme is combined with a hybrid error control scheme, consisting of forward error correction (FEC) and automatic repeat request (ARQ). The CDMA 1x EVDO mobile network is modeled by two states using the Markov wireless channel model to test transmission performance under diverse network conditions. Throughout the noisy environment simulation, the performance of the VSTP is compared with the Transmission Control Protocol (TCP) and User Datagram Protocol (UDP) to demonstrate its efficacy over error-prone mobile network.

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

    Rodrigues, Thiago; Rodrigues, Mariana; Paz, Daniel; Costa, Marcos Devanir; Santos, Bruno; Braga, Vinicius; Paiva Neto, Manoel de; Centeno, Ricardo; Cavalheiro, Sergio; Chaddad-Neto, Feres


    The 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.

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

    Thiago Rodrigues


    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.

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

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


    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.

  12. Mantra meditation as a bedside spiritual intervention.

    Chan, Roxane Raffin


    The increased acceptance of integrative care allows nurses to investigate their role as active providers of spiritual care at the bedside. Lack of clear role expectations and interventions support the need for a simple, flexible spiritual bedside intervention. The use of a meditation mantra is discussed.

  13. Babinski sign.

    Rehman, H U


    Despite all of the medical advances, Babinski sign has proved reliable in precise localization of central nervous system dysfunction. It is well accepted that Babinski sign is indicative of dysfunction of fibers within the pyramidal tract. Joseph François Félix Babinski first described the clinical significance of the reflex in 1896. He showed that the extensor plantar response was indicative of pyramidal dysfunction and that it was absent in hysteria. He also illustrated that it was present in infancy and transiently appeared in epilepsy and strychnine poisoning. Babinski also pointed to the existence of "formes frustes" of his reflex and recognized its occasional absence in patients with other clinical signs of pyramidal lesions. The sign emerges when the dysfunction of the pyramidal tract involves the fibers that project on motoneurons of foot muscles and is mediated by extensor hallucis longus. Babinski sign may not be present acutely after transverse lesions of the spinal cord or acute brain lesions because of temporary inexcitability of spinal motoneurons.

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

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


    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

  15. Bedside Teaching and Respecting the Pediatric Patient

    Touyz, Sarah Judith Jean


    Full Text Available Bedside teaching involving patients, physicians, and students is a ubiquitous technique used for medical training. Respect, valid informed consent, and transparency are key to ethical and effective teaching. Patient refusal in participating in bedside teaching must be respected. These ought to apply to patients of all ages, including children, who may not fully understand or be capable of consenting to participating in teaching.

  16. The bedside evaluation: ritual and reason.

    Verghese, Abraham; Brady, Erika; Kapur, Cari Costanzo; Horwitz, Ralph I


    The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician-patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician-patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians.

  17. Medical students' perceptions of bedside teaching.

    Gray, David; Cozar, Octavian; Lefroy, Janet


    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.

  18. Association of Attention Deficit Disorder With Bedside Anti-saccades in Survivors of Childhood Leukemia.

    Khan, Raja B; Hudson, Melissa M; Ness, Kirsten K; Liang, Zhu; Srivastava, Deokumar; Krull, Kevin R


    Impaired attention is well recognized in childhood cancer survivors. We prospectively evaluated 162 long-term survivors of childhood acute lymphoblastic leukemia to study an association between presence of neurologic soft signs as measured by Zurich Neuromotor Scale, bedside evaluation of anti-saccades, and attention deficit disorder. Attention deficit disorder was recognized in 10.5% of the study cohort. We did not find an association of attention deficit with presence of any soft sign. However, there was an association between presence of abnormal anti-saccades and attention deficit (P = .04). These results will require further validation and if confirmed may introduce a quick bedside method of assessing impaired attention in cancer survivors.

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

    Daum, Corinna; Hubschmid, Monica; Aybek, Selma


    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.

  20. Elderly Woman with Abdominal Pain: Bedside Ultrasound Diagnosis of Diverticulitis

    Jason D. Heiner


    Full Text Available A 72-year-old otherwise healthy female presented to the emergency department with two weeks of worsening abdominal pain. She was afebrile with normal vital signs. Her physical examination was notable for moderate abdominal tenderness without rebound to the left and suprapubic regions of the abdomen. Laboratory studies were remarkable for a white blood cell count of 13,000/mm3. A focused bedside ultrasound over the patient’s region of maximal discomfort revealed a thickened bowel wall and several small contiguous hypoechoic projections surrounding a hyperechoic center, suggestive of diverticulitis (Figure. She was given metronidazole and ciprofloxacin and her diagnosis of uncomplicated colonic diverticulitis was confirmed by computed tomography (CT.

  1. Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Union Slough National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  2. Bedside coaching to improve nurses' recognition of delirium.

    Gordon, Susan Jean; Melillo, Karen Devereaux; Nannini, Angela; Lakatos, Barbara E


    Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

  3. Reliability of subjective wound assessment

    M.C.T. Bloemen; P.P.M. van Zuijlen; E. Middelkoop


    Introduction: Assessment of the take of split-skin graft and the rate of epithelialisation are important parameters in burn surgery. Such parameters are normally estimated by the clinician in a bedside procedure. This study investigates whether this subjective assessment is reliable for graft take a

  4. Implementing bedside handover: strategies for change management.

    McMurray, Anne; Chaboyer, Wendy; Wallis, Marianne; Fetherston, Cathy


    To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians' attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication

  5. Signes Iconiques, Signes Linguistiques (Iconic Signs, Linguistic Signs)

    Besse, Henri


    This article discusses the audiovisual image as sign; the classification of signs according to two different semiologies, and two different semantic theories; and the relation to different pedagogical approaches. (Text is in French.) (AM)

  6. Signes Iconiques, Signes Linguistiques (Iconic Signs, Linguistic Signs)

    Besse, Henri


    This article discusses the audiovisual image as sign; the classification of signs according to two different semiologies, and two different semantic theories; and the relation to different pedagogical approaches. (Text is in French.) (AM)

  7. Bench-to-bedside review

    Janum, Susanne; Zingg, Walter; Classen, Volker;


    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...... 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...... 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...

  8. Sensitivity and specificity of vestibular bed-side examination in detecting VIII cranial nerve schwannoma with sensorineural sudden unilateral hearing loss as presenting symptom.

    Califano, L; Salafia, F; Melillo, M G; Mazzone, S


    The objectives of this study were to identify signs of vestibular nerve suffering through a bedside vestibular examination protocol in case of sudden sensorineural unilateral hearing loss without spontaneous signs of vestibular impairment and to propose a bed-side vestibular examination based protocol for the focused execution of gadolinium-enhanced magnetic resonance imaging (MRI) only if a vestibular schwannoma is suspected. 96 patients, 52 men, 44 women, mean age 57.73 +/- 12.85 years, suffering from sudden sensorineural unilateral hearing loss, which presented neither vertigo nor spontaneous nystagmus, were enrolled. Pure tone audiometry, tympanometry, measurement of acoustic reflexes and Anderson test to detect adaptation, bedside vestibular examination through head shaking test, vibration test, head impulse test, hyperventilation test and detection of nystagmus in supine and lateral decubitus to search for signs of vestibular impairment were performed. Patients with signs of vestibular impairment and pure tone audiometry threshold at high frequencies better than 70 dB nHL were subjected to auditory brainstem responses. Gadolinium enhanced MRI centred on internal acoustic canals was carried out in all patients with sudden sensorineural unilateral hearing loss. Main outcome measures were signs of vestibular impairment at vestibular bedside examination and presence of vestibular schwannoma on MRI. Signs of vestibular impairment were detected in 22/96 cases (22.9%); a vestibular schwannoma was detected by MRI in 5/96 cases (5.2%), always when vestibular impairment was present. In case of sudden sensorineural unilateral hearing loss, vestibular bedside examination seems to be useful to restrict the suspicion of a vestibular schwannoma to cases with signs of vestibular impairment, reducing the number of MRI exams, with considerable economic savings. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  9. Is 'bench-to-bedside' realistic for autism? An integrative neuroscience approach.

    Bauman, Melissa D; Schumann, Cynthia M


    Given the prevalence and societal impact of autism spectrum disorder (ASD), there is an urgent need to develop innovative treatments that will improve core social deficits, for which there is currently no reliable pharmacological treatment, prevention or cure. Development of novel biological interventions will depend upon the successful translation of basic neuroscience research into safe and effective medicines. This article outlines steps to bring neuroscience research from 'the bench' to treatment at 'bedside', from phenotyping the disorder to animal models to patient treatment. Although these steps appear simplistic, this is a daunting challenge because of the inherent complexity of the human brain, our lack of understanding of disease neurobiology underlying ASD, and the incredible heterogeneity of the disorder. For ASD, perhaps more than any other neurological or psychiatric disorder, progress will depend on integrative multidisciplinary approaches between basic scientists from varying neuroscience disciplines and clinicians to make 'bench to bedside' treatment a reality.

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

    Kimura, Bruce J


    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.

  11. Bedside ultrasound diagnosis of pulmonary contusion.

    Stone, Michael B; Secko, Michael A


    A 10-year-old boy presented to the emergency department after being struck by a van while crossing the street. He complained of right side chest pain, and a chest radiography was suggestive of pulmonary contusion. The treating physician performed a bedside ultrasound that revealed a right-sided pulmonary contusion that was subsequently confirmed on computed tomography of the thorax. The sonographic features of pulmonary contusion are described, and the possible role of lung sonography in the assessment of pediatric thoracic trauma is discussed.

  12. Bone tissue engineering: from bench to bedside

    Maria A. Woodruff


    Full Text Available The drive to develop bone grafts for the filling of major gaps in the skeletal structure has led to a major research thrust towards developing biomaterials for bone engineering. Unfortunately, from a clinical perspective, the promise of bone tissue engineering which was so vibrant a decade ago has so far failed to deliver the anticipated results of becoming a routine therapeutic application in reconstructive surgery. Here we describe our bench to bedside concept, the first clinical results and a detailed analysis of long-term bone regeneration studies in preclinical animal models, exploiting methods of micro- and nano analysis of biodegradable composite scaffolds.

  13. Teaching Evidence-Based Physical Diagnosis: Six Bedside Lessons.

    McGee, Steven


    Evidence-based physical diagnosis is an essential part of the bedside curriculum. By using the likelihood ratio, a simple measure of diagnostic accuracy, teachers can quickly adapt this approach to their bedside teaching. Six recurring themes in evidence-based physical diagnosis are fully reviewed, with examples, in this article.

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

    Peters, Max; Ten Cate, Olle


    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.

  15. Utility and potential of bedside ultrasound in palliative care

    Ekta Dhamija


    Full Text Available Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses. Bedside ultrasound leads to better clinical decision-making as well as more accurate and faster invasive therapeutic procedures. It also enhances patient comfort and reduces cost burden. However, use of bedside ultrasound is still not widespread among palliative care givers, owing to initial cost, lack of basic training in ultrasound and apprehensions about its use. A team approach involving radiologists is important to develop integration of bedside ultrasound in palliative care.

  16. Bedside ultrasound procedures: musculoskeletal and non-musculoskeletal.

    Sahlani, Lydia; Thompson, Laura; Vira, Amar; Panchal, Ashish R


    The widespread availability of ultrasound (US) technology has increased its use for point of care applications in many health care settings. Focused (point of care) US is defined as the act of bringing US evaluation to the bedside for real-time performance. These images are collected immediately by the practitioner, allowing for direct integration into the physician's medical decision-making process. The real-time bedside diagnostic ability of US becomes a key tool for the management of patients. The purpose of this review is to (1) provide a general description of the use of focused US for bedside procedures; (2) specify the indications and common techniques used in bedside US procedures; and (3) describe the techniques used for each bedside intervention.

  17. The reliability of British Sign Language and English versions of the Clinical Outcomes in Routine Evaluation--Outcome Measure with d/Deaf populations in the UK: an initial study.

    Rogers, Katherine; Evans, Chris; Campbell, Malcolm; Young, Alys; Lovell, Karina


    Previous research has argued that the mental well-being of d/Deaf people is poorer than that of hearing populations. However, there is a paucity of valid and reliable mental health instruments in sign language that have been normalised with d/Deaf populations. The aim of this study was to determine the reliability of the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) with d/Deaf populations. A British Sign Language (BSL) version was produced using a team approach to forward translation, and a back-translation check. The CORE-OM was incorporated into an online survey, to be completed in either BSL or English, as preferred by the participant. From December 2010 to March 2011, data were collected from 136 d/Deaf people. Cronbach's α was used to measure the internal consistency of items in the CORE-OM. Comparisons were made between versions, including comparisons with the non-clinical hearing population (not in receipt of mental health services) in a previous study. The reliability of the overall score, as well as the non-risk items in both the BSL and English versions, was satisfactory. The internal reliability of each domain in the BSL version was good (Cronbach's α > 0.70) and comparable to the English version in the hearing population. This was true for most domains of the CORE-OM in the English version completed by d/Deaf people, although the Functioning domain had a relatively low α of 0.79 and the Risk domain had an α of only 0.66 This raised the question whether it is advisable to use a mental health assessment with d/Deaf populations that has been standardised with hearing populations. Nevertheless, this study has shown that it is possible to collect data from d/Deaf populations in the UK via the web (both in BSL and English), and an online BSL version of the CORE-OM is recommended for use with Deaf populations in the community.

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

    Melody Ni


    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.

  19. Low-pressure cardiac tamponade masquerading as severe sepsis diagnosed with a bedside ultrasound and as the initial presentation of malignancy.

    Conti, Ricardo Augusto Slaibi; Oppenheim, Ian Mandeville


    We report a patient with low-pressure cardiac tamponade masquerading as sepsis and as the initial presentation of malignancy. A quick diagnosis was done by the intensivist performing a bedside ultrasound. The diagnosis of low-pressure cardiac tamponade is a challenge because the classic physical signs of cardiac tamponade can be absent. It is made even more challenging when the vital sign changes and physical examination findings mimic severe sepsis. One of the benefits of a bedside ultrasound in the assessment of a patient with an initial diagnosis of severe sepsis or septic shock is the rapid diagnosis of cardiac tamponade if it is present. A 55-year-old male presented to the emergency department with weakness, cough, and syncope. His examination was notable only for dusky mottling of his cheeks, chest, and neck. Specifically, there was no jugular venous distension or pulsus paradoxus. A chest radiograph showed a right upper lobe infiltrate, whereas his electrocardiogram showed only sinus tachycardia. His white blood cell count and lactic acid were elevated. The sepsis protocol was started and a bedside ultrasound revealed signs of cardiac tamponade. The patient immediately improved after a pericardiocentesis. Analysis of the pericardial biopsy revealed adenocarcinoma, later determined to be from a pulmonary primary source. Because low-pressure cardiac tamponade is life-threatening and difficult to diagnose, evaluation of the pericardium with a bedside ultrasound should be considered in patients with syncope, severe sepsis, or shock.

  20. Bedside ultrasound in pediatric emergency medicine.

    Levy, Jason A; Noble, Vicki E


    Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. As the modality advances and becomes more available, it will be important for primary care pediatricians to understand its uses and limitations and to ensure that pediatric emergency physicians have access to the proper training, equipment, and experience. This article is meant to review the current literature relating to emergency ultrasound in pediatric emergency medicine, as well as to describe potential pediatric applications.

  1. Impaired vestibulo-ocular reflex (VOR) in spinocerebellar ataxia type 3 (SCA3): bedside and search coil evaluation.

    Gordon, Carlos R; Zivotofsky, Ari Z; Caspi, Avi


    Vestibulo-Ocular Reflex (VOR) abnormalities in cerebellar ataxias are a matter of renewed interest. We have previously reported vestibular areflexia in a group of Yemenite-Jews with Spinocerebellar Ataxia Type 3 (SCA3) who had clear bilateral pathological horizontal Head Impulse Test (HIT). The objective of this study was to evaluate the VOR of ten SCA3 patients who have variable bedside HIT responses by recording their eye movements using magnetic search coils and to correlate these results with their clinical and genetic data. Eight out of the ten patients have abnormal horizontal HIT detected by both clinical bedside examination and laboratory tests. Results of bedside HIT testing were significantly correlated with the VOR gain recorded using magnetic search coils. No significant correlations were found between VOR gain and other clinical or genetic data. Our study confirms the presence of defective VOR in SCA3 patients and corroborates the useful of the HIT as a reliable bedside test for diagnosis of VOR deficits.

  2. [Lhermitte's sign].

    García-Moreno, J M; Izquierdo, G


    Besides Babinski's, Lhermitte's sign is likely the eponym mostly used in the neurological literature. We review here the history of this eponym as well as recent advances on its pathophysiology and treatment. Lhermitte's phenomenon is, on one hand, a symptom as it is spontaneously explained by patients, and, on the other hand, a sign as it may be triggered by flexion of the nape. Initially described after head and cervical spine trauma, firstly by Marie and then by Babinski, it was Jean Lhermitte who recognized on it an etiological specificity, namely, a demyelinating sign of cervical spinal posterior cords. He also made a pathophysiological interpretation of the phenomenon, namely, a stretching of posterior cords during flexion of the neck. All authors agree that this phenomenon is more common in multiple sclerosis, although it has been descibed in many other conditions. The history of how this sign was hatched, whose pathophysiology remains a mystery, is fascinating. And it is fascinating the fact that patients compare the phenomenon with a current, especially if we bear in mind that few people may have suffered an electrocution, mainly in that time when just a few ones could actually enjoy domestic electricity.

  3. Bedside prediction of right subclavian venous catheter insertion length

    Yoon Ji Choi


    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.

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

    to role-model professional behaviour. These qualities .... The bedside teaching evaluation questionnaire (Fig.1) was adapted ... on a scale of 1 - 5, with 1 meaning 'not done' and 5 .... study relates to issues such as students' motivation to learn,.

  5. Improving nurse–physician teamwork through interprofessional bedside rounding

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


    Background Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician–nurse teamwork are often suboptimal. Objective To improve nurse–physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. Intervention 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. Assessment 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. Results 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

  6. Blind bedside insertion of small bowel feeding tubes.

    Duggan, SN


    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.

  7. Blood gas analysis for bedside diagnosis.

    Singh, Virendra; Khatana, Shruti; Gupta, Pranav


    Arterial blood gas is an important routine investigation to monitor the acid-base balance of patients, effectiveness of gas exchange, and the state of their voluntary respiratory control. Majority of the oral and maxillofacial surgeons find it difficult to interpret and clinically correlate the arterial blood gas report in their everyday practice. This has led to underutilization of this simple tool. The present article aims to simplify arterial blood gas analysis for a rapid and easy bedside interpretation. In context of oral and maxillofacial surgery, arterial blood gas analysis plays a vital role in the monitoring of postoperative patients, patients receiving oxygen therapy, those on intensive support, or with maxillofacial trauma with significant blood loss, sepsis, and comorbid conditions like diabetes, kidney disorders, Cardiovascular system (CVS) conditions, and so on. The value of this analysis is limited by the understanding of the basic physiology and ability of the surgeon to interpret the report. Using a systematic and logical approach by using these steps would make the interpretation simple and easy to use for oral and maxillofacial surgeons.

  8. Performance of Bedside Lung Ultrasound by a Pediatric Resident

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


    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...

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

    Peter Steinmetz


    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.

  10. A portable near infrared spectroscopy system for bedside monitoring of newborn brain

    Rosen Harel


    Full Text Available Abstract Background Newborns with critical health conditions are monitored in neonatal intensive care units (NICU. In NICU, one of the most important problems that they face is the risk of brain injury. There is a need for continuous monitoring of newborn's brain function to prevent any potential brain injury. This type of monitoring should not interfere with intensive care of the newborn. Therefore, it should be non-invasive and portable. Methods In this paper, a low-cost, battery operated, dual wavelength, continuous wave near infrared spectroscopy system for continuous bedside hemodynamic monitoring of neonatal brain is presented. The system has been designed to optimize SNR by optimizing the wavelength-multiplexing parameters with special emphasis on safety issues concerning burn injuries. SNR improvement by utilizing the entire dynamic range has been satisfied with modifications in analog circuitry. Results and Conclusion As a result, a shot-limited SNR of 67 dB has been achieved for 10 Hz temporal resolution. The system can operate more than 30 hours without recharging when an off-the-shelf 1850 mAh-7.2 V battery is used. Laboratory tests with optical phantoms and preliminary data recorded in NICU demonstrate the potential of the system as a reliable clinical tool to be employed in the bedside regional monitoring of newborn brain metabolism under intensive care.

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

    Celenza, Antonio; Rogers, Ian R


    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.

  12. Signing off


    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 marked Signing Off.

  13. Refuting the lipstick sign.

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


    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.

  14. Controversy within Sign Language.

    Vernon, McCay


    A review of problems with using such manual communication systems as cued speech, fingerspelling, Signed or Manual English, American Sign Language, and Pidgin Sign provides a rationale for using a combination of American Sign Language and Pidgin Sign and a few markers from Signed English for a Total Communication system. (CB)

  15. Double-lung point sign in traumatic pneumothorax.

    Aspler, Anne; Pivetta, Emanuele; Stone, Michael B


    Lung ultrasound has emerged as a rapid and accurate screening tool for pneumothorax. The lung point sign, a sonographic representation of the point on the chest wall where the pleural layers re-adhere, is 100% specific to confirm the diagnosis. Double lung point sign for a single pneumothorax is extremely unusual and has only been reported twice in the literature. A 49-year-old woman was transported to the emergency department (ED) intubated and sedated with severe head injury. She remained hemodynamically stable without respiratory compromise throughout her ED course. Chest computed tomography was notable for an anterior left pneumothorax with underlying pulmonary contusion. Bedside ultrasound of this region revealed a double lung point sign. Our case report is the first to confirm association of the double lung point sign with a single pneumothorax on corresponding computed tomographic imaging.

  16. The bedside assistant in robotic surgery--keys to success.

    Yuh, Bertram


    Taking on the position of bedside assistant for a surgical robotic team can be a daunting task. Keys to success include preparation, proper operation set up, effective use of instruments to augment the actions of the console surgeon, and readiness for surgical emergencies. Effective communication, repetitive execution, and readiness facilitate the efforts of the surgical team.

  17. Accidental Carotid Artery Cannulation Detected by Bedside Ultrasound

    Chiles, Kris


    Full Text Available This report highlights the importance of using bedside ultrasound in the emergency department to confirm guide-wire placement when performing central venous catheter placement prior to dilating and cannulating the vessel. [West J Emerg Med. 2011;12(1:100-101.

  18. Bedside Ultrasound in a Case of Blunt Scrotal Trauma

    Mark Cannis


    Full Text Available This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedsideemergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompturological consultation and timely surgical repair. The utility of bedside emergency ultrasound inthe evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

  19. Beyond bench and bedside: disentangling the concept of translational research

    Laan, van der Anna Laura; Boenink, Marianne


    The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the b

  20. Signing off


    Physics Related Aptitude Test As the teacher shortage bites anyone with a degree in science expects to walk into a school and be received, with open arms, as a physics teacher. Are they really suitable? To help you decide Signing Off provides the following invaluable psychometric test. Extensively researched and, for single users only, it comes completely free to Physics Education subscribers! (Copies of this Physics Related Aptitude Test are available to credit-card customers from priced #35 per client, 125 dollars to US customers.) This invaluable psychometric test has been extensively researched. Your first lesson of the new school year introduces the study of electricity. Do you: A Use the notes prepared by your predecessor. B Find a video on electricity and play it to the class. C Arrange a series of exciting practical demonstrations to stimulate the young inquiring mind. D Let the children design and make their own circuits to light flashlight bulbs. Your 14-year-olds have completed a written test on heat and energy. Do you: A Mark correct only the work of students who have written their names neatly at the top LEFT HAND corner, as required. B Only set multiple choice tests, so that the computer can mark them for you. C Mark carefully by hand, explaining in detail to each student exactly how and why they have made errors and adding encouraging comments with lots of praise. D Give out correct sets of answers and allow students to mark their own work. There is a staff social. Do you: A Ask for a definition of the term 'social'. B Ask for a web-based version. C Determine to go, so that you can discuss setting up cross-curricular links with colleagues. D Join the organizing committee. Who do you admire most? A Sir Isaac Newton. B Bill Gates. C Leonardo da Vinci. D Leonardo di Caprio. You are required to teach biology class. Your response is: A Denial. B To ask for an appropriate computer simulation. C To attend a specialized course for biology

  1. Bedside Assessment of Acute Dizziness and Vertigo.

    Welgampola, Miriam S; Bradshaw, Andrew Phillip; Lechner, Corinna; Halmagyi, Gabor Michael


    Dizziness is a common symptom in emergency departments, general practice, and outpatient clinics. Faced with an acutely dizzy patient, the frontline physician must determine whether or not the symptoms are vestibular in origin and, if they are, which vestibular disorder they best fit. A focused history provides useful clues to the likely cause of dizziness, yet it is the clinical examination that yields the final answer. This article summarizes history and examination techniques that are useful in the assessment of acutely dizzy patients and discusses oculomotor signs that accompany common vestibular disorders.

  2. Life-sign detection with FMCW radar

    Jong, A.J. de; Anitori, L.


    In this paper we present some preliminary results on life-sign detection using FMCW radars. Several persons were observed from different aspects with carrier frequencies between 2.4 GHz and 24 GHz. In most cases, reliable life-sign measurements could be done, although we found a considerable influen

  3. Sign Language Diglossia.

    Stokoe, William C., Jr.

    Charles A. Ferguson's concept of "diglossia" (1959, 1964) is used in analyzing sign language. As in Haitian Creole or Swiss German, "two or more varieties" of sign language are "used by the same speakers under different conditions"--these are here called "High" (H) sign language and "Low" (L) sign language. H sign language is formally taught…

  4. Human dimensions in bedside teaching: focus group discussions of teachers and learners.

    Ramani, Subha; Orlander, Jay D


    Clinical teaching has moved from the bedside to conference rooms; many reasons are described for this shift. Yet, essential clinical skills, professionalism, and humanistic patient interactions are best taught at the bedside. Clinical teaching has moved from the bedside to conference rooms; many reasons are described for this decline. This study explored perceptions of teachers and learners on the value of bedside teaching and the humanistic dimensions of bedside interactions that make it imperative to shift clinical teaching back to the bedside. Focus group methodology was used to explore teacher and learner opinions. Four teacher groups consisted of (a) Chief Residents, (b) Residency Program Directors, (c) skilled bedside teachers, and (d) a convenience group of other Department of Medicine faculty at Boston University School of Medicine. Six learner groups consisted 2 each of 3rd-year students, PGY1 medicine residents, and PGY2 medicine residents. Each discussion lasted 60 to 90 minutes. Sessions were audiotaped, transcribed, and analyzed using qualitative methods. Teachers and learners shared several opinions on bedside teaching, particularly around humanistic aspects of bedside interactions. The key themes that emerged included (a) patient involvement in discussions, (b) teachers as role models of humanism, (c) preserving learner autonomy, (d) direct observation and feedback of learners at the bedside, (e) interactions with challenging patients, and (e) admitting limitations. Within these themes, participants noted some behaviors best avoided at the bedside. Teachers and learners regard the bedside as a valuable venue in which to learn core values of medicine. They proposed many strategies to preserve these humanistic values and improve bedside teaching. These strategies are essential for true patient-centered care.

  5. Elevated Intracranial Pressure Diagnosis with Emergency Department Bedside Ocular Ultrasound

    D. Amin


    Full Text Available Bedside sonographic measurement of optic nerve sheath diameter can aid in the diagnosis of elevated intracranial pressure in the emergency department. This case report describes a 21-year-old female presenting with 4 months of mild headache and 2 weeks of recurrent, transient binocular vision loss. Though limited by patient discomfort, fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound (BOUS revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. Lumbar puncture demonstrated a cerebrospinal fluid (CSF opening pressure of 54 cm H2O supporting the suspected diagnosis of idiopathic intracranial hypertension. Accurate fundoscopy can be vital to the appropriate diagnosis and treatment of patients with suspected elevated intracranial pressure, but it is often technically difficult or poorly tolerated by the photophobic patient. BOUS is a quick and easily learned tool to supplement the emergency physician’s fundoscopic examination and help identify patients with elevated intracranial pressure.

  6. Bedside diagnosis of mitochondrial dysfunction in aneurysmal subarachnoid hemorrhage

    Jacobsen, A.; Nielsen, T. H.; Nilsson, O.


    to diagnose and separate cerebral ischemia and mitochondrial dysfunction bedside. The study explores whether cerebral biochemical variables in SAH patients most frequently exhibit a pattern indicating ischemia or mitochondrial dysfunction. Methods - In 55 patients with severe SAH, intracerebral microdialysis...... was performed during neurocritical care with bedside analysis and display of glucose, pyruvate, lactate, glutamate, and glycerol. The biochemical patterns observed were compared to those previously described in animal studies of induced mitochondrial dysfunction as well as the pattern obtained in patients...... with recirculated cerebral infarcts. Results - In 29 patients, the biochemical pattern indicated mitochondrial dysfunction while 10 patients showed a pattern of cerebral ischemia, six of which also exhibited periods of mitochondrial dysfunction. Mitochondrial dysfunction was observed during 5162 h. An ischemic...

  7. Bench-to-bedside review: An approach to hemodynamic monitoring--Guyton at the bedside.

    Magder, Sheldon


    Hemodynamic monitoring is used to identify deviations from hemodynamic goals and to assess responses to therapy. To accomplish these goals one must understand how the circulation is regulated. In this review I begin with an historical review of the work of Arthur Guyton and his conceptual understanding of the circulation and then present an approach by which Guyton's concepts can be applied at the bedside. Guyton argued that cardiac output and central venous pressure are determined by the interaction of two functions: cardiac function, which is determined by cardiac performance; and a return function, which is determined by the return of blood to the heart. This means that changes in cardiac output are dependent upon changes of one of these two functions or of both. I start with an approach based on the approximation that blood pressure is determined by the product of cardiac output and systemic vascular resistance and that cardiac output is determined by cardiac function and venous return. A fall in blood pressure with no change in or a rise in cardiac output indicates that a decrease in vascular resistance is the dominant factor. If the fall in blood pressure is due to a fall in cardiac output then the role of a change in the return function and cardiac function can be separated by the patterns of changes in central venous pressure and cardiac output. Measurement of cardiac output is a central component to this approach but until recently it was not easy to obtain and was estimated from surrogates. However, there are now a number of non-invasive devices that can give measures of cardiac output and permit the use of physiological principles to more rapidly appreciate the primary pathophysiology behind hemodynamic abnormalities and to provide directed therapy.

  8. [Reverse Chaddock sign].

    Tashiro, Kunio


    It is widely accepted that the Babinski reflex is the most well-known and important pathological reflex in clinical neurology. Among many other pathological reflexes that elicit an upgoing great toe, such as Chaddock, Oppenheim, Gordon, Schaefer, and Stransky, only the Chaddock reflex is said to be as sensitive as the Babinski reflex. The optimal receptive fields of the Babinski and Chaddock reflexes are the lateral plantar surface and the external inframalleolar area of the dorsum, respectively. It has been said that the Babinski reflex, obtained by stroking the sole, is by far the best and most reliable method of eliciting an upgoing great toe. However, the Chaddock reflex, the external malleolar sign, is also considered sensitive and reliable according to the literature and everyday neurological practice. The major problems in eliciting the Babinski reflex by stroking the lateral part of the sole are false positive or negative responses due to foot withdrawal, tonic foot response, or some equivocal movements. On the other hand, according to my clinical experience, the external inframalleolar area, which is the receptive field of the Chaddock reflex, is definitely suitable for eliciting the upgoing great toe. In fact, the newly proposed method to stimulate the dorsum of the foot from the medial to the lateral side, which I term the "reversed Chaddock method," is equally sensitive to demonstrate pyramidal tract involvement. With the "reversed Chaddock method", the receptive field of the Chaddock reflex may be postulated to be in the territory of the sural nerve, which could be supported by the better response obtained on stimulation of the postero-lateral calf than the anterior shin. With regard to the receptive fields of the Babinski and Chaddock reflexes, the first sacral dermatome (S1) is also considered a reflexogenous zone, but since the dermatome shows marked overlapping, the zones vary among individuals. As upgoing toe responses are consistently observed in

  9. Diagnosis of Necrotizing Fasciitis with Bedside Ultrasound: the STAFF Exam

    Erik Castleberg; Natasa Jenson; Vi Am Dinh


    The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizi...


    Gerçek, Arzu; Lim, Sema; İşler, Banu; Eti, Zeynep; Göğüs, Yılmaz


    Objective: The aim of this study was to evaluate the correlation of sex, age, bedside scoring systems and body mass index with laryngoscopic view in patients with clinically difficult intubation.Methods: Five hundred patients, aged 20-70 years, were included in the study. The age, sex, weight and height of the patients were recorded preoperatively and body mass index was calculated. The patients were examined for Mallampati classification, thyromental distance, mouth opening, neck mobility an...

  11. Do lean practices lead to more time at the bedside?

    Brackett, Tiffany; Comer, Linda; Whichello, Ramona


    The aim of this review is to evaluate the application of value-added processes in healthcare, with an emphasis on their effects on bedside nursing. Literature relevant to Lean methodology and inpatient care was reviewed, excluding all research related to other service lines (i.e., surgical services, emergency services, laboratory, radiology, etc.). Increased value is also an important tenet of transforming care at the bedside (TCAB), an initiative launched by the Institute for Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (RWJF). Therefore, articles concerning TCAB were also included in this review. A systematic study of the literature revealed varied applications of Lean principles in practice, ranging from the implementation of a single tool, to full organizational restructuring. All articles reviewed reported positive results, although the majority lacked strong supporting evidence for claims of improvement. Even though there is some indication that the application of Lean principles to nursing processes is successful in improving specific outcomes, the authors cannot conclude that the implementation of Lean methodology or TCAB greatly influences direct patient care, or increases time spent at the bedside. © 2011 National Association for Healthcare Quality.

  12. Bedside ultrasonography-Applications in critical care: Part II

    Jose Chacko


    Full Text Available Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications. We also discuss compression ultrasonography - a quick and effective bedside screening tool for deep vein thrombosis of the lower extremity. Abdominal ultrasound offers vital clues in the emergency setting; in the unstable trauma victim, a focused examination may provide immediate answers and has largely superseded diagnostic peritoneal lavage in diagnosing intraperitoneal bleed. From estimation of intracranial pressure to transcranial Doppler studies, ultrasound is becoming increasingly relevant to neurocritical care. Ultrasound may also help with airway management in several situations, including percutaneous tracheostomy. Clearly, bedside ultrasonography has become an indispensable part of intensive care practice - in the rapid assessment of critically ill-patients as well as in enhancing the safety of invasive procedures.

  13. Sign Language Tutoring Tool

    Aran, Oya; Benoit, Alexandre; Carrillo, Ana Huerta; Fanard, François-Xavier; Campr, Pavel; Akarun, Lale; Caplier, Alice; Rombaut, Michele; Sankur, Bulent


    In this project, we have developed a sign language tutor that lets users learn isolated signs by watching recorded videos and by trying the same signs. The system records the user's video and analyses it. If the sign is recognized, both verbal and animated feedback is given to the user. The system is able to recognize complex signs that involve both hand gestures and head movements and expressions. Our performance tests yield a 99% recognition rate on signs involving only manual gestures and 85% recognition rate on signs that involve both manual and non manual components, such as head movement and facial expressions.

  14. Non-invasive bedside assessment of central venous pressure: scanning into the future.

    Jacques Rizkallah

    Full Text Available Noninvasive evaluation of central venous pressure (CVP can be achieved by assessing the Jugular Venous Pressure (JVP, Peripheral Venous Collapse (PVC, and ultrasound visualization of the inferior vena cava. The relative accuracy of these techniques compared to one another and their application by trainees of varying experience remains uncertain. We compare the application and utility of the JVP, PVC, and handheld Mini Echo amongst trainees of varying experience including a medical student, internal medicine resident, and cardiology fellow. We also introduce and validate a new physical exam technique to assess central venous pressures, the Anthem sign.Patients presenting for their regularly scheduled echocardiograms at the hospital echo department had clinical evaluations of their CVP using these non-invasive bedside techniques. The examiners were blinded to the echo results, each other's assessments, and patient history; their CVP estimates were compared to the gold standard level 3 echo-cardiographer's estimates at the completion of the study.325 patients combined were examined (mean age 65, s.d. 16 years. When compared to the gold standard of central venous pressure by a level 3 echocardiographer, the JVP was the most sensitive at 86%, improving with clinical experience (p<0.01. The classic PVC technique and Anthem sign had better specificity compared to the JVP. Mini Echo estimates were comparable to physical exam assessments.JVP evaluation is the most sensitive physical examination technique in CVP assessments. The PVC techniques along with the newly described Anthem sign may be of value for the early learner who still has not mastered the art of JVP assessment and in obese patients in whom JVP evaluation is problematic. Mini Echo estimates of CVPs are comparable to physical examination by trained clinicians and require less instruction. The use of Mini Echo in medical training should be further evaluated and encouraged.

  15. Automatic sign language identification

    Gebre, B.G.; Wittenburg, P.; Heskes, T.


    We propose a Random-Forest based sign language identification system. The system uses low-level visual features and is based on the hypothesis that sign languages have varying distributions of phonemes (hand-shapes, locations and movements). We evaluated the system on two sign languages -- British SL and Greek SL, both taken from a publicly available corpus, called Dicta Sign Corpus. Achieved average F1 scores are about 95% - indicating that sign languages can be identified with high accuracy...

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

    Haug, Tobias


    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…

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

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


    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.

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

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


    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

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

    Michael Butterfield


    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

  20. Diagnosis of necrotizing faciitis with bedside ultrasound: the STAFF Exam.

    Castleberg, Erik; Jenson, Natasa; Dinh, Vi Am


    The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

  1. Warning Signs of Bullying

    ... to talk to kids about bullying. Respond to Bullying Learn how to respond to bullying . From stopping ... Text Size: A A A Warning Signs for Bullying There are many warning signs that may indicate ...

  2. Clarence Cannon Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Clarence Cannon Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list...

  3. Signed languages and globalization

    Hiddinga, A.; Crasborn, O.


    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

  4. British Sign Name Customs

    Day, Linda; Sutton-Spence, Rachel


    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…

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

    Paales, Liina


    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…

  6. Arabic Alphabet and Numbers Sign Language Recognition

    Mahmoud Zaki Abdo


    Full Text Available This paper introduces an Arabic Alphabet and Numbers Sign Language Recognition (ArANSLR. It facilitates the communication between the deaf and normal people by recognizing the alphabet and numbers signs of Arabic sign language to text or speech. To achieve this target, the system able to visually recognize gestures from hand image input. The proposed algorithm uses hand geometry and the different shape of a hand in each sign for classifying letters shape by using Hidden Markov Model (HMM. Experiments on real-world datasets showed that the proposed algorithm for Arabic alphabet and numbers sign language recognition is suitability and reliability compared with other competitive algorithms. The experiment results show that the increasing of the gesture recognition rate depends on the increasing of the number of zones by dividing the rectangle surrounding the hand.

  7. [Computerizing the radiological sign].

    Bertaud, V; Belhadj, I; Dameron, O; Garcelon, N; Hendaoui, L; Marin, F; Duvauferrier, R


    The goal of this article is to present to the radiologist the different theories of the sign and their consequences for sign representation in computer systems. All the theories of the sign are presented, but the most relevant are highlighted in order to explain the great modeling systems currently in use (such as DICOM-SR or the UMLS). The constructivist approach of the notion of disease, the semiosis process, which starting from signs produces new signs, and the structuralist analysis of sign through language are emphasized. The purpose of this analysis is to end up with a consensual representation of the sign that can be understood by human beings and processed by machines. Such a representation, also known as an ontology, is based on a semantic organization of language, thus allowing medicine to become a truly scientific discipline. It aims at disambiguating the symbols given to machines, which will help us in our reasoning.

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

    Bartnik, Daniel J.; Rymut, Russell A.


    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

  9. MEMS reliability

    Hartzell, Allyson L; Shea, Herbert R


    This book focuses on the reliability and manufacturability of MEMS at a fundamental level. It demonstrates how to design MEMs for reliability and provides detailed information on the different types of failure modes and how to avoid them.

  10. Development and User Research of a Smart Bedside Station System toward Patient-Centered Healthcare System.

    Yoo, Sooyoung; Lee, Kee-Hyuck; Baek, Hyunyoung; Ryu, Borim; Chung, Eunja; Kim, Kidong; Yi, Jay Chaeyong; Park, Soo Beom; Hwang, Hee


    User experience design that reflects real-world application and aims to support suitable service solutions has arisen as one of the current issues in the medical informatics research domain. The Smart Bedside Station (SBS) is a screen that is installed on the bedside for the personal use and provides a variety of convenient services for the patients. Recently, bedside terminal systems have been increasingly adopted in hospitals due to the rapid growth of advanced technology in healthcare at the point of care. We designed user experience (UX) research to derive users' unmet needs and major functions that are frequently used in the field. To develop the SBS service, a service design methodology, the Double Diamond Design Process Model, was undertaken. The problems or directions of the complex clinical workflow of the hospital, the requirements of stakeholders, and environmental factors were identified through the study. The SBS system services provided to patients were linked to the hospital's main services or to related electronic medical record (EMR) data. Seven key services were derived from the results of the study. The primary services were as follows: Bedside Check In and Out, Bedside Room Service, Bedside Scheduler, Ready for Rounds, My Medical Chart, Featured Healthcare Content, and Bedside Community. This research developed a patient-centered SBS system with improved UX using service design methodology applied to complex and technical medical services, providing insights to improve the current healthcare system.

  11. Bedside Evaluation of the Functional Organization of the Auditory Cortex in Patients with Disorders of Consciousness.

    Henriques, Julie; Pazart, Lionel; Grigoryeva, Lyudmila; Muzard, Emelyne; Beaussant, Yvan; Haffen, Emmanuel; Moulin, Thierry; Aubry, Régis; Ortega, Juan-Pablo; Gabriel, Damien


    To measure the level of residual cognitive function in patients with disorders of consciousness, the use of electrophysiological and neuroimaging protocols of increasing complexity is recommended. This work presents an EEG-based method capable of assessing at an individual level the integrity of the auditory cortex at the bedside of patients and can be seen as the first cortical stage of this hierarchical approach. The method is based on two features: first, the possibility of automatically detecting the presence of a N100 wave and second, in showing evidence of frequency processing in the auditory cortex with a machine learning based classification of the EEG signals associated with different frequencies and auditory stimulation modalities. In the control group of twelve healthy volunteers, cortical frequency processing was clearly demonstrated. EEG recordings from two patients with disorders of consciousness showed evidence of partially preserved cortical processing in the first patient and none in the second patient. From these results, it appears that the classification method presented here reliably detects signal differences in the encoding of frequencies and is a useful tool in the evaluation of the integrity of the auditory cortex. Even though the classification method presented in this work was designed for patients with disorders of consciousness, it can also be applied to other pathological populations.

  12. The sandwich sign

    Nasreen Mahomed


    Full Text Available The sandwich sign refers to the sandwiching of mesenteric vessels and fat by enlarged mesenteric nodes on cross-sectional imaging, commonly occurring in lymphoma, but not specific to lymphoma. The sign is radiologically indistinguishable from post-transplant lymphoproliferative disorders. The radiological significance of the sandwich sign is in suggesting the diagnosis of lymphoma so that appropriate treatment may be initiated early as the tumour has a rapid growth pattern.

  13. Traffic Signs Inventory System

    J. Ružbarský


    Full Text Available The paper is focused on practical application of Cambridge Correlator. The goal is to propose a traffic signs inventory system by using excellent characteristics of correlator in the rapid optical correlation. The proposal of this inventory system includes obtaining of traffic signs to create the database either collecting the GPS coordinates. It is necessary to know the traffic signs position and also to document the entire surface route for later evaluation in offline mode.

  14. Equine cellular therapy--from stall to bench to bedside?

    Burk, Janina; Badylak, Stephen F; Kelly, Jeremy; Brehm, Walter


    Pioneering clinical stem cell research is being performed in the horse, a recipient of cutting edge veterinary medicine as well as a unique animal model, paving the way for human medical applications. Although demonstrable progress has been made on the clinical front, in vitro characterization of equine stem cells is still in comparatively early stages. To translate the promising results of clinical stem cell therapy in the horse, advances must be made in the characterization of equine stem cells. Aiming to improve communication between veterinarians and other natural scientists, this review gives an overview of veterinary "bedside" achievements, focusing on stem cell therapies in equine orthopedics as well as the current state of in vitro characterization of equine multipotent mesenchymal stromal cells (MSCs) and equine embryonic stem cells (ESCs).

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

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


    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.

  16. Implementing interprofessional bedside rounding at the prequalification stage

    Tuite DR


    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.  

  17. Prevalence of diabetic autonomic neuropathy measured by simple bedside tests

    Dyrberg, Torben Bech; Benn, Jette; Christiansen, J S


    To investigate the prevalence of diabetic autonomic neuropathy, five simple bedside tests, beat-to-beat variation during quiet respiration, beat-to-beat variation during forced respiration, heart rate and blood pressure response to standing, heart rate response to exercise, and heart rate response....... The prevalence of diabetic autonomic neuropathy in the whole diabetic population indicated by abnormal response in beat-to-beat variation during forced respiration was 27%. Diabetic autonimic neuropathy increased in frequency with duration of disease. Patients with nephropathy or proliferative retinopathy had...... a significantly higher prevalence of diabetic autonomic neuropathy as indicated by abnormal beat-to-beat variation during forced respirations (p less than 0.01) than patients without these complications....

  18. The Forbidden Signs

    Kilstrup, Mogens


    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. Software reliability

    Bendell, A


    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

  20. British Sign Language.

    Kyle, Jim; Woll, Bencie


    The author reports on the use of British Sign Language in the United Kingdom and dispels some myths that surround the language. It is pointed out that there is a low level of interest in deaf people and their method of communication. Research needs in the area of sign language systems are briefly considered. (SB)

  1. Sign Language Advantage.

    Daniels, Marilyn


    Describes Sign in Education, a pilot program in the United Kingdom that integrated Deaf children and hearing children in a hearing classroom with a culturally Deaf teacher who taught the national curriculum in British Sign Language one afternoon a week. Explores the advantage to the Deaf community, as well as the majority culture of adopting such…

  2. Completely random signed measures

    Hellmund, Gunnar

    Completely random signed measures are defined, characterized and related to Lévy random measures and Lévy bases.......Completely random signed measures are defined, characterized and related to Lévy random measures and Lévy bases....

  3. Standardization of Sign Languages

    Adam, Robert


    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…

  4. Artefactual stripe sign

    Rayner, J. [St George Hospital, Kogarah, NSW, (Australia)


    Full text: The stripe sign consist of `the presence on the perfusion image of a VQ lung scan of a stripe of perfused lung tissue between a perfusion defect and the adjacent pleural surface`. In the revised PIOPED criteria, it is predictive of the absence of pulmonary embolism in the area of the sign. This case study involved a 71-year-old woman who presented with left-sided pleuritic chest pain. The perfusion lung scan demonstrated a perfusion defect involving the left posterior and superior basal segments with an associated stripe sign. A repeat LPO view at a more posterior angle and tomography of the lungs failed to demonstrate the stripe. In this case, the stripe sign was an artefact, perhaps `shine through` from the underlying lung. This evidence suggests that before the stripe sign is used to diagnose a patient, it should be apparent on at least two views of differing angles or on tomography.

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

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


    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

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

    Wiese, Lothar; Bruun, Brita; Baek, Leif


    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....... The rapid test used at the bedside had a sensitivity of 88% for the detection of P. falciparum compared to 95% when the test was performed in the microbiology laboratory. The risk of technical problems and invalid tests was highest when the test was used at the bedside. The rapid diagnostic test may...... 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...

  7. Discovering Ways That Influence the Older Nurse to Continue Bedside Practice

    LeeAnna Spiva; Patricia Hart; Frank McVay


    A descriptive qualitative approach was used to investigate older nurses practicing bedside nursing and to identify ways to influence older nurses to continue bedside practice. A purposive sample of 18 older nurses was recruited from a healthcare system located in the Southeastern United States. Interpretative analysis of interviews resulted in the identification of three constitutive patterns and eight themes. The first constitutive pattern identified was attributes of the older nurse. The th...

  8. [Yes, we should keep ABO agglutination test within bedside transfusion checks].

    Daurat, G


    ABO incompatible transfusions are still a frequent cause of serious adverse transfusion reactions. Bedside check is intended to detect patient errors and prevent ABO mismatch. France is one of the few countries that includes ABO agglutination test for red blood cells in bedside checks. Evaluation of this ABO agglutination test, performed with a special card, shows that, on the field, despite frequent users' mishandling, it can detect up to 93% of ABO incompatibilities. This is not enough to rely on this sole test for bedside checks. But, linking it with an another test, currently, checks that the right blood is given to the right patient, rises the sensitivity of the whole bedside procedure up to an estimated 99.65%, for detection of ABO incompatibilities. This linkage has been introduced in the French regulation in 2003. Since then, the incidence of ABO incompatible transfusions has decreased dramatically and faster than in any other country, so France has now, probably, the lowest rate of ABO incompatible transfusions. The investigation of the few ABO accidents that still occur, shows that professionals have always bypassed this linkage. On the other hand, introducing bedside recipient and blood products barcode or radio-chip checks in all the 1500 French hospitals, though technically possible, would provide very little enhancement and lead to major difficulties and expenses. Linkage of ABO agglutination test to patient and blood checks within the bedside procedure has proved to be efficient and should be kept.

  9. Dermatomyositis: Signs and Symptoms

    ... Meet our Partners How to Get Involved Donate Dermatomyositis (DM) Share print email share facebook twitter google ... Signs and Symptoms What happens to someone with dermatomyositis? For many decades, DM was considered “ polymyositis with ...

  10. Signs of Overload

    ... Listen Text Size Email Print Share Signs of Overload Page Content Article Body Although stress is a ... 12 (Copyright © 2004 American Academy of Pediatrics) The information contained on this Web site should not be ...

  11. Pertussis Signs & Symptoms

    ... of Kids with Infectious Diseases (PKIDs) Signs and Symptoms Language: English Español (Spanish) Recommend on Facebook Tweet ... not for as long as 3 weeks. Early Symptoms In those who have been vaccinated: In most ...

  12. The Babinski sign.

    Morrow, Jasper M; Reilly, Mary M


    Joseph Babinski (1857-1932), a French neurologist of Polish descent, was the first person to describe extension of the big toe following stimulation of the sole of the foot on 22 February 1896 (Babinski, 1896). He referred to the sign as 'phénomène des orteils' (toes phenomenon) but it is now usually referred to eponymously as the 'Babinski sign' or descriptively as the extensor plantar response.

  13. Reliability Engineering

    Lazzaroni, Massimo


    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

  14. A blended approach to invasive bedside procedural instruction.

    Lenchus, Joshua; Issenberg, S Barry; Murphy, Daniel; Everett-Thomas, Ruth; Erben, Laura; Arheart, Kristopher; Birnbach, David J


    This study assessed the impact of a blended, standardized curriculum for invasive bedside procedural training on medical knowledge and technical skills for Internal Medicine residents. The investigators developed a curriculum in procedural instruction and performance for Internal Medicine house staff, and implemented the program at a tertiary care academic medical center with a primary affiliation with a US medical school. The investigators chose procedures recommended for technical competence by the American Board of Internal Medicine: lumbar puncture, thoracentesis, paracentesis, central venous catheter insertion, and knee arthrocentesis. The program included: (1) assessment of baseline medical knowledge and technical proficiency on mannequins, (2) video instruction of procedure, (3) faculty-led discussion of critical concepts, (4) faculty demonstration of the procedure on mannequin, (5) individual practice on simulators, (6) post-intervention knowledge evaluation, and (7) post-intervention skills evaluation. The performance achieved during the initial skills evaluation on a mannequin was compared to the performance achieved on the first patient subsequent to the instructional portion. All participants with complete data demonstrated a statistically significant pre-intervention to post-intervention improvement (p instruction can significantly improve performance in participants' medical knowledge and technical skills.

  15. Bedside Tested Ocular Motor Disorders in Multiple Sclerosis Patients

    G. Servillo


    Full Text Available Background/Aims. Ocular motor disorders (OMDs are a common feature of multiple sclerosis (MS. In clinical practice, if not reported by patients, OMDs are often underdiagnosed and their prevalence is underestimated. Methods. We studied 163 patients (125 women, 76.7%, 38 men, 23.3%; median age 45.0 years; median disease duration 10 years; median EDSS 3.5 with definite MS (n=150, 92% or clinically isolated syndrome (n=13, 8% who underwent a thorough clinical examination of eye movements. Data on localization of previous relapses, MS subtype, and MRI findings were collected and analyzed. Results. Overall, 111/163 (68.1% patients showed at least one abnormality of eye movement. Most frequent OMDs were impaired smooth pursuit (42.3%, saccadic dysmetria (41.7%, unilateral internuclear ophthalmoplegia (14.7%, slowing of saccades (14.7%, skew deviation (13.5%, and gaze evoked nystagmus (13.5%. Patients with OMDs had more severe disability (P=0.0005 and showed more frequently infratentorial MRI lesions (P=0.004. Localization of previous relapses was not associated with presence of OMDs. Conclusion. OMDs are frequent in patients with stable (no relapses MS. A precise bedside examination of eye motility can disclose abnormalities that imply the presence of subclinical MS lesions and may have a substantial impact on definition of the diagnosis and on management of MS patients.

  16. Bedside tests to predict laryngoscopic difficulty in pediatric patients.

    Mansano, André Marques; Módolo, Norma Sueli Pinheiro; Silva, Leopoldo Muniz da; Ganem, Eliana Maria; Braz, Leandro Gobbo; Knabe, Andrea de Carvalho; Freitas, Fernanda Moreira de


    Pediatric airway management is a priority during anesthesia, critical care and emergency medicine. The purpose of this study is to validate bedside tests that predict airway management difficulty in anesthetized children. Children under 12 years of age were recruited in a cross-sectional study to assess the value of some anthropometric measures as predictors of laryngoscopic difficulty. The patients were divided into three groups by age. Weight, height, neck circumference, BMI (body mass index), inter incisors distance thyromental distance, sternomental distance, frontal plane to chin distance (FPCD) and the Mallampati index were determined and were correlated with the CML (Cormack & Lehane classification). The incidence of difficult laryngoscopy (CML 3 or 4) was 3.58%. Factors that were significantly associated with laryngoscopic difficulty included short inter incisors distance, high FPCD, thyromental distance, sternomental distance and the Mallampati index. The FPCD/weight index exhibited a higher area under the ROC curve than any other variable considered. This study confirms that the FPCD and the FPCD/weight ratio are the most consistent predictors of laryngoscopic difficulty in pediatric patients. For patients over 6 months of age, the IID also correlated with laryngoscopic difficulty. For children who were capable of obeying simple orders, the Mallampati test correlated better with laryngoscopic difficulty than did the Mallampati test with phonation. Our results strongly suggest that skilled professionals should perform airway management in children, especially in patients with a high FPCD or a high FPCD/weight ratio. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Computational triadic algebras of signs

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


    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.

  18. Signs In Place

    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 influence the way people move about from one place to another. If a person gets lost, a map or GPS can...... be an effective guidance tool. However, “signs in place” offer alternative or additional guidelines to help people with their journey. This paper, first, seeks to understand road traffic signs in terms of mobility in everyday life. It, then, attempts to distinguish the different perspectives of mobility...... 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...

  19. Signs in Place

    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...... be an effective guidance tool. However, “signs in place” offer alternative or additional guidelines to help people with their journey. This paper firstly seeks to understand road traffic signs in terms of mobility in everyday life. It then attempts to distinguish the different perspectives of mobility...... 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....

  20. Babinski and Babinski sign.

    Bassetti, C


    Babinski's sign probably is the best known neurologic eponym, referring to dorsiflexion of the great toe with or without fanning of the other toes and withdrawal of the leg. This follows plantar stimulation in patients with pyramidal tract dysfunction. Although the plantar reflex already had been described, Babinski--a French neurologist of Polish descent and a pupil of Charcot--was the first to differentiate between a normal and pathologic response of the toes and recognize its clinical implication. Despite the continuing controversy over its pathophysiologic interpretation, the clinical utility of Babinski's sign remains unchanged almost 100 years after its description.

  1. Cardio-thoracic surgical patients' experience on bedside nursing handovers: Findings from a qualitative study.

    Lupieri, Giulia; Creatti, Chiara; Palese, Alvisa


    The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism.

  2. Repeated bedside echocardiography in children with respiratory failure

    Jehlicka Petr


    Full Text Available Abstract Background The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods A total of 235 children, average age 3.21 (SD 1.32 years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS, return of spontaneous circulation after cardiopulmonary resuscitation (ROSC, bronchopulmonary dysplasia (BPD, cardiomyopathy (CMP and cardiopulmonary disease (CPD. Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI, left ventricle shortening fraction (SF, cardiac output (CO, and the mitral valve ratio of peak velocity of early wave (E to the peak velocity of active wave (A as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1 and after 72 hours of comprehensive treatment (time-2. The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests. Results A total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p Conclusion Echocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

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

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


    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

    Michael P Chae


    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.

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


    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. Cyclotron production of (44)Sc: From bench to bedside.

    van der Meulen, Nicholas P; Bunka, Maruta; Domnanich, Katharina A; Müller, Cristina; Haller, Stephanie; Vermeulen, Christiaan; Türler, Andreas; Schibli, Roger


    (44)Sc, a PET radionuclide, has promising decay characteristics (T1/2 = 3.97 h, Eβ(+)av = 632 keV) for nuclear imaging and is an attractive alternative to the short-lived (68)Ga (T1/2 = 68 min, Eβ(+)av = 830 keV). The aim of this study was the optimization of the (44)Sc production process at an accelerator, allowing its use for preclinical and clinical PET imaging. (44)CaCO3 targets were prepared and irradiated with protons (~11 MeV) at a beam current of 50 μA for 90 min. (44)Sc was separated from its target material using DGA extraction resin and concentrated using SCX cation exchange resin. Radiolabeling experiments at activities up to 500 MBq and stability tests were performed with DOTANOC by investigating different scavengers, including gentisic acid. Dynamic PET of an AR42J tumor-bearing mouse was performed after injection of (44)Sc-DOTANOC. The optimized chemical separation method yielded up to 2 GBq (44)Sc of high radionuclidic purity. In the presence of gentisic acid, radiolabeling of (44)Sc with DOTANOC was achieved with a radiochemical yield of ~99% at high specific activity (10 MBq/nmol) and quantities which would allow clinical application. The dynamic PET images visualized increasing uptake of (44)Sc-DOTANOC into AR42J tumors and excretion of radioactivity through the kidneys of the investigated mouse. The concept "from-bench-to-bedside" was clearly demonstrated in this extended study using cyclotron-produced (44)Sc. Sufficiently high activities of (44)Sc of excellent radionuclidic purity are obtainable for clinical application, by irradiation of enriched calcium at a cyclotron. This work demonstrates a promising basis for introducing (44)Sc to clinical routine of nuclear imaging using PET. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Toward the Ideal Signing Avatar

    Nicoletta Adamo-Villani


    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.

  8. The ivy sign

    Nasreen Mahomed


    Full Text Available The ivy sign refers to diffuse bilateral leptomeningeal enhancement on post- contrastT1-weighted magnetic resonance imaging (MRI and increased signal intensity in bilateralsubarachnoid spaces and perivascular spaces on T2-weighted fluid attenuation inversionrecovery (FLAIR MRI sequences in patients with moyamoya disease.

  9. Flemish Sign Language Standardisation

    Van Herreweghe, Mieke; Vermeerbergen, Myriam


    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…

  10. Signing in Science

    Ashby, Rachael


    This article describes British Sign Language (BSL) as a viable option for teaching science. BSL is used by a vast number of people in Britain but is seldom taught in schools or included informally alongside lessons. With its new addition of a large scientific glossary, invented to modernise the way science is taught to deaf children, BSL breaks…

  11. Buffer Zone Sign Template

    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.

  12. Derivative Sign Patterns

    Clark, Jeffrey


    Analysis of the patterns of signs of infinitely differentiable real functions shows that only four patterns are possible if the function is required to exhibit the pattern at all points in its domain and that domain is the set of all real numbers. On the other hand all patterns are possible if the domain is a bounded open interval.

  13. Derivative Sign Patterns

    Clark, Jeffrey


    Analysis of the patterns of signs of infinitely differentiable real functions shows that only four patterns are possible if the function is required to exhibit the pattern at all points in its domain and that domain is the set of all real numbers. On the other hand all patterns are possible if the domain is a bounded open interval.

  14. Sign Language Web Pages

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


    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…

  15. The Sign of Love



    @@ 一、故事内容 Mr Rabbit and Mr Wolf are neighbors.Mr Rabbit has many friends,but Mr Wolf has none.One day Mr Wolf wants to know the truth.He asks a lot of anitmals and finds the secret:it is a red paper heart.They all call it"the sign of love".

  16. These signs here now

    Raudaskoski, Pirkko Liisa


    Hallidays (1984) formulations of systemic-functional linguistics together with Hodge and Kress' (1988) social semiotics share the assumption that signs are not arbitrary: People make choices out of a web of possible constructions or expressions, and those choices can be shown to be motivated...

  17. Evaluation of new grids for bedside chest radiotherapy. Effects of X-ray beam misalignment

    Hatemura, Masahiro; Ikeda, Ryuji; Katsuda, Noboru; Moribe, Nobuyuki; Takada, Takao; Takahashi, Mutsumasa [Kumamoto University (Japan). Hospital; Higashida, Yoshiharu


    We investigated the effects of different degrees of misalignment on the performance of new grids in bedside radiography. Two types of new grids (a conventional grid with a grid ratio of 3 : 1 and a parallel hole grid) designed for bedside radiography were compared with a conventional 5 : 1 grid. The effects of scatter fraction, contrast improvement factor, bucky factor, and tolerance to misalignment on grid performance were examined. The scatter rejection and contrast improvement of the new grids were significantly lower compared with a 5 : 1 grid at accurate alignment. However, the two new grids have much more tolerance to misalignment than the conventional grid. The two new grids may be used for bedside radiography without the need for accurate alignment. (author)

  18. Learning Clinical Skills during Bedside Teaching Encounters in General Practice: A Video-Observational Study with Insights from Activity Theory

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


    Purpose: This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. Design/methodology/approach: An audio and/or video observational study examining…

  19. Vital sign monitoring using human patient simulators at pharmacy schools in Japan.

    Tokunaga, Jin; Takamura, Norito; Ogata, Kenji; Yoshida, Hiroki; Setoguchi, Nao; Matsuoka, Toshikazu; Hirokane, Taminori; Yamaoka, Akihiro; Sato, Keizo


    To develop, implement, and assess an experience-based education program using human patient simulators to instruct pharmacy students in monitoring vital signs to identify drug treatment effects and adverse events. Medical emergency care programs using human patient simulators were prepared and facilitated practical clinical training in resuscitation, which required selecting drugs while monitoring changes in blood pressure, pulse, and arterial blood oxygen saturation. Training encompassed the monitoring of routes of drug administration, drawing of simulated blood, vital-sign monitoring based on a pharmaceutical universal training model, vital-sign monitoring devices and simulators, and medical emergency education using biological simulators. Before and after bedside training, students were asked to complete a questionnaire to assess their understanding of vital sign monitoring and emergency care. Students successfully learned how to monitor routes of drug administration, vital signs, and pathological conditions. There was a significant increase in students' recognition of the importance of vital-sign monitoring. Experienced-based training using patient simulators successfully prepared pharmacy students to monitor vitals signs and identify drug treatment effects and adverse events.

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

    Jones P


    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

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

    William Mulkerin


    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.

  2. The vital signs of chronic disease management.

    Harries, Anthony D; Zachariah, Rony; Kapur, Anil; Jahn, Andreas; Enarson, Donald A


    The vital signs of pulse rate, blood pressure, temperature and respiratory rate are the 'nub' of individual patient management. At the programmatic level, vital signs could also be used to monitor the burden and treatment outcome of chronic disease. Case detection and treatment outcome constitute the vital signs of tuberculosis control within the WHO's 'DOTS' framework, and similar vital signs could be adapted and used for management of chronic diseases. The numbers of new patients started on therapy in each month or quarter (new incident cases) are sensitive indicators for programme performance and access to services. Using similar reporting cycles, treatment outcomes for all patients can be assessed, the vital signs being: alive and retained on therapy at the respective facility; died; stopped therapy; lost to follow-up; and transferred out to another facility. Retention on treatment constitutes the prevalent number of cases, the burden of disease, and this provides important strategic information for rational drug forecasting and logistic planning. If case numbers and outcomes of chronic diseases were measured reliably and consistently as part of an integrated programmatic approach, this would strengthen the ability of resource-poor countries to monitor and assess their response to these growing epidemics.

  3. Wrong Signs in Regression Coefficients

    McGee, Holly


    When using parametric cost estimation, it is important to note the possibility of the regression coefficients having the wrong sign. A wrong sign is defined as a sign on the regression coefficient opposite to the researcher's intuition and experience. Some possible causes for the wrong sign discussed in this paper are a small range of x's, leverage points, missing variables, multicollinearity, and computational error. Additionally, techniques for determining the cause of the wrong sign are given.

  4. Bedside ultrasound in the diagnosis of uterine rupture following surgical abortion.

    Derr, Charlotte; Henry, Melinda


    Reports of uterine rupture following surgical abortion are rare but may result in hemorrhage, sepsis, and even death. In this unique case, we describe how a transabdominal pelvic ultrasound performed at the bedside by an emergency department physician identified uterine rupture with retained products of conception and led to an emergent laparotomy and hysterectomy. This case illustrates how bedside ultrasound may be used in patients presenting with abdominopelvic pain following surgical abortion to shorten the time to definitive treatment and ultimately lower the morbidity and mortality associated with a diagnosis of life-threatening uterine rupture.

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

    Adam Goodman


    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.

  6. [Computerized decision support systems: EBM at the bedside].

    Capobussi, Matteo; Banzi, Rita; Moja, Lorenzo; Bonovas, Stefanos; González-Lorenzo, Marien; Liberati, Elisa Giulia; Polo Friz, Hernan; Nanni, Oriana; Mangia, Massimo; Ruggiero, Francesca


    One of the aims of Evidence-Based Medicine is to improve quality and appropriateness of care by the expedition of the knowledge transfer process. Computerized Decision Support Systems (CDSSs) are computer programs that provide alerts to the prescribing doctor directly at the moment of medical examination. In fact, alerts are integrated within the single patient electronic health record. CDSS based on the best available and updated evidence and guidelines may be an efficient tool to facilitate the transfer of the latest results from clinical research directly at the bedside, thus supporting decision-making. The CODES (COmputerized DEcision Support) trial is a research program funded by the Italian Ministry of Health and the Lombardy Region. It aims to evaluate the feasibility of the implementation of a CDSS at the hospital level and to assess its efficacy in daily clinical practice. The CODES project includes two pragmatic RCTs testing a CDSS (i.e. the EBMeDS - MediDSS) in two large Italian hospitals: the first is a general hospital in Vimercate (Lombardy), the second is an oncologic research center in Meldola (Emilia Romagna). The CDSS supports a full spectrum of decisions: therapy, drug interactions, diagnosis, and management of health care services are covered by a hundreds of reminders. However only few reminders are activated per patient, highlighting crucial problems in the delivery of high-quality care. The two trials have similar design and primary outcome, the rate at which alerts detected by the software are resolved by a decision of the clinicians. The project also includes the assessment of barriers and facilitators in the adoption of these new technologies by hospital staff members and the retrospective evaluation of the repeated risks in prescription habits. The trials are ongoing and currently more than 10,000 patients have been randomized. The qualitative analysis revealed a progressive shift in the perception of the tool. Doctors are now seeing it

  7. Manual Signing in Adults with Intellectual Disability: Influence of Sign Characteristics on Functional Sign Vocabulary

    Meuris, Kristien; Maes, Bea; De Meyer, Anne-Marie; Zink, Inge


    Purpose: The purpose of this study was to investigate the influence of sign characteristics in a key word signing (KWS) system on the functional use of those signs by adults with intellectual disability (ID). Method: All 507 signs from a Flemish KWS system were characterized in terms of phonological, iconic, and referential characteristics.…

  8. Visual Signs of Ageing

    Helle Rexbye


    Full Text Available Consumer culture has placed the ageing body in a dilemma of representation. Physical appearance has become increasingly important as a symbol of identity, and at the same time society idealizes youth. This study explores visual ageing empirically. By using photographs of older persons (70+ as starting point, it is explored how visual age is assessed and interpreted. It is shown that informants read age in a spread of stages and categories. Main age indicators are biological markers: skin, eyes, and hair colour, but supplemented by vigour, style, and grooming. Furthermore, in-depth interviews indicate that visual age is mainly interpreted into categories and moral regulations rooted in early modernity. Subsequently the question of a postmodern perspective of visual ageing is discussed in this article. The empirical findings in the study question a postmodern fluidity of visual signs – at least when the concern is signs of ageing.

  9. The Integral Sign Galaxy

    Noll, Keith


    We will observe the unusual warped disk galaxy known as the Integral Sign Galaxy, UGC 3697, with a small two-position WFPC2 mosaic. Observations will be obtained in three broad band filters and the resulting image will be released on the 19th anniversary of the launch of the Hubble Space Telescope on ~April 24, 2009. Multidrizzled mosaics will be made available through the archive.

  10. Microelectronics Reliability


    convey any rights or permission to manufacture, use, or sell any patented invention that may relate to them. This report was cleared for public release...testing for reliability prediction of devices exhibiting multiple failure mechanisms. Also presented was an integrated accelerating and measuring ...13  Table 2  T, V, F and matrix versus  measured  FIT

  11. Planetary Vital Signs

    Kennel, Charles; Briggs, Stephen; Victor, David


    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?

  12. Reliability of the hip examination in osteoarthritis: effect of standardization.

    Cibere, Jolanda; Thorne, Anona; Bellamy, Nicholas; Greidanus, Nelson; Chalmers, Andrew; Mahomed, Nizar; Shojania, Kam; Kopec, Jacek; Esdaile, John M


    To assess the reliability of the physical examination of the hip in osteoarthritis (OA) among rheumatologists and orthopedic surgeons, and to evaluate the benefits of standardization. Thirty-five physical signs and techniques were evaluated using a 6 x 6 Latin square design. Subjects with mild to severe hip OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of physical examination techniques. For dichotomous signs, agreement was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), whereas for continuous and ordinal signs a reliability coefficient was calculated using analysis of variance. A PABAK >0.60 and a reliability coefficient >0.80 were considered to indicate adequate reliability. Adequate post-standardization reliability was achieved for 25 (71%) of 35 signs. The most highly reliable signs included true and apparent leg length discrepancy > or =1.5 cm; hip flexion, abduction, adduction, and extension strength; log roll test for hip pain; internal rotation and flexion range of motion; and Thomas test for flexion contracture. The standardization process was associated with substantial improvements in reliability for a number of physical signs, although minimal or no change was noted for some. Only 1 sign, Trendelenburg's sign, was highly unreliable post-standardization. With the exception of gait, a comprehensive hip examination can be performed with adequate reliability. Post-standardization reliability is improved compared with pre-standardization reliability for some physical signs. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.

  13. The Danish Sign Language Dictionary

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas


    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....

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

    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)


    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.)

  15. Green's Theorem for Sign Data

    Louis M. Houston


    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...

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

    ten Holt, Gineke A.; Arendsen, Jeroen; de Ridder, Huib; Koenderink-van Doorn, Andrea J.; Reinders, Marcel J. T.; Hendriks, Emile A.


    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 data-driven ASLR methods has shortcomings which may not be solvable without the use of knowledge on human sign language processing. Handling variation in the precise execution of signs is an example of such shortcomings: data-driven methods (which include almost all current methods) have difficulty recognizing signs that deviate too much from the examples that were used to train the method. Insight into human sign processing is needed to solve these problems. Perceptual research on sign language can provide such insights. This paper discusses knowledge derived from a set of sign perception experiments, and the application of such knowledge in ASLR. Among the findings are the facts that not all phases and elements of a sign are equally informative, that defining the 'correct' form for a sign is not trivial, and that statistical ASLR methods do not necessarily arrive at sign representations that resemble those of human beings. Apparently, current ASLR methods are quite different from human observers: their method of learning gives them different sign definitions, they regard each moment and element of a sign as equally important and they employ a single definition of 'correct' for all circumstances. If the object is for an ASLR method to handle natural sign language, then the insights from sign perception research must be integrated into ASLR.

  17. Sign Language Comprehension: The Case of Spanish Sign Language

    Rodriguez Ortiz, I. R.


    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…

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

    C. de Vos; R. Pfau


    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 w

  19. American Sign Language and Pidgin Sign English: What's the Difference?

    Reilly, Judy; McIntire, Marina L.


    The differences between Pidgin Sign English and American Sign Language in simultaneity, or the visible presence of two or more linguistic units (manual or nonmanual) co-occurring, are demonstrated. Differences are exemplified in handshape-classifier pronouns, directional verbs, co-occurring manual signs, and nonmanual behavior. (PMJ)

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

    Kristin Adkins


    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.

  1. Bench, Bedside, Curbside, and Home: Translational Research to Include Transformative Change Using Educational Research

    Felege, Christopher; Hahn, Emily; Hunter, Cheryl


    Translational research originated in the medical field during the 1990s to describe taking discovery based research through the steps of applying it to clinical research and patient-oriented care. This model is implicitly linear, depicting the flow of information from researchers' bench, to a clinical trial bedside, to a primary care physician's…

  2. Discovering Ways That Influence the Older Nurse to Continue Bedside Practice

    LeeAnna Spiva


    Full Text Available A descriptive qualitative approach was used to investigate older nurses practicing bedside nursing and to identify ways to influence older nurses to continue bedside practice. A purposive sample of 18 older nurses was recruited from a healthcare system located in the Southeastern United States. Interpretative analysis of interviews resulted in the identification of three constitutive patterns and eight themes. The first constitutive pattern identified was attributes of the older nurse. The themes comprising this pattern were (a professional growth in confidence and skills through experience and (b passion and love for nursing. The second constitutive pattern was enduring stress and frustration. The themes comprising this pattern were (a physical and mental changes associated with aging, (b increased patient acuity and patient load, (c constant change, and (d time constraints. The third constitutive pattern was enhancements needed for older nurses to continue bedside nursing. The themes comprising this pattern were (a work environment enhancements and (b organizational relationship enhancements. Findings may provide a better understanding of the older nurse's role in bedside nursing.

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

    Aakash Pandita


    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.

  4. Evaluation of dysphagia in early stroke patients by bedside, endoscopic, and electrophysiological methods.

    Umay, Ebru Karaca; Unlu, Ece; Saylam, Guleser Kılıc; Cakci, Aytul; Korkmaz, Hakan


    We aimed in this study to evaluate dysphagia in early stroke patients using a bedside screening test and flexible fiberoptic endoscopic evaluation of swallowing (FFEES) and electrophysiological evaluation (EE) methods and to compare the effectiveness of these methods. Twenty-four patients who were hospitalized in our clinic within the first 3 months after stroke were included in this study. Patients were evaluated using a bedside screening test [including bedside dysphagia score (BDS), neurological examination dysphagia score (NEDS), and total dysphagia score (TDS)] and FFEES and EE methods. Patients were divided into normal-swallowing and dysphagia groups according to the results of the evaluation methods. Patients with dysphagia as determined by any of these methods were compared to the patients with normal swallowing based on the results of the other two methods. Based on the results of our study, a high BDS was positively correlated with dysphagia identified by FFEES and EE methods. Moreover, the FFEES and EE methods were positively correlated. There was no significant correlation between NEDS and TDS levels and either EE or FFEES method. Bedside screening tests should be used mainly as an initial screening test; then FFEES and EE methods should be combined in patients who show risks. This diagnostic algorithm may provide a practical and fast solution for selected stroke patients.

  5. The bedside examination of the vestibulo-ocular reflex (VOR): an update.

    Kheradmand, A; Zee, D S


    Diagnosing dizzy patients remains a daunting challenge to the clinician in spite of modern imaging and increasingly sophisticated electrophysiological testing. Here we review the major bedside tests of the vestibulo-ocular reflex and how, when combined with a proper examination of the other eye movement systems, one can arrive at an accurate vestibular diagnosis.

  6. Signs In Place

    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 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...

  7. Novel Use of Google Glass for Procedural Wireless Vital Sign Monitoring.

    Liebert, Cara A; Zayed, Mohamed A; Aalami, Oliver; Tran, Jennifer; Lau, James N


    Purpose This study investigates the feasibility and potential utility of head-mounted displays for real-time wireless vital sign monitoring during surgical procedures. Methods In this randomized controlled pilot study, surgery residents (n = 14) performed simulated bedside procedures with traditional vital sign monitors and were randomized to addition of vital sign streaming to Google Glass. Time to recognition of preprogrammed vital sign deterioration and frequency of traditional monitor use was recorded. User feedback was collected by electronic survey. Results The experimental group spent 90% less time looking away from the procedural field to view traditional monitors during bronchoscopy (P = .003), and recognized critical desaturation 8.8 seconds earlier; the experimental group spent 71% (P = .01) less time looking away from the procedural field during thoracostomy, and recognized hypotension 10.5 seconds earlier. Trends toward earlier recognition of deterioration did not reach statistical significance. The majority of participants agreed that Google Glass increases situational awareness (64%), is helpful in monitoring vitals (86%), is easy to use (93%), and has potential to improve patient safety (85%). Conclusion In this early feasibility study, use of streaming to Google Glass significantly decreased time looking away from procedural fields and resulted in a nonsignificant trend toward earlier recognition of vital sign deterioration. Vital sign streaming with Google Glass or similar platforms is feasible and may enhance procedural situational awareness.

  8. Puusepp's sign--clinical significance of a forgotten pyramidal sign.

    Tacik, Pawel; Krasnianski, M; Zierz, S


    The pyramidal signs in the lower extremity can be divided into three groups: (1) Babinski's group characterised by dorsoflexion of the great toe, (2) pyramidal signs marked by plantar flexion of the toes (e.g. Rossolimo's sign), and (3) synkinetic movements such as Strümpell's phenomenon. Puusepp's sign described by the Estonian neurologist and neurosurgeon Ludvig Puusepp belongs to none of these three groups. Its eliciting does not differ from that of Babinski's sign. The response, however, is different and consists of a tonic slow abduction of the little toe. We showed its relevance on the basis of clinical examination of six patients: four females aged 29, 50, 43 and 57 years and two males aged 42 and 49 years. The diagnoses were as follows: a new relapse of multiple sclerosis, a secondary progressive multiple sclerosis, a left middle cerebral artery stroke, a lumbago resulting in L3-L4 fusion surgery, an amyotrophic lateral sclerosis and a left intracerebral haemorrhage respectively. Puusepp's sign was the only elicitable pyramidal sign in all the patients but two. The 50-year-old female patient revealed on neurological examination Babinski's sign on the left side and Puusepp's sign on the right side. The testing of pyramidal signs in the 57-year-old woman displayed a bilateral Strümpell's sign and a left Puusepp's sign. These six cases showed that although rarely recognized in the clinical practice Puusepp's sign contributed to establishing the diagnosis of a central motor neuron involvement in the case of an absent Babinski's sign. Thus, its testing does not differ from that of Babinski's sign which requires only a little attention from the examiner, but provides an important piece of clinical information.

  9. Acquisition and Long-term Retention of Bedside Ultrasound Skills in First-Year Medical Students.

    Steinmetz, Peter; Oleskevich, Sharon; Lewis, John


    The purpose of this study was to assess bedside ultrasound skill acquisition and retention in medical students after completion of the first year of a new undergraduate bedside ultrasound curriculum at McGill University. Skill acquisition was assessed in first-year medical students (n = 195) on completion of their bedside ultrasound instruction. Instruction included 6 clinically based 60-minute practical teaching sessions evenly spaced throughout the academic year. Students' ability to meet course objectives was measured according to a 4-point Likert rating scale. Evaluations were performed by both instructors and the students themselves. Retention of skill acquisition was evaluated 8 months later on a year-end practical examination. The mean percentage ± SD of students assigned a rating of "strongly agree" or "agree" by instructors was 98% ± 0.4% for all 6 teaching sessions (strongly agree, 52% ± 3%; agree, 46% ± 3%). According to student self-evaluations, the mean percentage of students assigned a rating of strongly agree was significantly greater than the percentage assigned by instructors for all teaching sessions (86% ± 2% versus 52% ± 3%; P year-end examination showed that 91% ± 2% of students were assigned a rating of strongly agree or agree for their ability to demonstrate skills learned 8 months previously. Ninety-five percent of students reported that bedside ultrasound improved their understanding of anatomy for all 6 teaching sessions (mean, 95% ± 0.01%). These results demonstrate that first-year medical students show acquisition and long-term retention of basic ultrasound skills on completion of newly implemented bedside ultrasound instruction.

  10. INFINITY construction contract signed


    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.

  11. Error Bounds for the Sign Function

    Frommer, Andreas; Lippert, Thomas; Rittich, H


    The Overlap operator fulfills the Ginsparg-Wilson relation exactly and therefore represents an optimal discretization of the QCD Dirac operator with respect to chiral symmetry. When computing propagators or in HMC simulations, where one has to invert the overlap operator using some iterative solver, one has to approxomate the action of the sign function of the (symmetrized) Wilson fermion matrix Q on a vector b in each iteration. This is usually done iteratively using a "primary" Lanczos iteration. In this process, it is very important to have good stopping criteria which allow to reliably assess the quality of the approximation to the action of the sign function computed so far. In this work we show how to cheaply recover a secondary Lanczos process, starting at an arbitrary Lanczos vector of the primary process and how to use this secondary process to efficiently obtain computable error estimates and error bounds for the Lanczos approximations to sign(Q)b, where the sign function is approximated by the Zolo...

  12. Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors.

    Salam, Abdus; Siraj, Harlina Halizah; Mohamad, Nabishah; Das, Srijit; Rabeya, Yousuf


    Bedside teaching is a vital component of medical education. It is applicable to any situation where teaching is imparted in the presence of patients. In teaching in the patients' presence, learners have the opportunities to use all of their senses and learn the humanistic aspect of medicine such as role modeling, which is vital but difficult to communicate in words. Unfortunately, bedside teaching has been on the decline. To investigate the reasons for the decline in bedside teaching, its importance and its revival, a review of literature was carried out using PubMed and other data bases. The review revealed that the major concerns of bedside teaching were time constraint, false preceptors' concern about patients' comfort, short stay of patients in hospitals, learner distraction by technology, lack of experience and unrealistic faculty expectation. Whatsoever the reasons, bedside teaching cannot be replaced with anything else. There are newer approaches of effective bedside teaching, and the core focus of all such approaches is educational process. A bedside teacher must learn how to involve patients and learners in the educational processes. Moreover, bedside teaching is the process through which learners acquire the skills of communication by asking patients' permission, establishing ground rules, setting time limit, introducing the team, diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. It is most important to ensure a comfortable environment for all participants, the learner, the patient and the bedside teacher. Ongoing faculty development programs on educational processes and realistic faculty expectations may overcome the problems.

  13. Kinship in Mongolian Sign Language

    Geer, Leah


    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…

  14. Issues in Sign Language Lexicography

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


    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...... as a review of a sign language dictionary that has recently been published in the Netherlands...

  15. 3 CFR - Presidential Signing Statements


    ... issued statements addressing constitutional or other legal questions upon signing bills into law (signing... of the use of signing statements to raise constitutional objections to statutory provisions. There is no doubt that the practice of issuing such statements can be abused. Constitutional...

  16. How do signs organize in directed signed social networks?

    Guo, Long


    We introduce a reshuffled approach to empirical analyze signs' organization in real directed signed social networks of Epinions and Slashdots from the global viewpoint. In the reshuffled approach, each negative link has probability $p_{rs}$ to exchange its sign with another positive link chosen randomly. Through calculating the entropies of social status ($S_{in}$ and $S_{out}$) of and mimicking opinion formation of the majority-rule model on each reshuffled signed network, we find that $S_{in}$ and $S_{out}$ reach their own minimum values as well as the magnetization $|m^{*}|$ reaches its maximum value at $p_{rs}=0$. Namely, individuals share the homogeneous properties of social status and dynamic status in real directed signed social networks. Our present work provides some interesting tools and perspective to understand the signs' organization in signed social networks.

  17. Translating Signs, Producing Subjects

    Brett Neilson


    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

  18. Negation switching invariant signed graphs

    Deepa Sinha


    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.

  19. Preventing deaths from cryptococcal meningitis: from bench to bedside.

    Roy, Monika; Chiller, Tom


    Cryptococcal meningitis (CM), a fungal disease caused by Cryptococcus spp., is the most common form of meningitis and a leading cause of death among persons with HIV/AIDS in sub-Saharan Africa. Detection of cryptococcal antigen, which is present several weeks before overt signs of meningitis develop, provides an opportunity to detect infection early. Screening persons with HIV for cryptococcal infection when they access healthcare can identify asymptomatic infected patients allowing for prompt treatment and prevention of death. A newly developed point-of-care assay for cryptococcal antigen, as well as growing evidence supporting the utility and cost-effectiveness of screening, are further reasons to consider broad implementation of cryptococcal screening in countries with a high burden of cryptococcal disease.

  20. A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia: A pilot study

    Sureshkumar Radhakrishnan


    Full Text Available Background: As with most neurologic conditions, stroke involves impairment of the swallowing mechanism. This could be a spectrum of issues, the worst of which is aspiration. At the same time, the prolonged presence of a naso-gastric tube (NGT has its own morbidity. Flexible endoscopic evaluation of swallowing (FEES is one reliable method to assess the structural and functional status of the oropharynx and larynx, during the swallowing process. Objective: To study the utility of FEES in decision-making with respect to resumption of oral intake in stroke patients. To document the findings of FEES in stroke patients, and to look for correlations between these and the site of stroke. Materials and Methods: Protocol insertion of naso-gastric tube in all stroke patients, at presentation. Initial assessment by a neurologist and swallowing therapist, depending on cognitive status of the patient. All patients underwent MRI Brain with diffusion weighted sequences. After detailed clinical examination, they underwent swallow exercises under the supervision of a trained swallowing therapist. The decision to remove NGT was taken clinically by the combined decision of neurologist and swallowing therapist. Then all patients underwent FEES by the ENT surgeon. The final decision for NGT removal was taken as per the FEES findings. Result: Sixteen stroke patients underwent the FEES procedure during a period of six months. The oropharyngeal and laryngeal findings varied depending on the area of stroke involvement. Of these, change in decision regarding swallowing rehabilitation or NGT removal was needed in four patients, following the FEES findings. Conclusions: FEES is an easy, efficient and reliable method to evaluate the swallowing status in stroke patients. In combination with good bedside clinical examination and swallow exercises, it can be a good tool in assessing patients with post- stroke dysphagia. Post-stroke rehabilitation and prevention of aspiration

  1. Grid reliability

    Saiz, P; Rocha, R; Andreeva, J


    We are offering a system to track the efficiency of different components of the GRID. We can study the performance of both the WMS and the data transfers At the moment, we have set different parts of the system for ALICE, ATLAS, CMS and LHCb. None of the components that we have developed are VO specific, therefore it would be very easy to deploy them for any other VO. Our main goal is basically to improve the reliability of the GRID. The main idea is to discover as soon as possible the different problems that have happened, and inform the responsible. Since we study the jobs and transfers issued by real users, we see the same problems that users see. As a matter of fact, we see even more problems than the end user does, since we are also interested in following up the errors that GRID components can overcome by themselves (like for instance, in case of a job failure, resubmitting the job to a different site). This kind of information is very useful to site and VO administrators. They can find out the efficien...

  2. Rigler’s sign and the football sign

    Sheetal Daya


    Full Text Available Rigler’s sign was first described in 1941 by L G Rigler as a new radiological sign for recognising free air in the peritoneal cavity on supine radiograph. The presence of pneumoperitoneum allows free intraperitoneal air to be contrasted with intraluminal gas, accentuating the wall of gas-containing viscera. It is observed in infants and very ill patients where only limited radiographs of the abdomen are possible. The football sign was first described by R E Miller in the 1960s. Seen on supine abdominal radiographs, this describes an oval radiolucency resembling an American football. It is important for the radiologist to recognise the supporting signs of pneumoperitoneum, such as Rigler’s sign and the football sign, on supine abdominal radiographs, especially in neonates and infants, where erect chest/abdominal radiographs are not always possible.

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

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


    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.

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

    Yang-Sook Yoo, RN, PhD


    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.

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

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


    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:

  6. Chvostek's sign in paediatric practice.

    Hasan, Zeeshaan U; Absamara, Rania; Ahmed, Mas


    Chvostek's Sign was first described in 1876, as a clinical clue associated with patients who suffered from latent tetany, and is induced by percussion of the angle of the jaw. However, over the years many clinicians have called into question the strength of the association with latent tetany, particularly in paediatric practice. This review examines the variation in techniques used to elicit the sign in studies conducted on this phenomenon in children as well as how differences in the classification of a positive Chvostek's sign have lead to varied reports on the strength of the association. Furthermore, an appraisal of the literature regarding the proposed mechanism of Chvostek's sign is reported alongside analysing other diseases which have been associated with Chvostek's sign to uncover any unifying mechanism for the presence of this clinical sign in children.

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

    Abdus Salam


    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.

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

    Haug, Tobias


    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…

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

    Ferguson Z


    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.

  10. Bringing mini-chalk talks to the bedside to enhance clinical teaching.

    Pitt, Michael B; Orlander, Jay D


    Chalk talks - where the teacher is equipped solely with a writing utensil and a writing surface - have been used for centuries, yet little has been written about strategies for their use in medical education. Structured education proximal to patient encounters (during rounds, at the bedside, or in between patients in clinic) maximizes the opportunities for clinical learning. This paper presents a strategy to bring mini-chalk talks (MCTs) to the bedside as a practical way to provide relevant clinical teaching by visually framing teachable moments. Grounded in adult learning theory, MCTs leverage teaching scripts to facilitate discussion, involve learners at multiple levels, and embrace the increased retention associated with visual aids. These authors provide specific recommendations for the design and implementation of MCT sessions including what topics work well, how to prepare, and how to involve and engage the learners. ADHD: Attention Deficit Hyperactivity Disorder; MCT: Mini-chalk talks.

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

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


    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.

  12. Accuracy of ED Bedside Ultrasound for Identification of Gallstones: Retrospective Analysis of 575 Studies

    Scruggs, William


    Full Text Available Study Objective: To determine the ability of emergency department (ED physicians to diagnose cholelithiasis with bedside ultrasound. Methods: ED gallbladder ultrasounds recorded over 37 months were compared to radiology ultrasound interpretation. Results: Of 1,690 ED gallbladder ultrasound scans performed during this period, radiology ultrasound was performed in 575/1690 (34% cases. ED physician bedside interpretation was 88% sensitive [95% CI, 84-91] and 87% specific [95% CI, 82-91], while positive predictive value (PPV was 91% [88- 94%] and negative predictive value (NPV was 83% [78-87%], using radiology interpretation as the criterion reference. Conclusion: ED physician ultrasound of the gallbladder for cholelithiasis is both sensitive and specific.

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

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


    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. Space is special in Sign.

    Campbell, Ruth; Woll, Bencie


    Following groundbreaking work by linguists and cognitive scientists over the past thirty years, it is now generally accepted that sign languages of the deaf, such as ASL (American Sign Language) or BSL (British Sign Language), are structured and processed in a similar manner to spoken languages. The one striking difference is that they operate in a wholly non-auditory, visuospatial medium. How does the medium impact on language processing itself?

  15. Sign Languages of the World

    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...... or team of experts in the particular sign language, at the invitation of the editors. Thirty-eight different deaf sign languages and alternate sign languages from every continent are represented, and over seventy international deaf and hearing scholars have contributed to the volume....

  16. Traffic-Sign Recognition Systems

    Escalera, Sergio


    This work presents a full generic approach to the detection and recognition of traffic signs. The approach is based on the latest computer vision methods for object detection, and on powerful methods for multiclass classification. The challenge was to robustly detect a set of different sign classes in real time, and to classify each detected sign into a large, extensible set of classes. To address this challenge, several state-of-the-art methods were developed that can be used for different recognition problems. Following an introduction to the problems of traffic sign detection and categoriza

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


    and progressive swelling. She had a complicated medical history, including the recent diagnosis of deep venous thrombosis with associated pulmonary...pseudoseizures, chronic lymphadenopathy, peripheral neuropathy, and fibromyalgia . The physical exam was remarkable for slight left eye proptosis, left...need for CT scan if the diagnosis can be made. In this case, the CT scan demonstrates a fairly significant RBH (Figure 2), yet the focused bedside

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

    Lauridsen, Sigurd


    rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack of political accountability towards citizens. In this paper......, 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....

  19. Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

    Devine, Deborah A; Wenger, Barb; Krugman, Mary; Zwink, Jennifer E; Shiskowsky, Kaycee; Hagman, Jan; Limon, Shelly; Sanders, Carolyn; Reeves, Catherine


    An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

  20. Evaluation of a BED-SIDE Platelet Function Assay : Performance and Clinical Utility.

    Lau Wei


    Full Text Available Platelets have a pivotal role in the initial defense against insult to the vasculature and are also recognized of critical importance in the acute care settings of percutaneous coronary intervention and cardiopulmonary bypass. In these environments both platelet count and function may be markedly compromised. Unfortunately, current assays to evaluate the parameters of platelet count and function are of limited utility for bed-side testing. Moreover, it is suggested that there may be significant inter patient variation in response to antiplatelet therapy that may be exacerbated by other agents (e.g. heparin that are routinely administered during cardiac intervention. Here we describe a practical, rapid and user-friendly whole blood platelet function assay that has been developed for use in bed-side settings. Platelet agonists were formulated with an anticoagulant and lyophilized in blood collection tubes standardised to receive a l mL fresh whole blood sample. In the presence of an agonist, platelets are activated and interact (aggregate. Using traditional cell counting principles, non-aggregated platelets are counted whereas aggregated platelets are not. The percentage (% of functional platelets in reference to a baseline tube may then be determined. Results are available within four minutes. Platelet aggregation in whole blood demonstrated good correlation with turbidometric aggregometry for both ADP (r=0.91 and collagen (r=0.88. Moreover, in clinical settings where antiplatelet agents were administered, this rapid, bed-side, platelet function assay demonstrated utility in monitoring patient response to these therapies. This novel bed-side assay of platelet function is extremely suitable for the clinical environment with a rapid turn-around time. In addition, it provides a full haematology profile, including platelet count, and should permit enhancement of transfusion and interventional decisions.

  1. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

    John Jarrell; Maria Adele Giamberardino; Magali Robert; Maryam Nasr-Esfahani


    Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eigh...

  2. Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

    Rantz, Marilyn J; Hicks, Lanis; Petroski, Gregory F; Madsen, Richard W; Alexander, Greg; Galambos, Colleen; Conn, Vicki; Scott-Cawiezell, Jill; Zwygart-Stauffacher, Mary; Greenwald, Leslie


    There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

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

    Eichmann, Hanna


    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…

  4. Signs of Change: Contemporary Attitudes to Australian Sign Language

    Slegers, Claudia


    This study explores contemporary attitudes to Australian Sign Language (Auslan). Since at least the 1960s, sign languages have been accepted by linguists as natural languages with all of the key ingredients common to spoken languages. However, these visual-spatial languages have historically been subject to ignorance and myth in Australia and…

  5. “Playboy Bunny” Sign of Congestive Heart Failure

    Fukunori Kinjo


    Full Text Available In emergency, ultrasound has been widely used as a non-invasive and effective examination to evaluate congestive heart failure. We highlight “Playboy Bunny” sign as a reliable marker and an important clue to the diagnosis of passive hepatic congestion, caused by congestive heart failure. [West J Emerg Med. 2011;12(4:433–434.

  6. Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety

    Kinney Michelle A O


    Full Text Available Abstract Background Maternal cardiovascular and pulmonary events during labor and delivery may result in adverse maternal and fetal outcome. Potential etiologies include primary cardiac events, pulmonary embolism, eclampsia, maternal hemorrhage, and adverse medication events. Remifentanil patient-controlled analgesia is an alternative when conventional neuraxial analgesia for labor is contraindicated. Although remifentanil is a commonly used analgesic, its use for labor analgesia is not clearly defined. Case presentation We present an unexpected and unique case of remifentanil toxicity resulting in the need for an emergent bedside cesarean delivery. A 30-year-old G3P2 woman receiving subcutaneous heparin anticoagulation due to a recent deep vein thrombosis developed cardiopulmonary arrest during labor induction due to remifentanil toxicity. Conclusion A rapid discussion among the attending obstetric, anesthesia, and nursing teams resulted in consensus to perform an emergent bedside cesarean delivery resulting in an excellent fetal outcome. During maternal cardiopulmonary arrest, a prompt decision to perform a bedside cesarean delivery is essential to avoid significant maternal and fetal morbidity. Under these conditions, rapid collaboration among obstetric, anesthesia, and nursing personnel, and an extensive multi-layered safety process are integral components to optimize maternal and fetal outcomes.

  7. Back to the bedside: the 8-year evolution of a resident-as-teacher rotation.

    Ilgen, Jonathan S; Takayesu, James K; Bhatia, Kriti; Marsh, Regan H; Shah, Sachita; Wilcox, Susan R; Krauss, William H; Nadel, Eric S


    Teaching our residents to teach is a vital responsibility of Emergency Medicine (EM) residency programs. As emergency department (ED) overcrowding may limit the ability of attending physicians to provide bedside instruction, senior residents are increasingly asked to assume this role for more junior trainees. Unfortunately, a recent survey suggests that only 55% of all residencies provide instruction in effective teaching methods. Without modeling from attending physicians, many residents struggle with this responsibility. We introduced a "Resident-as-Teacher" curriculum in 2002 as a means to address a decline in bedside instruction and provide our senior residents with a background in effective teaching methods. Here, we describe the evolution of this resident-as-teacher rotation, outline its current structure, cite potential pitfalls and solutions, and discuss the unique addition of a teach-the-teacher curriculum. A resident-as-teacher rotation has evolved into a meaningful addition to our senior residents' training, fostering their growth as educators and addressing our need for bedside instruction. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Frontiers of reliability

    Basu, Asit P; Basu, Sujit K


    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

  9. Learning to Detect Traffic Signs

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


    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...

  10. Comparison of the bedside head impulse test with the video head impulse test in a clinical practice setting: a prospective study of 500 outpatients.

    Chun Wai eYip


    Full Text Available Objectives: The primary aim was to determine the sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of the bedside head impulse test (bHIT using the video HIT (vHIT as the gold standard for quantifying the function of the vestibulo-ocular reflex (VOR. Secondary aims were to determine the bHIT inter-rater reliability, and sensitivity in detecting unilateral and bilateral vestibulopathy.Methods: In this prospective study, 500 consecutive outpatients presenting to a tertiary neuro-otology clinic with vertigo or dizziness of various vestibular etiologies who did not have any of the pre-defined exclusion criteria were recruited. Bedside HITs were done by three experienced neuro-otology clinicians masked to the diagnosis, and the results were compared with the vHIT. The patients were likewise blinded to the bHIT and vHIT findings. Patients with VOR deficits were identified on the vHIT by referencing to the pre-selected pathological gain of 40%, the bHIT sensitivity = 51.7% and 83%, respectively. For bilateral vestibulopathy, overall bHIT sensitivity = 66.3%, reaching 86.84% for severely reduced bidirectional gains.Conclusions: For the primary outcome, the bHIT had moderate sensitivity and low PPV. While the study did not elucidate the best choice for vHIT reference, it demonstrated how the bHIT test properties varied with vHIT thresholds: selecting a lower threshold improved the sensitivity but diminished the PPV, while a higher threshold had the opposite effect. The VOR was most likely normal if the bHIT was negative due to its high NPV. The bHIT was moderately sensitive for detecting unilateral and bilateral vestibulopathy overall, but better for certain subgroups.

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

    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)


    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.)

  12. Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed-method research protocol.

    Malfait, Simon; Eeckloo, Kristof; Lust, Elisa; Van Biesen, Wim; Van Hecke, Ann


    To evaluate the feasibility, appropriateness, meaningfulness and effectiveness of bedside shift reporting in a minimum of five interventions and five control wards. Hospitals continually improve their quality of care. Next to improvements in clinical performance, more patient participation is stimulated through different methods. Methods to enhance patient participation such as bedside shift reporting lack rigorously performed research to determine their feasibility, appropriateness, meaningfulness and effectiveness. Small-scale research and a previous pilot study indicate that bedside shift reporting improves patient participation, nurse-nurse communication and nurse-patient communication. The development, implementation and evaluation of bedside shift report are based on the Medical Research Council framework for complex interventions in health care. A matched, controlled, mixed-method, longitudinal study design will be used. The Feasibility-Appropriateness-Meaningfulness-Effectiveness framework will be applied for the quantitative and qualitative evaluation of bedside shift report. A tailored intervention and implementation process for bedside shift report will be developed using diagnostic interviews, co-design and acceptability testing. The intervention will be evaluated before implementation and three times after implementation. Individual and focus group interviews will be performed. Questionnaires, observations and analysis of the medical records and administrative databases will be completed. This study was funded in October 2015. Research Ethics Committee approval was granted in March 2016. There is a pressing need for rigorous research into the effects of interventions for improving patient participation. This study addresses the significance of bedside shift report as an intervention to improve quality of care, communication and patient participation within a large-scale, matched, controlled research design. © 2016 John Wiley & Sons Ltd.

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

    Haytham Samy Diab


    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.


    André Crim Valente


    Full Text Available The work of Ferdinand de Saussure was massively revisited, in 2013, the year of the centenary of the death of the Genevian Master. In fact, his linguistic production has always been the object of several studies since the publication of Course in General Linguistics, in 1916. This article brings to light the considerations of renowned linguists on the Saussurean work and its links with Discourse Analysis (DA, considering the notions of language sign and discourse sign. Among the various branches of DA, it is made an option herein for the Semiolinguistic conception of discourse, based on the work of Patrick Charaudeau, with emphasis on the concept of contract of communication. With the support of such theoretical support, media texts, verbal and non-verbal, will be analyzed in order to highlight the importance of linguistic signs – language and discourse signs – in the construction of meaning in such text genre.

  15. Sign Inference for Dynamic Signed Networks via Dictionary Learning

    Yi Cen


    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.

  16. Sign order in Slovenian Sign Language locative constructions

    Matic Pavlič


    Full Text Available In both sign and spoken languages, locative relations tend to be encoded within constructions that display the non-basic word/sign order. In addition, in such an environment, sign languages habitually use a distinct predicate type – a classifier predicate – which may independently affect the order of constituents in the sentence. In this paper, I present Slovenian Sign Language (SZJ locative constructions, in which (i the argument that enables spatial anchoring (“ground” precedes both the argument that requires spatial anchoring (“figure” and the predicate. At the same time, (ii the relative order of the figure with respect to the predicate depends on the type of predicate employed: a non-classifier predicate precedes the figure, while a classifier predicate only comes after the figure.

  17. Delta-Reliability

    Eugster, P.; Guerraoui, R.; Kouznetsov, P.


    This paper presents a new, non-binary measure of the reliability of broadcast algorithms, called Delta-Reliability. This measure quantifies the reliability of practical broadcast algorithms that, on the one hand, were devised with some form of reliability in mind, but, on the other hand, are not considered reliable according to the ``traditional'' notion of broadcast reliability [HT94]. Our specification of Delta-Reliability suggests a further step towards bridging the gap between theory and...

  18. Reliability computation from reliability block diagrams

    Chelson, P. O.; Eckstein, E. Y.


    Computer program computes system reliability for very general class of reliability block diagrams. Four factors are considered in calculating probability of system success: active block redundancy, standby block redundancy, partial redundancy, and presence of equivalent blocks in the diagram.

  19. Is quantitative electromyography reliable?

    Cecere, F; Ruf, S; Pancherz, H


    The reliability of quantitative electromyography (EMG) of the masticatory muscles was investigated in 14 subjects without any signs or symptoms of temporomandibular disorders. Integrated EMG activity from the anterior temporalis and masseter muscles was recorded bilaterally by means of bipolar surface electrodes during chewing and biting activities. In the first experiment, the influence of electrode relocation was investigated. No influence of electrode relocation on the recorded EMG signal could be detected. In a second experiment, three sessions of EMG recordings during five different chewing and biting activities were performed in the morning (I); 1 hour later without intermediate removal of the electrodes (II); and in the afternoon, using new electrodes (III). The method errors for different time intervals (I-II and I-III errors) for each muscle and each function were calculated. Depending on the time interval between the EMG recordings, the muscles considered, and the function performed, the individual errors ranged from 5% to 63%. The method error increased significantly (P masseter (mean 27.2%) was higher than for the temporalis (mean 20.0%). The largest function error was found during maximal biting in intercuspal position (mean 23.1%). Based on the findings, quantitative electromyography of the masticatory muscles seems to have a limited value in diagnostics and in the evaluation of individual treatment results.

  20. [Hemiplegia with two Babinski's sign].

    Leon-Sarmiento, Fidias E; Montoya, María C; Camacho, John E; Bayona-Prieto, Jaime; Bayona, Edgardo


    Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 years-old, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

  1. Hush sign: a new clinical sign in temporal lobe epilepsy.

    Kutlu, Gulnihal; Bilir, Erhan; Erdem, Atilla; Gomceli, Yasemin B; Kurt, G Semiha; Serdaroglu, Ayse


    Neurologists have been analyzing the clinical behaviors that occur during seizures for many years. Several ictal behaviors have been defined in temporal lobe epilepsy (TLE). Ictal behaviors are especially important in the evaluation of epilepsy surgery candidates. We propose a new lateralizing sign in TLE originating from the nondominant hemisphere-the "hush" sign. Our patients were 30- and 21-year old women (Cases 1 and 2, respectively). Their epileptogenic foci were localized to the right mesial temporal region after noninvasive presurgical investigations. Case 1 had no cranial MRI abnormality, whereas cranial MRI revealed right hippocampal atrophy in Case 2. These women repeatedly moved their right index fingers to their mouth while puckering their lips during complex partial seizures. We have named this ictal behavior the "hush" sign. Anterior temporal lobectomy with amygdalohippocampectomy was performed in both patients, and pathological examinations revealed hippocampal sclerosis. The "hush" sign no longer occurred after seizures were controlled. They were seizure free as of 30 and 31 months of follow-up, respectively. We believe that the "hush" sign may be supportive of a diagnosis of TLE originating from the nondominant hemisphere. This sign may occur as a result of ictal activation of a specific brain region in this hemisphere.

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

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


    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...

  3. Bedside echocardiography in internal medicine: which are the key questions and answers for our decision-making?

    Chiara Cogliati


    Full Text Available The advent of portable equipment in the last years has brought ultrasound (US technology available at patient bedside, giving the opportunity to non-cardiologists to extend cardiac assessment based on physical examination. Bedside echocardiography is a question-driven examination, where simple and often dichotomous answers are searched. It is performed using phased-array probes and bi-dimensional images are visually evaluated to obtain information regarding cardiac size and function, presence of pericardial effusion, gross valvular diseases. Although this approach cannot in any case substitute a standard 2D color-Doppler echocardiography, bedside echocardiography has been demonstrated to maintain a good diagnostic accuracy when limited to basic questions, even in the hands of short-trained non cardiologist physicians. At present the bedside US approach is widely used in different settings and focused echocardiography takes part together with US explorations of lung, abdomen and deep veins in an integrated perspective that perfectly fits with the holistic approach of the internist. In this context we address two typical scenarios encountered in the internal medicine divisions - the patient presenting with dyspnea or nonpost- traumatic hypotension - showing the main questions we can ask to bedside echocardiography for a rapid identification of the determinants of symptoms and consequently for a therapeutic choice based on more objective evidence.

  4. Know the Signs of Concussion

    ... news/fullstory_167572.html Know the Signs of Concussion This serious health threat affects kids as well ... 2, 2017 WEDNESDAY, Aug. 2, 2017 (HealthDay News) -- Concussions have been in the news a lot because ...

  5. Signs and Symptoms of Mumps

    ... Serology Publications and Resources Multimedia MMWR Articles Outbreak Articles Related Links World Health Organization Medline Plus Signs & Symptoms of Mumps Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir ...

  6. Diagnosing Dementia--Positive Signs

    ... 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 ...

  7. Triage of the Sign Problem

    Splittorff, K


    We discuss the sign problem in QCD at nonzero chemical potential and its relation with chiral symmetry breaking and the spectrum of the Dirac operator using the framework of chiral random matrix theory. We show that the Banks-Casher formula is not valid for theories with a sign problem and has to be replaced by an alternative mechanism that is worked out in detail for QCD in one dimension at nonzero chemical potential.

  8. Diagnostic accuracy of bedside tests for predicting difficult intubation in Indian population: An observational study.

    Dhanger, Sangeeta; Gupta, Suman Lata; Vinayagam, Stalin; Bidkar, Prasanna Udupi; Elakkumanan, Lenin Babu; Badhe, Ashok Shankar


    Unanticipated difficult intubation can be challenging to anesthesiologists, and various bedside tests have been tried to predict difficult intubation. The aim of this study was to determine the incidence of difficult intubation in the Indian population and also to determine the diagnostic accuracy of bedside tests in predicting difficult intubation. In this study, 200 patients belonging to age group 18-60 years of American Society of Anesthesiologists I and II, scheduled for surgery under general anesthesia requiring endotracheal intubation were enrolled. Patients with upper airway pathology, neck mass, and cervical spine injury were excluded from the study. An attending anesthesiologist conducted preoperative assessment and recorded parameters such as body mass index, modified Mallampati grading, inter-incisor distance, neck circumference, and thyromental distance (NC/TMD). After standard anesthetic induction, laryngoscopy was performed, and intubation difficulty assessed using intubation difficulty scale on the basis of seven variables. The Chi-square test or student t-test was performed when appropriate. The binary multivariate logistic regression (forward-Wald) model was used to determine the independent risk factors. Among the 200 patients, 26 patients had difficult intubation with an incidence of 13%. Among different variables, the Mallampati score and NC/TMD were independently associated with difficult intubation. Receiver operating characteristic curve showed a cut-off point of 3 or 4 for Mallampati score and 5.62 for NC/TMD to predict difficult intubation. The diagnostic accuracy of NC/TM ratio and Mallampatti score were better compared to other bedside tests to predict difficult intubation in Indian population.

  9. Bedside tomographic scintigraphy: a diagnostic tool in intensive care and the emergency room

    Bone, Dianna; Persson, Mikael; Ribbe, Tommy; Dale, Susanne


    Scintigraphic tomography (SPECT) with a gamma camera is an established tool for the diagnosis of disturbances in perfusion of the myocardium. The technique has been shown to be useful in the management of patients with acute myocardial infarction. However, SPECT is not widely used for seriously ill patients due to the need to transport the patient to the gamma camera system. In order to make tomography available by the bedside, a form of limited view angle tomography, Ectomography, has been implemented on a mobile gamma camera system. Projection data are acquired by rotating a slant hole collimator in front of the stationary detector and therefore, the head gantry is simple and easily transported. The mobile system is completely self-contained providing acquisition, reconstruction and bedside display. System sensitivity can be increased by using a segmented collimator, making it possible to present reconstructed sections for diagnosis less than 10 min after the start of acquisition. At present, reconstruction is performed with 2D filtered back projection. A comparative study of patients with suspected coronary artery disease has shown that Ectomography and SPECT yield similar diagnostic information. In an experimental study, in which a coronary artery was occluded, it has been possible to use Ectomography to define myocardial area at risk and final infarct size. Myocardial imaging has been performed in the intensive care unit and a pilot study has demonstrated that brain scans can also be performed. Bedside tomographic scintigraphy has been shown to be feasible and studies can be performed without moving the patient. The method should provide, therefore, an alternative to SPECT in intensive care and the emergency room.

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

    Feisst V


    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

  11. Bedside tomographic scintigraphy: a diagnostic tool in intensive care and the emergency room

    Bone, Dianna E-mail:; Persson, Mikael; Ribbe, Tommy; Dale, Susanne


    Scintigraphic tomography (SPECT) with a gamma camera is an established tool for the diagnosis of disturbances in perfusion of the myocardium. The technique has been shown to be useful in the management of patients with acute myocardial infarction. However, SPECT is not widely used for seriously ill patients due to the need to transport the patient to the gamma camera system. In order to make tomography available by the bedside, a form of limited view angle tomography, Ectomography, has been implemented on a mobile gamma camera system. Projection data are acquired by rotating a slant hole collimator in front of the stationary detector and therefore, the head gantry is simple and easily transported. The mobile system is completely self-contained providing acquisition, reconstruction and bedside display. System sensitivity can be increased by using a segmented collimator, making it possible to present reconstructed sections for diagnosis less than 10 min after the start of acquisition. At present, reconstruction is performed with 2D filtered back projection. A comparative study of patients with suspected coronary artery disease has shown that Ectomography and SPECT yield similar diagnostic information. In an experimental study, in which a coronary artery was occluded, it has been possible to use Ectomography to define myocardial area at risk and final infarct size. Myocardial imaging has been performed in the intensive care unit and a pilot study has demonstrated that brain scans can also be performed. Bedside tomographic scintigraphy has been shown to be feasible and studies can be performed without moving the patient. The method should provide, therefore, an alternative to SPECT in intensive care and the emergency room.

  12. VLSI Reliability in Europe

    Verweij, Jan F.


    Several issue's regarding VLSI reliability research in Europe are discussed. Organizations involved in stimulating the activities on reliability by exchanging information or supporting research programs are described. Within one such program, ESPRIT, a technical interest group on IC reliability was

  13. Signs and senses: diagnosis and prognosis in early medieval pulse and urine texts.

    Wallis, F


    The character of early medieval medical manuscripts makes it difficult to generalize about the nature of medical knowledge in this period. In order to reconstitute one field of medical science, namely diagnosis and prognosis, while avoiding the pitfalls of unjustified generalization, this essay limits itself to reconstructing the understanding of pulse and urine inspection available in a particular place and time: the Italian monastery of Monte Cassino at the end of the first millennium. The available texts reveal little about the rationale behind these bedside techniques; indeed, pulse and urine seem to be signs without any semiotics, any underlying theory. The clue to this paradox is the fact that these texts see pulse and urine as primarily prognostic rather than diagnostic. Prognosis was understood to be analogous to forms of intuition, judgement, revelation, and prophecy that operated outside the logic of causality. Hence a fully rationalized semiotics was not regarded as necessary for effective medical practice.

  14. An Evaluation of the Five Most Used Evidence Based Bedside Information Tools in Canadian Health Libraries

    Alison Farrell


    Full Text Available Objective – This project sought to identify the five most used evidence based bedside information tools used in Canadian health libraries, to examine librarians’ attitudes towards these tools, and to test the comprehensiveness of the tools. Methods – The author developed a definition of evidence based bedside information tools and a list of resources that fit this definition. Participants were respondents to a survey distributed via the CANMEDLIB electronic mail list. The survey sought to identify information from library staff regarding the most frequently used evidence based bedside information tools. Clinical questions were used to measure the comprehensiveness of each resource and the levels of evidence they provided to each question.Results – Survey respondents reported that the five most used evidence based bedside information tools in their libraries were UpToDate, BMJ Clinical Evidence, First Consult, Bandolier and ACP Pier. Librarians were generally satisfied with the ease of use, efficiency and informative nature of these resources. The resource assessment determined that not all of these tools are comprehensive in terms of their ability to answer clinical questions or with regard to the inclusion of levels of evidence. UpToDate was able to provide information for the greatest number of clinical questions, but it provided a level of evidence only seven percent of the time. ACP Pier was able to provide information on only 50% of the clinical questions, but it provided levels of evidence for all of these.Conclusion – UpToDate and BMJ Clinical Evidence were both rated as easy to use and informative. However, neither product generally includes levels of evidence, so it would be prudent for the practitioner to critically appraise information from these sources before using it in a patient care setting. ACP Pier eliminates the critical appraisal stage, thus reducing the time it takes to go from forming a clinical question to

  15. Moving theranostics trom bench to bedside in an interdisciplinary research team.

    Swierczewska, Magdalena; Lee, Seulki; Chen, Xiaoyuan


    The Laboratory of Molecular Imaging and Nanomedicine of the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health has been led by Xiaoyuan Chen since 2009. The Laboratory of Molecular Imaging and Nanomedicine contains three interdisciplinary, versatile groups: the Theranostic Nanomedicine; PET/Optical Imaging Probe; and Biological Molecular Imaging Sections, consisting of chemists, engineers, biologists and clinicians working together to transfer biomedical technology from bench to bedside. To find out more about our laboratory and meet our group, please visit us at

  16. Diagnosis of Mondor’s Disease in the Emergency Department with Bedside Ultrasound

    J. Michael O’Neal


    Full Text Available Mondor’s disease is a rare condition characterized by a superficial thrombophlebitis that can occur in the thoracoabdominal and genital areas. Findings with ultrasound in penile Mondor’s disease are readily measurable: a noncompressible penile vein without flow and absence of tears of the corpus cavernosum or tunica albuginea, hematoma, or evidence of fracture of the penis. We present a case of Mondor’s disease, diagnosed with bedside ultrasound, in the emergency department. Ultrasonography is readily available within the emergency department, and we suggest its use in aiding diagnosis of genitourinary disorders such as Mondor’s disease.

  17. Assistance System for Traffic Signs Inventory

    Karel Zídek


    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.

  18. Research on Recognition and Evaluation of Traffic Guide Sign

    Li Yuan


    Full Text Available Traffic guide signs are effective only when they are clearly recognized by drivers. Three experiments were conducted in this study. In the first, the influence factors of guide sign recognition were studied. This study investigated 11 main factors with a convenience sample of drivers from Nanjing city in China. Weights of different influence factors were obtained through analytic hierarchy process (AHP. The results showed that the setting position, occlusion degree, and character size of guide sign had the most significant influence on the guide sign recognition, while other factors were less important. In the second stage, an evaluation model of guide sign recognition was developed based on weights of different factors. Four equations were presented to calculate the comprehensive score of guide sign, and the level of recognition was divided into five grades according to the comprehensive score. At last, a typical case in Nanjing was studied to verify the rationality and reliability of the evaluation model. Results from the real application indicate that the method had good applicability and can be used by traffic engineers.

  19. Lexical and sentential processing in British Sign Language.

    MacSweeney, Mairéad; Campbell, Ruth; Woll, Bencie; Brammer, Michael J; Giampietro, Vincent; David, Anthony S; Calvert, Gemma A; McGuire, Philip K


    Studies of spoken and written language suggest that the perception of sentences engages the left anterior and posterior temporal cortex and the left inferior frontal gyrus to a greater extent than non-sententially structured material, such as word lists. This study sought to determine whether the same is true when the language is gestural and perceived visually. Regional neural activity was measured using functional MRI while Deaf and hearing native signers of British Sign Language (BSL) detected semantic anomalies in well-formed BSL sentences and when they detected nonsense signs in lists of unconnected BSL signs. Processing BSL sentences, when contrasted with signed lists, was reliably associated with greater activation in the posterior portions of the left middle and superior temporal gyri and in the left inferior frontal cortex, but not in the anterior temporal cortex, which was activated to a similar extent whether lists or sentences were processed. Further support for the specificity of these areas for processing the linguistic-rather than visuospatial-features of signed sentences came from a contrast of hearing native signers and hearing sign-naïve participants. Hearing signers recruited the left posterior temporal and inferior frontal regions during BSL sentence processing to a greater extent than hearing non-signers. These data suggest that these left perisylvian regions are differentially associated with sentence processing, whatever the modality of the linguistic input.

  20. Crab Orchard National Wildlife Refuge : Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Crab Orchard National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  1. Sign Plan : Necedah National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Necedah National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given...

  2. Sign Plan Squaw Creek National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Squaw Creek National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  3. Sign Plan Swan Lake National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Swan Lake National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  4. Sign Plan : Trempealeau National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Trempealeau National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  5. Sign Plan : Shiawassee National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Shiawassee National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  6. Chautauqua National Wildlife Refuge : Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Chautauqua National Wildlife Refuge Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is...

  7. Care of the trauma patient beyond the emergency department: a patient care standard to guide bedside nurses.

    Jaekel, Camilla; Paar, Cheryl; Schiltz, Jenifer; Peterson, Rose


    Injuries sustained from illicit drug use or alcohol intoxication are common in emergency departments. Ongoing assessments of psychosocial issues in trauma patients are imperative, even after the patient leaves the specialized area of the emergency department. Oftentimes, bedside nurses are ill prepared to identify the subtle clues of deeper psychosocial issues in complex patients such as trauma patients. This article focuses on the rationale for the development of a patient care standard to guide the bedside staff nurse in the care of the trauma patient. An example of a multiple trauma diagnosis-related patient care standard is presented.

  8. Detection of Acute Pulmonary Embolism by Bedside Ultrasound in a Patient Presenting in PEA Arrest: A Case Report

    Hangyul Chung-Esaki


    Full Text Available Optimal management of the critically ill patient in shock requires rapid identification of its etiology. We describe a successful application of an emergency physician performed bedside ultrasound in a patient presenting with shock and subsequent cardiac arrest. Pulmonary embolus was diagnosed using bedside echocardiogram and confirmed with CTA of the thorax. Further validation and real-time implementation of this low-cost modality could facilitate the decision to implement thrombolytics for unstable patients with massive pulmonary embolism who cannot undergo formal radiographic evaluation.

  9. Why some health policies don't make sense at the bedside.

    Asch, D A; Hershey, J C


    Cost-effectiveness analysis and other forms of decision analysis are becoming more common in the medical literature and are increasingly influential in the development of health policy. Nevertheless, many clinicians find it difficult to apply policies developed from these analyses to individual encounters with patients. We examine the assumptions behind these analyses and argue that the perspective they embody can make clinical strategies appear to be less risky in theory than they are at the bedside. We believe that this problem underlies the intuitive concern many physicians have about policy analyses and calls into question the value of these analyses in shaping clinical practice. These analyses aggregate the benefits and burdens of alternative interventions across different individual persons. Thus, overall population risk appears blunted, as it would in a diversified portfolio of stocks that react differently to financial forces or in a herd of cattle that react differently to veterinary interventions. The assumptions behind these analyses make sense if aggregate outcome is what matters, but not if one cares about each individual investment or animal. Because such aggregation tends to understate individual risk, when applied to human health policy, it may misrepresent the interests of patients and cannot be assumed to provide useful guidelines for decision making at the bedside.

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

    Itai Gat


    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.

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

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


    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.

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

    Inga E. Larsson


    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.

  13. The role of bedside ultrasound in the diagnosis and outcome of patients with acute respiratory failure

    Andrea Bellone


    Full Text Available The aim of the present study was to evaluate the relationship between a bedside ultrasound evaluation during an episode of acute respiratory failure and the patient’s outcome. A retrospective observational study was conducted in the emergency departments (EDs of two hospitals in Como (Sant’Anna Hospital and Valduce Hospital over two years. Two hundred and twenty eight adult patients with acute respiratory failure were recruited for the study. One hundred and eight patients (group A received immediately a bedside ultrasound diagnostic test by expert investigastors at the time of ED admission, while 120 patients (group B were evaluated and managed without a preliminary ultrasound diagnostic approach. The concordance between initial and final diagnosis was statistically significant in group A vs group B (P<0.01. In-hospital mortality was significantly lower in group A as compared with group B [3 (2.7% vs 6 (5%, respectively; P<0.01]; in group A only nine patients (8.3% compared with seventeen patients (14.1% in group B (P<0.01 were transferred to the intensive care unit for monitoring and treatment. The study proposed is not able to recommend the procedure because it is a retrospective design. In spite of this, our study supports the routine use of ultrasonography for the evaluation of patients having acute respiratory failure.

  14. Provision of alcohol hand rub at the hospital bedside: a case study.

    King, S


    A pilot study was performed on a 28-bed acute hospital ward, promoting hand disinfection by providing Sterillium alcohol hand rub at the bedside. Bottles of Sterillium with pump dispensers were attached to the end of each patient's bed, next to the observation charts. Posters promoting the use of the product were prominently displayed and several ward staff attended a presentation on the effectiveness of Sterillium. Although this was a small study, Alert Organism rates during the three-month trial indicated a reduction in methicillin-resistant Staphylococcus aureus (MRSA) incidence and an increased Clostridium difficile incidence. Several other factors that may have influenced the study outcomes will be discussed. There were no health and safety problems during the trial, but other issues were identified which have implications for introducing the bedside rub on a hospital wide basis, including the type of holder used, logistical arrangements and the staff and patient information requirements. The strategies adopted to address these issues will be discussed.

  15. A Novel Bedside Technique for Differentiation of Exudative From Transudative Pleural Effusion

    Ashraf Ashraf Askari


    Full Text Available Background:At present, differentiation between exudative and transudative pleural  effusion is based solely on laboratory measures and is time-consuming. Asimple  bedside method would be of great help to differentiate between these two types of effusions.We present a new method for this purpose assessed in 46 patients.Methods: Standard laboratory tests and our method were tested using the same fluid  samples in 46 patients with pleural effusion. Aprincipal in physics called the capillary Tube law (h=2a/rpg was used to compare the samples. The imbibition of the fluid  level less than 15mm signified exudate and greater than 15mm signified transudate.Results: Our data shows that this method is 74% sensitive and 89.4% specific compared to the standard method when analyzed statistically by the chi-square and Kappa  agreement (Cronbach’s K tests. Conclusion: The capillary tube test has an acceptable validity for bedside diagnosis  of exudative or transudative effusions.  

  16. The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses' Perceptions.

    Larsson, Inga E; Sahlsten, Monika J M


    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.

  17. Signed Networks in Social Media

    Leskovec, Jure; Kleinberg, Jon


    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 classical theory of structural balance tends to capture certain common patterns of interaction, but that it is also at odds with some of the fundamental phenomena we observe --- particularly related to the evolving, directed nature of these on-line networks. We then develop an alternate theory of status that better explains the observed edge signs and provides insights into the underlying social mechanisms. Our work provides one of the first large-scale evaluations of theories of signed networks using on-line datasets, as ...

  18. Reliability Generalization: "Lapsus Linguae"

    Smith, Julie M.


    This study examines the proposed Reliability Generalization (RG) method for studying reliability. RG employs the application of meta-analytic techniques similar to those used in validity generalization studies to examine reliability coefficients. This study explains why RG does not provide a proper research method for the study of reliability,…

  19. Distinguishing fungal and bacterial keratitis on clinical signs

    Astrid Leck


    Full Text Available In many settings, laboratory support for the diagnosis of the type of microbial keratitis is not available. Experienced ophthalmologists have long maintained that it is sometimes possible to distinguish fungal from bacterial microbial keratitis on the basis of clinical signs. Formal data to support this view are limited, and it is important to establish the validity of such claims to understand whether signs can reliably guide clinical decisions. In addition, antifungal treatment is often in limited supply and prohibitively expensive. Therefore, it is not feasible or desirable to prescribe empirical antifungal therapy to every patient who presents with microbial keratitis in tropical regions, where fungal infections are more frequent. Here we review research to determine whether it is possible to reliably distinguish bacterial and fungal infection clinical features alone.

  20. Compiling a Sign Language Dictionary

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas


    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 eve...

  1. Signing Shakespeare: Romeo Loves Juliet.

    Goldfarb, Liz; Cambridge, Terry


    A language arts teacher of junior high students with deafness or hearing impairments familiarized her students with "Romeo and Juliet" by telling the story in speech and signs, exploring the characters's personalities, reviewing vocabulary, putting the characters into contemporary situations, and directing the students in a full-scale production…

  2. Models as coherent sign structures

    Gazendam, H.W.M.; Jorna, R.J.J.M.; Gazendam, H.W.M.; Cijsouw, R.S.


    This chapter explains how models function as the glue that keeps organizations together. In an analysis of models from a semiotic and cognitive point of view, assumptions about evolutionary dynamics and bounded rationality are used. It is concluded that a model is a coherent sign structure,

  3. Symptom,sign and syndrome


    2010381 Clinical and electrophysiological characteristics of Lambert-Eaton myasthenic syndrome:retrospective study in forty-five patients. GUAN Yuzhou(管宇宙),et al. Dept Neurol,PUMC & CAMS,Bejing 100730. Chin J Neurol 2010;331-334. Objective To analyze the symptoms and signs in forty-five Lambert-Eaton myasthenia syndrome (LEMS)patients

  4. Lexical Frequency in Sign Languages

    Johnston, Trevor


    Measures of lexical frequency presuppose the existence of corpora, but true machine-readable corpora of sign languages (SLs) are only now being created. Lexical frequency ratings for SLs are needed because there has been a heavy reliance on the interpretation of results of psycholinguistic and neurolinguistic experiments in the SL research…

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

    Damstrup, Camilla Vantore


    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....

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

    Teri A. Reynolds


    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.

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

    Solheim Svein


    Full Text Available Abstract 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.

  8. The Role of Bedside Troponin T Test for Identification of High Risk Patients With Acute Chest Pain

    Guo xiaobi; Feng Jianzhan; Guo Hengshan


    Objectives Evaluation of patients with acute chest pain when they admitted is time-consuming. We prospectively investigated the role of bedside troponin T test for predicting the risk of death and acute heart failure of patients with acute chest pain. Methods and Results 502 consecutive patients with chest pain for less than 24 hours were determined by troponin T test at bedside and quantitative troponin I test in lab. For bedside troponin T tests, there were 160 patients in positive and 323 in negative. During 30 days of followed-up. Myocardial infarction evolved in 139 patients among 160 patients in positive troponin T test, only 7 patients in negative one. Acute heart failure occurred in 51 patients among the positive group, but 37 occurred it at negative group.The odds ratio of acute heart failure of positive group vs.negative group was 3.6. Patients died 39 in positive group, 15 in negative group, the all-cause death odds ratio of positive group vs. negative group was 6.7; 31patients died with cardiac event in positive group, 5 in negative group only. Conclusions Bedside Troponin T test is a powerful and independent predictor of death and acute heart failure for patients with acute chest pain.

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

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


    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

  10. 47 CFR 2.302 - Call signs.


    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Call signs. 2.302 Section 2.302... RULES AND REGULATIONS Call Signs and Other Forms of Identifying Radio Transmissions § 2.302 Call signs. The table which follows indicates the composition and blocks of international call signs available...

  11. Eye Gaze in Creative Sign Language

    Kaneko, Michiko; Mesch, Johanna


    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…

  12. Tactile Signing with One-Handed Perception

    Mesch, Johanna


    Tactile signing among persons with deaf-blindness is not homogenous; rather, like other forms of language, it exhibits variation, especially in turn taking. Early analyses of tactile Swedish Sign Language, tactile Norwegian Sign Language, and tactile French Sign Language focused on tactile communication with four hands, in which partially blind or…

  13. Numeral Incorporation in Japanese Sign Language

    Ktejik, Mish


    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…

  14. Eye Gaze in Creative Sign Language

    Kaneko, Michiko; Mesch, Johanna


    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…

  15. Assuring reliability program effectiveness.

    Ball, L. W.


    An attempt is made to provide simple identification and description of techniques that have proved to be most useful either in developing a new product or in improving reliability of an established product. The first reliability task is obtaining and organizing parts failure rate data. Other tasks are parts screening, tabulation of general failure rates, preventive maintenance, prediction of new product reliability, and statistical demonstration of achieved reliability. Five principal tasks for improving reliability involve the physics of failure research, derating of internal stresses, control of external stresses, functional redundancy, and failure effects control. A final task is the training and motivation of reliability specialist engineers.

  16. The Accelerator Reliability Forum

    Lüdeke, Andreas; Giachino, R


    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.

  17. Enlightenment on Computer Network Reliability From Transportation Network Reliability

    Hu Wenjun; Zhou Xizhao


    Referring to transportation network reliability problem, five new computer network reliability definitions are proposed and discussed. They are computer network connectivity reliability, computer network time reliability, computer network capacity reliability, computer network behavior reliability and computer network potential reliability. Finally strategies are suggested to enhance network reliability.

  18. Reliability of pressure ulcer staging: a review of literature and 1 institution's strategy.

    Bruce, Tracey A; Shever, Leah L; Tschannen, Dana; Gombert, Jan


    Pressure ulcers are an increasing health care problem. Accurate identification and classification of pressure ulcers impacts patient outcomes, health care costs, and quality initiatives.To identify existing evidence related to answering the question "Does bedside nursing staff accurately and reliably stage pressure ulcers as evidenced in their documentation?" Further evidence from one large tertiary care center with pressure ulcer identification and staging by nurses is also reported. Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases were searched to identify existing evidence on the accuracy and reliability of pressure ulcer classification by nurses. Two reviewers independently screened results. A total of 54 full-text articles were obtained for review and 10 were included for final review. In addition, the accuracy and consistency of pressure ulcer identification and staging were examined at one large tertiary health system by extracting data from electronic health records for 1488 patient visits and assessments for 1499 patients. Comparisons were done for pressure ulcer documentation from 1 nurse's assessment to the following shift nurse's assessment and from the bedside nurse's assessment to assessments done by pressure ulcer experts.Review of the literature revealed that the reliability of pressure ulcer identification and classification is limited and highly variable. Some reports in the literature suggested nurses had difficulty distinguishing a pressure ulcer from other types of wounds. In addition, inaccuracies in pressure ulcer documentation were also identified. Further analysis of data within one large tertiary health care system revealed unreliable pressure ulcer documentation.

  19. Human Reliability Program Overview

    Bodin, Michael


    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.

  20. Power electronics reliability analysis.

    Smith, Mark A.; Atcitty, Stanley


    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.

  1. Reliable Design Versus Trust

    Berg, Melanie; LaBel, Kenneth A.


    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?

  2. Bedside rationing by general practitioners: a postal survey in the Danish public healthcare system

    Lauridsen, Sigurd; Norup, Michael; Rossel, Peter


    ABSTRACT: BACKGROUND: It is ethically controversial whether medical doctors are morally permitted to ration the care of their patients at the bedside. To explore whether general practitioners in fact do ration in this manner we conducted a study within primary care in the Danish public healthcare...... of the study were twofold: an assessment of the proportion of GPs who, in a mainly hypothetical setting, would consider cost-quality trade-offs relevant to their clinical decision-making given their economic impact on the healthcare system; and a measure of the extent to which they would disclose...... this information to patients. RESULTS: In the hypothetical setting 95% of GPs considered cost-quality trade-offs relevant to their clinical decision-making given the economic impact of such trade-offs on the healthcare system. In all 90% stated that this consideration had been relevant in clinical decision...

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

    Daniel, Michelle


    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. Bedside patient data viewer using RFID and e-Ink technology.

    Nikodijevic, Aleksandar; Pichler, Patrick; Forjan, Mathias; Sauermann, Stefan


    In the daily routine of hospitals, which work with paper based medical records, the staff has to find the appropriate patient file if it needs information about the patient. With the introduction of ELGA the Austrian hospitals have to use specific standards for their clinical documentation. These structured documents can be used to feed an e-Ink reader with information about every patient in a hospital. Combined with RFID and security measures, the clinical staff is supported during the patient file searching process. The developed experimental setup of the Bedside Patient Data Viewer demonstrates a prototype of such a system. An Amazon Kindle Paperwhite is used to display processed data, supplied by a Raspberry Pi with an attached RFID module for identification purposes. Results show that such a system can be implemented, however a lot of organizational and technical issues remain to be solved.

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

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


    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.

  6. Televisitation: virtual transportation of family to the bedside in an acute care setting.

    Nicholas, Bonnie


    Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC's patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.

  7. Signed Networks in Social Media

    Leskovec, Jure; Huttenlocher, Daniel; Kleinberg, Jon


    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...

  8. Vital Signs-Secondhand Smoke


    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.

  9. Vital Signs - Child Passenger Safety


    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.

  10. Viking Lander reliability program

    Pilny, M. J.


    The Viking Lander reliability program is reviewed with attention given to the development of the reliability program requirements, reliability program management, documents evaluation, failure modes evaluation, production variation control, failure reporting and correction, and the parts program. Lander hardware failures which have occurred during the mission are listed.

  11. SU-E-I-11: A New Cone-Beam CT System for Bedside Head Imaging

    Sun, H; Zeng, W; Xu, P; Wang, Z; Xing, X; Sun, M [Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Jiangsu (China)


    Purpose: To design and develop a new mobile cone-beam CT (CBCT) system for head imaging with good soft-tissue visibility, to be used bedside in ICU and neurosurgery department to monitor treatment and operation outcome in brain patients. Methods: The imaging chain consists of a 30cmx25cm amorphous silicon flat panel detector and a pulsed, stationary anode monoblock x-ray source of 100kVp at a maximal tube current of 10mA. The detector and source are supported on motorized mechanisms to provide detector lateral shift and source angular tilt, enabling a centered digital radiographic imaging mode and half-fan CBCT, while maximizing the use of the x-ray field and keep the source to detector distance short. A focused linear anti-scatter grid is mounted on the detector, and commercial software with scatter and other corrective algorithms is used for data processing and image reconstruction. The gantry rotates around a horizontal axis, and is able to adjust its height for different patient table positions. Cables are routed through a custom protective sleeve over a large bore with an in-plane twister band, facilitating single 360-degree rotation without a slip-ring at a speed up to 5 seconds per rotation. A UPS provides about 10 minutes of operation off the battery when unplugged. The gantry is on locked casters, whose brake is control by two push handles on both sides for easy reposition. The entire system is designed to have a light weight and a compact size for excellent maneuverability. Results: System design is complete and main imaging components are tested. Initial results will be presented and discussed later in the presentation. Conclusion: A new mobile CBCT system for head imaging is being developed. With its compact size, a large bore, and quality design, it is expected to be a useful imaging tool for bedside uses. The work is supported by a grant from Chinese Academy of Sciences.

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

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


    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.

  13. Low Cost Reversible Signed Comparator

    Farah Sharmin


    Full Text Available Nowadays exponential advancement in reversible comp utation has lead to better fabrication and integration process. It has become very popular ove r the last few years since reversible logic circuit s dramatically reduce energy loss. It consumes less p ower by recovering bit loss from its unique input-o utput mapping. This paper presents two new gates called RC-I and RC-II to design an n-bit signed binary comparator where simulation results show that the p roposed circuit works correctly and gives significa ntly better performance than the existing counterparts. An algorithm has been presented in this paper for constructing an optimized reversible n-bit signed c omparator circuit. Moreover some lower bounds have been proposed on the quantum cost, the numbers of g ates used and the number of garbage outputs generated for designing a low cost reversible sign ed comparator. The comparative study shows that the proposed design exhibits superior performance consi dering all the efficiency parameters of reversible logic design which includes number of gates used, quantum cost, garbage output and constant inputs. This proposed design has certainly outperformed all the other existing approaches.

  14. Road and Street Centerlines, MDTA Road Signs like Stop signs, Toll signs, Roadway Signs, Stop Signs, Toll signs, Overhead signs, Published in 2010, 1:1200 (1in=100ft) scale, Maryland Transportation Authority.

    NSGIC GIS Inventory (aka Ramona) — , published at 1:1200 (1in=100ft) scale, was produced all or in part from Field Survey/GPS information as of 2010. It is described as 'MDTA Road Signs like Stop...

  15. The Role of Sign Phonology and Iconicity During Sign Processing: The Case of Deaf Children

    Ormel, E.A.; Hermans, D.; Knoors, H.E.T.; Verhoeven, L.T.W.


    To investigate the influence of sign phonology and iconicity during sign processing in deaf children, the roles of these sign features were examined using an experimental sign-picture verification paradigm. Participants had to make decisions about sign-picture pairs, manipulated according to

  16. 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.

    Sawe, Hendry Robert; Haeffele, Cathryn; Mfinanga, Juma A; Mwafongo, Victor G; Reynolds, Teri A

    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.

  17. Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial

    Gerritsen, A.; Rooij, T. de; Dijkgraaf, M.G.; Busch, O.R.; Bergman, J.J.; Ubbink, D.T.; Duijvendijk, P. van; Erkelens, G.W.; Klos, M.; Kruyt, P.M.; Bac, D.J.; Rosman, C.; Tan, A.C.; Molenaar, I.Q.; Monkelbaan, J.F.; Mathus-Vliegent, E.M.; Besselink, M.G.


    OBJECTIVES: Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses i

  18. Vital Signs-Trucker Safety


    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.

  19. Grandfather Moose: Sign Language Nursery Rhymes.

    Hamilton, Harley


    "Grandfather Moose" rhymes, written to follow the Mother Goose tradition, are short, appealing, easy-to-memorize sign language nursery rhymes which employ visual poetic devices such as similar signs and transitional flow of movement. (CB)

  20. CDC Vital Signs: Motor Vehicle Crash Deaths

    ... government is Tracking the nation’s progress in reducing crash injuries and deaths. ... Motor Vehicle Crash Deaths Vital Signs: Motor Vehicle Crash Injuries Vital Signs: Child Passenger Safety CDC: Child Passenger ...

  1. South African sign language assistive translation

    Olivrin, GJ


    Full Text Available The authors describe a novel approach and practical solution to an interactive sign language machine translation system from English to South African Sign Language. They interface the system with the GNApp application, which is an augmentative...

  2. Mark Twain National Wildlife Refuge: Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Mark Twain NWR (including the Louisa District, the Annada District, and the Brussels District) Sign Plan explains how signs are used on the Refuge to help guide...

  3. Signs and Symptoms of Untreated Lyme Disease

    ... FAQ Health care providers Educational materials Signs and Symptoms of Untreated Lyme Disease Recommend on Facebook Tweet ... area where Lyme disease occurs . Early Signs and Symptoms (3 to 30 days after tick bite) Fever, ...

  4. Signs and Symptoms of Mood Disorders

    ... Public Service Announcements Partnering with DBSA Signs and Symptoms of Mood Disorders Depression and bipolar disorder (also ... a Confidential Online Mood Disorder Screening Signs and symptoms of depression Prolonged sadness or unexplained crying spells ...

  5. Cooperative Sign Language Tutoring: A Multiagent Approach

    Yıldırım, Ilker; Aran, Oya; Yolum, Pınar; Akarun, Lale

    Sign languages can be learned effectively only with frequent feedback from an expert in the field. The expert needs to watch a performed sign, and decide whether the sign has been performed well based on his/her previous knowledge about the sign. The expert's role can be imitated by an automatic system, which uses a training set as its knowledge base to train a classifier that can decide whether the performed sign is correct. However, when the system does not have enough previous knowledge about a given sign, the decision will not be accurate. Accordingly, we propose a multiagent architecture in which agents cooperate with each other to decide on the correct classification of performed signs. We apply different cooperation strategies and test their performances in varying environments. Further, through analysis of the multiagent system, we can discover inherent properties of sign languages, such as the existence of dialects.

  6. A Feasibility Study for Life Signs Monitoring via a Continuous-Wave Radar

    Francesco Soldovieri


    Full Text Available We present a feasibility study for life signs detection using a continuous-wave radar working in the band around 4 GHz. The data-processing is carried out by using two different data processing approaches, which are compared about the possibility to characterize the frequency behaviour of the breathing and heartbeat activity. The two approaches are used with the main aim to show the possibility of monitoring the vital signs activity in an accurate and reliable way.

  7. Reliability and safety engineering

    Verma, Ajit Kumar; Karanki, Durga Rao


    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...

  8. Signed Young Modules and Simple Specht Modules

    Danz, Susanne; Lim, Kay Jin


    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...

  9. Irreducible Specht modules are signed Young modules

    Hemmer, David J.


    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...

  10. Sign (di)Lemma for Dimension Shifting

    Nitin Nitsure


    There is a surprising occurrence of some minus signs in the isomorphisms produced in the well-known technique of dimension shifting in calculating derived functors in homological algebra. We explicitly determine these signs. Getting these signs right is important in order to avoid basic contradictions. We illustrate the result – which we call as the sign lemma for dimension shifting – by some de Rham cohomology and Chern class considerations for compact Riemann surfaces.

  11. Cutaneous signs of classical dermatomyositis.

    Auriemma, M; Capo, A; Meogrossi, G; Amerio, P


    Idiopathic immune myopathies (IIM) are an heterogeneous group of autoimmune muscle disorders characterized by progressive muscle involvement. Dermatomyositis (DM) is the most common form of IIM. It is a multisystem disorder characterized by symmetric proximal, extensor, inflammatory myopathy, vascular involvement and a characteristic cutaneous eruption. Six types of DM have been identified: idiopathic, juvenile (JDM), cancer-related other autoimmune diseases-related, iatrogenic DM and amyopathic DM. Cutaneous manifestations of DM are the most important aspect of this disease and can precede from several months to years muscle or systemic involvement. Three groups of signs have been described: pathognomonic, highly characteristic and compatible. Although differences exist among the different clinical presentation of skin lesions, they share common histological findings including the presence of interface dermatitis with epidermal atrophy, basement membrane degeneration, vacuolar alteration of basal keratinocytes, and dermal changes consisting of interstitial mucin deposition and a sparse lymphocytic infiltrate. DM is a serious disease; the correct evaluation of any skin lesion suggesting an early diagnosis is of utmost importance. Skin signs may, also, represent a marker of treatment efficacy even though systemic symptoms worsening may not always be followed by more severe skin lesions.

  12. Automatic Road Sign Inventory Using Mobile Mapping Systems

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


    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.

  13. 30 CFR 56.12021 - Danger signs.


    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Danger signs. 56.12021 Section 56.12021 Mineral... HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Electricity § 56.12021 Danger signs. Suitable danger signs shall be posted at all major electrical installations....

  14. 30 CFR 57.12021 - Danger signs.


    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Danger signs. 57.12021 Section 57.12021 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Underground § 57.12021 Danger signs. Suitable danger signs shall be posted at all major...

  15. Mark Twain National Wildlife Refuge : Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Mark Twain NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list...

  16. Sign Plan : Seney National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Seney NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list of...

  17. Smart Signs Show You the Way

    Lijding, M.E.M.; Meratnia, N.; Benz, H.P.; Matysiak Szóstek, A.


    Smart Signs are a new type of electronic door and way signs based on small computers which can be seamlessly incorporated in the environment. Smart Signs provide personalized context-aware guidance and messaging designed to support wayfinding activities in large indoor spaces and their surroundings.

  18. Sign Plan : Sherburne National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Sherburne NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list...

  19. Sign Plan: Kenai National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Kenai NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list of...

  20. Sign Plan : Mingo National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Mingo NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list of...

  1. How many Babinski's signs are there?

    Kakitani, Fabio T; Collares, Daniel; Kurozawa, Adam Y; Lima, Plínio M G de; Teive, Hélio A G


    In addition to the famous sign described by Joseph Babinski, which is also known as Babinski's reflex, there are references in the literature to various other signs described by this famous disciple of J-M Charcot. This article reviews all the neurological signs described by Babinski.

  2. Smart Signs Show You the Way

    Lijding, M.E.M.; Meratnia, Nirvana; Benz, H.P.; Matysiak Szóstek, A.

    Smart Signs are a new type of electronic door and way signs based on small computers which can be seamlessly incorporated in the environment. Smart Signs provide personalized context-aware guidance and messaging designed to support wayfinding activities in large indoor spaces and their surroundings.

  3. Sign Plan : Big Stone National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Big Stone NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list of...

  4. Dictionaries of African Sign Languages: An Overview

    Schmaling, Constanze H.


    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…

  5. Sign Language Planning: Pragmatism, Pessimism and Principles

    Turner, Graham H.


    This article introduces the present collection of sign language planning studies. Contextualising the analyses against the backdrop of core issues in the theory of language planning and the evolution of applied sign linguistics, it is argued that--while the sociolinguistic circumstances of signed languages worldwide can, in many respects, be…

  6. The Legal Recognition of Sign Languages

    De Meulder, Maartje


    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…

  7. A Segmental Framework for Representing Signs Phonetically

    Johnson, Robert E.; Liddell, Scott K.


    The arguments for dividing the signing stream in signed languages into sequences of phonetic segments are compelling. The visual records of instances of actually occurring signs provide evidence of two basic types of segments: postural segments and trans-forming segments. Postural segments specify an alignment of articulatory features, both manual…

  8. Parker River National Wildlife Refuge : Sign Plan

    US Fish and Wildlife Service, Department of the Interior — The Parker River NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a list...

  9. Research on the Translation of Public Signs

    Qiannan, Ma


    Because of the increasing international image of China, the translation of public signs in city has become the very important issue. From the point of view of cross-cultural communication, the public signs have crucial influence on the image of the city, even for the whole China. However, there exist many translation errors of the public signs in…

  10. Sign Plan : Minnesota Valley National Wildlife Refuge

    US Fish and Wildlife Service, Department of the Interior — The Minnesota Valley NWR Sign Plan explains how signs are used on the Refuge to help guide and educate visitors. An inventory of current signs is given as well as a...

  11. Dictionaries of African Sign Languages: An Overview

    Schmaling, Constanze H.


    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…

  12. Measurement System Reliability Assessment

    Kłos Ryszard


    Full Text Available Decision-making in problem situations is based on up-to-date and reliable information. A great deal of information is subject to rapid changes, hence it may be outdated or manipulated and enforce erroneous decisions. It is crucial to have the possibility to assess the obtained information. In order to ensure its reliability it is best to obtain it with an own measurement process. In such a case, conducting assessment of measurement system reliability seems to be crucial. The article describes general approach to assessing reliability of measurement systems.

  13. Reliable knowledge discovery

    Dai, Honghua; Smirnov, Evgueni


    Reliable Knowledge Discovery focuses on theory, methods, and techniques for RKDD, a new sub-field of KDD. It studies the theory and methods to assure the reliability and trustworthiness of discovered knowledge and to maintain the stability and consistency of knowledge discovery processes. RKDD has a broad spectrum of applications, especially in critical domains like medicine, finance, and military. Reliable Knowledge Discovery also presents methods and techniques for designing robust knowledge-discovery processes. Approaches to assessing the reliability of the discovered knowledge are introduc

  14. Reliability of fluid systems

    Kopáček Jaroslav


    Full Text Available This paper focuses on the importance of detection reliability, especially in complex fluid systems for demanding production technology. The initial criterion for assessing the reliability is the failure of object (element, which is seen as a random variable and their data (values can be processed using by the mathematical methods of theory probability and statistics. They are defined the basic indicators of reliability and their applications in calculations of serial, parallel and backed-up systems. For illustration, there are calculation examples of indicators of reliability for various elements of the system and for the selected pneumatic circuit.

  15. Circuit design for reliability

    Cao, Yu; Wirth, Gilson


    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.

  16. Team Objective Structured Bedside Assessment (TOSBA): a novel and feasible way of providing formative teaching and assessment.

    Miller, S D W; Butler, M W; Meagher, F; Costello, R W; McElvaney, N G


    It can be challenging to teach and assess medical students successfully in the setting of a hospital ward using real patients. We describe a novel method of providing weekly formative clinical assessment and teaching to final year students on an acute medical ward: The Team Objective Structured Bedside Assessment (TOSBA). The TOSBA involves three groups of five students rotating through three ward-based stations (each station consists of an inpatient and facilitator). Each group spends 25 minutes at a bedside station where the facilitator asks consecutive students to perform one of five clinical tasks. Every student receives a standardised grade and is provided with educational feedback at each of the three stations. We report our 15-month experience using the TOSBA format to assess and teach a large number of medical students on a weekly basis. We discuss the advantages and potential drawbacks of our approach.

  17. Assessing the Left Ventricular Systolic Function at the Bedside: The Role of Transpulmonary Thermodilution-Derived Indices

    Gerardo Aguilar


    Full Text Available Evaluating the systolic function of the left ventricle (LV is important in the hemodynamic management of the critically ill patients with circulatory failure. Echocardiography is considered the standard monitor for estimating the LV function at the bedside in the intensive care unit. However, it requires a trained operator and is not a real-time monitoring tool. For monitoring of the systolic function, the pulmonary artery catheter has been the gold standard for a long time. However, now there are alternatives to this device, with transpulmonary thermodilution being one of them. This paper provides an overview of the usefulness of the transpulmonary thermodilution-derived indices for assessing systolic function at the bedside.

  18. Let there be no light: the effect of bedside light on sleep quality and background electroencephalographic rhythms

    Cho, Jounhong Ryan; Joo, Eun Yeon; Koo, Dae Lim; Hong, Seung Bong


    Objectives: Artificial lighting has been beneficial to society, but unnecessary light exposure at night may cause various health problems. We aimed to investigate how whole-night bedside light can affect sleep quality and brain activity. Patients and methods: Ten healthy sleepers underwent two polysomnography (PSG) sessions, one with the lights off and one with the lights on. PSG variables related to sleep quality were extracted and compared between lights-off and lights-on sleep. Sp...

  19. Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius

    Jagoo Zaheda B; Kassean Hemant K


    Abstract Background The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system. Methods A force field analysis in terms of the driving forces had shown that there was dissatisf...

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

    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.

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

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


    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.

  2. Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test.

    Atkinson, Joanna; Denmark, Tanya; Marshall, Jane; Mummery, Cath; Woll, Bencie


    To provide accurate diagnostic screening of deaf people who use signed communication, cognitive tests must be devised in signed languages with normative deaf samples. This article describes the development of the first screening test for the detection of cognitive impairment and dementia in deaf signers. The British Sign Language Cognitive Screening Test uses standardized video administration to screen cognition using signed, rather than spoken or written, instructions and a large norm-referenced sample of 226 deaf older people. Percentiles are provided for clinical comparison. The tests showed good reliability, content validity, and correlation with age, intellectual ability, and education. Clinical discrimination was shown between the normative sample and 14 deaf patients with dementia. This innovative testing approach transforms the ability to detect dementia in deaf people, avoids the difficulties of using an interpreter, and enables culturally and linguistically sensitive assessment of deaf signers, with international potential for adaptation into other signed languages.

  3. Distinctive Feature Extraction for Indian Sign Language (ISL) Gesture using Scale Invariant Feature Transform (SIFT)

    Patil, Sandeep Baburao; Sinha, G. R.


    India, having less awareness towards the deaf and dumb peoples leads to increase the communication gap between deaf and hard hearing community. Sign language is commonly developed for deaf and hard hearing peoples to convey their message by generating the different sign pattern. The scale invariant feature transform was introduced by David Lowe to perform reliable matching between different images of the same object. This paper implements the various phases of scale invariant feature transform to extract the distinctive features from Indian sign language gestures. The experimental result shows the time constraint for each phase and the number of features extracted for 26 ISL gestures.

  4. Distinctive Feature Extraction for Indian Sign Language (ISL) Gesture using Scale Invariant Feature Transform (SIFT)

    Patil, Sandeep Baburao; Sinha, G. R.


    India, having less awareness towards the deaf and dumb peoples leads to increase the communication gap between deaf and hard hearing community. Sign language is commonly developed for deaf and hard hearing peoples to convey their message by generating the different sign pattern. The scale invariant feature transform was introduced by David Lowe to perform reliable matching between different images of the same object. This paper implements the various phases of scale invariant feature transform to extract the distinctive features from Indian sign language gestures. The experimental result shows the time constraint for each phase and the number of features extracted for 26 ISL gestures.

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

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


    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.

  6. LED system reliability

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


    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 ex

  7. Principles of Bridge Reliability

    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...

  8. Improving machinery reliability

    Bloch, Heinz P


    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.

  9. Hawaii Electric System Reliability

    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)


    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.

  10. Hawaii electric system reliability.

    Silva Monroy, Cesar Augusto; Loose, Verne William


    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.

  11. Diagnose value of bedside color doppler echocardiography to children in neonatal intensive care unit%床旁彩色多普勒超声心动图对NICU患儿的诊断价值

    冯俊; 常凤玲


    , which was not diagnosed with CHD. Conclusion: Bedside color Doppler echocardiography can provide reliable diagnosis information for children and provide reliable evidence for further examination and treatment.

  12. Chapter 9: Reliability

    Algora, Carlos; Espinet-Gonzalez, Pilar; Vazquez, Manuel; Bosco, Nick; Miller, David; Kurtz, Sarah; Rubio, Francisca; McConnell,Robert


    This chapter describes the accumulated knowledge on CPV reliability with its fundamentals and qualification. It explains the reliability of solar cells, modules (including optics) and plants. The chapter discusses the statistical distributions, namely exponential, normal and Weibull. The reliability of solar cells includes: namely the issues in accelerated aging tests in CPV solar cells, types of failure and failures in real time operation. The chapter explores the accelerated life tests, namely qualitative life tests (mainly HALT) and quantitative accelerated life tests (QALT). It examines other well proven and experienced PV cells and/or semiconductor devices, which share similar semiconductor materials, manufacturing techniques or operating conditions, namely, III-V space solar cells and light emitting diodes (LEDs). It addresses each of the identified reliability issues and presents the current state of the art knowledge for their testing and evaluation. Finally, the chapter summarizes the CPV qualification and reliability standards.

  13. Phonological development in hearing learners of a sign language: The role of sign complexity and iconicity

    Ortega, G.; Morgan, G.


    The present study implemented a sign-repetition task at two points in time to hearing adult learners of British Sign Language and explored how each phonological parameter, sign complexity, and iconicity affected sign production over an 11-week (22-hour) instructional period. The results show that tr

  14. Conjoining Word and Image in British Sign Language (BSL): An Exploration of Metaphorical Signs in BSL

    Brennan, Mary


    The Lexicon of British Sign Language (BSL), including, and perhaps especially, the productive lexicon, is highly motivated. Many sign linguists in the last few decades have played down the role of iconicity and other types of motivation in signed language. They have suggested that because sign forms and structures conform to rules of linguistic…

  15. Forced Choice Recognition of Sign in Novice Learners of British Sign Language.

    Campbell, Ruth; And Others


    Investigation of the accuracy of novice learners of British Sign Language (BSL) and sign-naive subjects in recognizing possible and impossible BSL signs and in naming signs suggests that rated iconicity and the ability to process potentially meaningful gestures, determined recognition and naming accuracy. (19 references) (Author/CB)

  16. How Do You Sign "Apartheid"? The Politics of South African Sign Language.

    Penn, Claire; Reagan, Timothy


    Discusses sign language use in South Africa and the deaf as an oppressed community. The following issues are addressed: language planning and sign language, the role of sign language as the vernacular of an oppressed linguistic community, and the implications of sign language for other cultural and social issues that divide South African society.…

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

    Devisch, Ignaas; Vanheule, Stijn


    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.

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

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


    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.

  19. A bedside food cart as an alternate food service for acute and palliative oncological patients.

    Pietersma, Patti; Follett-Bick, Sandra; Wilkinson, Brenda; Guebert, Nancy; Fisher, Kim; Pereira, Jose


    Patients with advanced cancer experience various problems with eating, and their meals should be tailored to meet their specific needs. Two methods of food service were compared in a shared acute oncology/palliative care unit; an electrical food cart allowing patients to select their food types and portions at the bedside, and a traditional food tray delivery service that relied on meals being prepared in a centralized kitchen and then delivered by tray. Over a 10-day period, lunch meals were delivered by food cart and supper meals via food trays. Twenty-seven out of 32 patients participated in the trial. Patients significantly preferred the food cart to the trays with respect to the timing and appeal of the meal, appropriateness of food types and food portions and the variety of the food choices. A food cart as used in this trial provides a more flexible and appropriate method of food delivery to in-patients in the oncology and palliative unit. Further studies should examine whether this translates to improved caloric intake and quality of life parameters.

  20. Bringing technology to the bedside: using smartphones to improve interprofessional communication.

    Whitlow, Malinda Lee; Drake, Emily; Tullmann, Dorothy; Hoke, George; Barth, Denise


    The purpose of this project was to evaluate the impact of using Smartphones at the bedside on the quality of interprofessional communication and measure the response time between nurses and physicians compared with the usual paging device. Smartphones were provided to nurses and physicians on a 26-bed medical unit during a 2-month study period. Data were collected using Nurse-Physician Communication Questionnaires and Time and Motion data collection tools. Baseline data gathered from a convenience sample of general medicine nurses (n=61) and physicians (n=44) indicated that both nurses and physicians were dissatisfied with the current one-way paging devices and were frequently interrupted during patient care (P=.000). Postimplementation data suggested that the use of Smartphones significantly reduced patient interruptions (P=.021), allowed nurses to stay with patients (P=.002), and reduced wait times for a returned call (P=.001). Nurse travel time to answer a telephone call and time spent on hold by nurses and physicians also decreased by 100% from a range of 8 to 79 minutes down to 0 minutes. Staff reported improvement in quality of communication, and significant workflow efficiency was noted. Further research on the impact on patient safety and satisfaction is needed and other nursing units should consider implementing Smartphones within their medical centers.

  1. The effects of oxygen induced pulmonary vasoconstriction on bedside measurement of pulmonary gas exchange.

    Weinreich, Ulla M; Thomsen, Lars P; Rees, Stephen E; Rasmussen, Bodil S


    In patients with respiratory failure measurements of pulmonary gas exchange are of importance. The bedside automatic lung parameter estimator (ALPE) of pulmonary gas exchange is based on changes in inspired oxygen (FiO2) assuming that these changes do not affect pulmonary circulation. This assumption is investigated in this study. Forty-two out of 65 patients undergoing coronary artery bypass grafting (CABG) had measurements of mean pulmonary arterial pressure (MPAP), cardiac output and pulmonary capillary wedge pressure thus enabling the calculation of pulmonary vascular resistance (PVR) at each FiO2 level. The research version of ALPE was used and FiO2 was step-wise reduced a median of 0.20 and ultimately returned towards baseline values, allowing 6-8 min' steady state period at each of 4-6 levels before recording the oxygen saturation (SpO2). FiO2 reduction led to median decrease in SpO2 from 99 to 92 %, an increase in MPAP of 4 mmHg and an increase in PVR of 36 dyn s cm(-5). Changes were immediately reversed on returning FiO2 towards baseline. In this study changes in MPAP and PVR are small and immediately reversible consistent with small changes in pulmonary gas exchange. This indicates that mild deoxygenation induced pulmonary vasoconstriction does not have significant influences on the ALPE parameters in patients after CABG.

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

    Mellon, Brad F


    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.

  3. Managing change in the nursing handover from traditional to bedside handover - a case study from Mauritius.

    Kassean, Hemant K; Jagoo, Zaheda B


    The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system. A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 - step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making. An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general. This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system.

  4. The effect of transforming care at the bedside initiative on healthcare teams' work environments.

    Lavoie-Tremblay, Mélanie; O'Conner, Patricia; Harripaul, Anastasia; Biron, Alain; Ritchie, Judith; Lavigne, Genevieve L; Baillargeon, Sophie; Ringer, Justin; Macgibbon, Brenda; Taylor-Ducharme, Sharon; Sourdif, Jacynthe


    Different initiatives have been implemented in healthcare organizations to improve efficiency, such as transforming care at the bedside (TCAB). However, there are important gaps in understanding the effect of TCAB on healthcare teams' work environments. The specific aim of the study is to describe findings regarding the TCAB initiative effects on healthcare teams' work environments. A pretest and posttest study design was used for this study. The TCAB initiative was implemented in fall 2010 in a university health center in Montreal, Canada. The sample consisted of healthcare workers from four different care units. Statistically significant improvement was observed with the communicating specific information subscale from the measure of processes of care variable, and a significant difference was found between the support from colleagues variable, which was higher at baseline than postprogram. The differences for psychological demand, decisional latitude, and effort-reward were not significant. TCAB is an intervention that allows healthcare teams to implement change to improve patients' and families' outcomes. Ongoing energy should focus on how to improve communication among all members of the team and ensure their support. © 2013 Sigma Theta Tau International.

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

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


    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 (F2,186 = 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.

  6. Multicenter validation of a bedside antisaccade task as a measure of executive function

    Hellmuth, J.; Mirsky, J.; Heuer, H.W.; Matlin, A.; Jafari, A.; Garbutt, S.; Widmeyer, M.; Berhel, A.; Sinha, L.; Miller, B.L.; Kramer, J.H.


    Objective: To create and validate a simple, standardized version of the antisaccade (AS) task that requires no specialized equipment for use as a measure of executive function in multicenter clinical studies. Methods: The bedside AS (BAS) task consisted of 40 pseudorandomized AS trials presented on a laptop computer. BAS performance was compared with AS performance measured using an infrared eye tracker in normal elders (NE) and individuals with mild cognitive impairment (MCI) or dementia (n = 33). The neuropsychological domain specificity of the BAS was then determined in a cohort of NE, MCI, and dementia (n = 103) at UCSF, and the BAS was validated as a measure of executive function in a 6-center cohort (n = 397) of normal adults and patients with a variety of brain diseases. Results: Performance on the BAS and laboratory AS task was strongly correlated and BAS performance was most strongly associated with neuropsychological measures of executive function. Even after controlling for disease severity and processing speed, BAS performance was associated with multiple assessments of executive function, most strongly the informant-based Frontal Systems Behavior Scale. Conclusions: The BAS is a simple, valid measure of executive function in aging and neurologic disease. PMID:22573640

  7. Evaluating Isolation Behaviors by Nurses Using Mobile Computer Workstations at the Bedside.

    Beam, Elizabeth L; Gibbs, Shawn G; Hewlett, Angela L; Iwen, Peter C; Nuss, Suzanne L; Smith, Philip W


    This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.

  8. Delivery of RNAi Therapeutics to the Airways-From Bench to Bedside.

    Qiu, Yingshan; Lam, Jenny K W; Leung, Susan W S; Liang, Wanling


    RNA interference (RNAi) is a potent and specific post-transcriptional gene silencing process. Since its discovery, tremendous efforts have been made to translate RNAi technology into therapeutic applications for the treatment of different human diseases including respiratory diseases, by manipulating the expression of disease-associated gene(s). Similar to other nucleic acid-based therapeutics, the major hurdle of RNAi therapy is delivery. Pulmonary delivery is a promising approach of delivering RNAi therapeutics directly to the airways for treating local conditions and minimizing systemic side effects. It is a non-invasive route of administration that is generally well accepted by patients. However, pulmonary drug delivery is a challenge as the lungs pose a series of anatomical, physiological and immunological barriers to drug delivery. Understanding these barriers is essential for the development an effective RNA delivery system. In this review, the different barriers to pulmonary drug delivery are introduced. The potential of RNAi molecules as new class of therapeutics, and the latest preclinical and clinical studies of using RNAi therapeutics in different respiratory conditions are discussed in details. We hope this review can provide some useful insights for moving inhaled RNAi therapeutics from bench to bedside.

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

    de Graaf J


    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.

  10. Cutting healthcare costs without rationing at the bedside: preserving the doctor-patient fiduciary relationship.

    Lomas, S J; Rice, C L


    In his essay on bedside rationing, Peter Ubel argues that in an era of rising healthcare costs, it is time to relax the patient-centered ethic of physicians as unconditional patient advocates so they can individualize rationing decisions. This paper raises several concerns with the arguments and the examples he provides to make his case. First, he overlooks cost-effectiveness when making medical spending decisions. Second, his examples of wasteful, unproven and potentially harmful interventions call for physician education, not rationing, as he suggests. Third, informed patients can play a role in lowering costs through shared decision making. Fourth, individualized rationing decisions will worsen already pervasive disparities in medical care. The paper envisions the ideal cost-conscious physician as one who is knowledgeable about cost-effective practices, avoids unproven interventions whenever possible, and facilitates shared decision making through patient education. Such an individual would not, however, withhold interventions of proven benefit except when accommodating a patient's preferences for a particular therapy. The doctor and patient can only work together within the constraints of system-wide rationing if the fiduciary relationship is never violated.

  11. Validity of the Multidimensional Health Locus of Control Scales in American Sign Language

    Athale, Ninad; Aldridge, Arianna; Malcarne, Vanessa L.; Nakaji, Melanie; Samady, Waheeda; Sadler, Georgia Robins


    Few instruments have been translated and validated for people who use American Sign Language (ASL) as their preferred language. This study examined the reliability and validity of a new ASL version of the widely-used Multidimensional Health Locus of Control (MHLC) scales. Deaf individuals (N = 311) were shown the ASL version via videotape, and their responses were recorded. Confirmatory factor analysis supported the four-factor structure of the MHLC. Scale reliabilities (Cronbach’s alphas) ra...

  12. Photovoltaic system reliability

    Maish, A.B.; Atcitty, C. [Sandia National Labs., NM (United States); Greenberg, D. [Ascension Technology, Inc., Lincoln Center, MA (United States)] [and others


    This paper discusses the reliability of several photovoltaic projects including SMUD`s PV Pioneer project, various projects monitored by Ascension Technology, and the Colorado Parks project. System times-to-failure range from 1 to 16 years, and maintenance costs range from 1 to 16 cents per kilowatt-hour. Factors contributing to the reliability of these systems are discussed, and practices are recommended that can be applied to future projects. This paper also discusses the methodology used to collect and analyze PV system reliability data.

  13. Structural Reliability Methods

    Ditlevsen, Ove Dalager; Madsen, H. O.

    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......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...

  14. Facial Dystonia with Facial Grimacing and Vertical Gaze Palsy with "Round the Houses" Sign in a 29-Year-Old Woman.

    Crespi, J; Bråthen, G; Quist-Paulsen, P; Pagonabarraga, J; Roig-Arnall, C


    A 29-year-old woman developed progressive dysarthria and coordination problems from the age of 15. Examination showed dysarthria, facial dystonia, bibrachial dystonia, hyperreflexia, ataxia, and emotional incontinence. Downward supranuclear gaze palsy was prominent with a "Round the Houses" sign. Magnetic resonance imaging of the brain and medulla, electroneurography, and cerebrospinal fluid were normal. A computed tomography scan showed hepatosplenomegaly. This combination of progressive neurological symptoms together with hepatosplenomegaly was suggestive of inborn error of metabolism. A bone marrow biopsy showed an increased number of macrophages with foamy content, highly suggestive of lysosomal disease. Plasmatic chitotriosidase activity and CCL18 were increased. Genetic testing showed heterozygosis for the variation c.1070C→T (p.Ser357Leu) and c.1843→T (Arg615Cys), confirming the diagnosis of Niemann-Pick type C (NPC). The "Round the Houses" sign has only been described in patients with progressive supranuclear palsy (PSP). This sign is described as an inability to produce pure vertical saccades along the midline and instead moving the eyes in a lateral arc to accomplish the movement. The observation of this sign in a patient with NPC indicates that this bedside finding is not specific for PSP, but a sign of medial longitudinal fasciculus dysfunction. The presence of facial dystonia with facial grimacing together with supranuclear gaze palsy is highly characteristic and useful for the diagnosis of NPC. NPC is an important underdiagnosed condition, given the availability of treatment and a mean diagnostic delay of 6 years.

  15. Comprehension of safety signs for construction workers: comparison of existing and newly designed signs.

    Arphorn, Sara; Augsornpeug, Naiphaporn; Srisorrachatr, Suwat; Pruktharathikul, Vichai


    The comprehension of safety signs for construction workers was compared among existing and improved designs. Safety signs considered were existing signs, existing signs improved by adding text, existing signs improved by adding/changing pictorials, and existing signs improved by adding/changing pictorials and text. Three hundred and eighty-four construction workers were randomized for assignments into four groups. They were working on nine constructions work sites randomly selected from work sites located in Bangkok, Thailand. The number of workers in each work site was calculated for the proportion of the sample size and then they were randomized so that equal numbers of workers were included in the four groups. The four types of safety signs and an interview form were used to test their comprehension of safety signs. For data analysis, percentages, means, standard deviations, the chi-square test, the one-way ANOVA and LSD tests were applied. The results showed that the mean comprehension scores of the existing signs improved by adding text, the existing signs improved by adding/changing pictorials, and the existing signs improved by adding/changing pictorials and text were significantly higher than those of the existing signs. In addition, the mean comprehension scores of the existing signs improved by adding text and the existing signs improved by adding/changing pictorials and text were significantly higher than those of the existing signs improved by adding/changing pictorials. The highest mean comprehension score of safety signs for the construction workers was found in the existing signs improved by adding/changing pictorials and text. These results indicated that for construction workers, the comprehension of safety signs with pictorials and explanatory text was better than that of the existing signs.

  16. A tour in sign language

    François Briard


    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...

  17. Reliable Electronic Equipment

    N. A. Nayak


    Full Text Available The reliability aspect of electronic equipment's is discussed. To obtain optimum results, close cooperation between the components engineer, the design engineer and the production engineer is suggested.

  18. Reliability prediction techniques

    Whittaker, B.; Worthington, B.; Lord, J.F.; Pinkard, D.


    The paper demonstrates the feasibility of applying reliability assessment techniques to mining equipment. A number of techniques are identified and described and examples of their use in assessing mining equipment are given. These techniques include: reliability prediction; failure analysis; design audit; maintainability; availability and the life cycle costing. Specific conclusions regarding the usefulness of each technique are outlined. The choice of techniques depends upon both the type of equipment being assessed and its stage of development, with numerical prediction best suited for electronic equipment and fault analysis and design audit suited to mechanical equipment. Reliability assessments involve much detailed and time consuming work but it has been demonstrated that the resulting reliability improvements lead to savings in service costs which more than offset the cost of the evaluation.



    A sign pattern matrix is a matrixwhose entries are from the set {+ ,- ,0}. The symmetric sign pattern matrices that require unique inertia have recently been characterized. The purpose of this paper is to more generally investigate the inertia sets of symmetric sign pattern matrices. In particular, nonnegative fri-diagonal sign patterns and the square sign pattern with all + entries are examined. An algorithm is given for generating nonnegative real symmetric Toeplitz matrices with zero diagonal of orders n≥3 which have exactly two negative eigenvalues. The inertia set of the square pattern with all + off-diagonal entries and zero diagonal entries is then analyzed. The types of inertias which can be in the inertia set of any sign pattern are also obtained in the paper. Specifically, certain compatibility and consecutiveness properties are established.

  20. Epidemic spreading on evolving signed networks

    Saeedian, M; Jafari, G R; Kertesz, J


    Most studies of disease spreading consider the underlying social network as obtained without the contagion, though epidemic influences peoples willingness to contact others: A friendly contact may be turned to unfriendly to avoid infection. We study the susceptible-infected (SI) disease spreading model on signed networks, in which each edge is associated with a positive or negative sign representing the friendly or unfriendly relation between its end nodes. In a signed network, according to Heiders theory, edge signs evolve such that finally a state of structural balance is achieved, corresponding to no frustration in physics terms. However, the danger of infection affects the evolution of its edge signs. To describe the coupled problem of the sign evolution and disease spreading, we generalize the notion of structural balance by taking into account the state of the nodes. We introduce an energy function and carry out Monte-Carlo simulations on complete networks to test the energy landscape, where we find loc...

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

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


    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.

  2. The rating reliability calculator

    Solomon David J


    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.

  3. Reliability of power connections

    BRAUNOVIC Milenko


    Despite the use of various preventive maintenance measures, there are still a number of problem areas that can adversely affect system reliability. Also, economical constraints have pushed the designs of power connections closer to the limits allowed by the existing standards. The major parameters influencing the reliability and life of Al-Al and Al-Cu connections are identified. The effectiveness of various palliative measures is determined and the misconceptions about their effectiveness are dealt in detail.

  4. Aphasia in a user of British Sign Language: Dissociation between sign and gesture.

    Marshall, Jane; Atkinson, Jo; Smulovitch, Elaine; Thacker, Alice; Woll, Bencie


    This paper reports a single case investigation of "Charles", a Deaf man with sign language aphasia following a left CVA. Anomia, or a deficit in sign retrieval, was a prominent feature of his aphasia, and this showed many of the well-documented characteristics of speech anomia. For example, sign retrieval was sensitive to familiarity, it could be cued, and there were both semantic and phonological errors. Like a previous case in the literature (Corina, Poizner, Bellugi, Feinberg, Dowd, & O'Grady-Batch, 1992), Charles demonstrated a striking dissociation between sign and gesture, since his gesture production was relatively intact. This dissociation was impervious to the iconicity of signs. So, Charles' sign production showed no effect of iconicity, and gesture production was superior to sign production even when the forms of the signs and gestures were similar. The implications of these findings for models of sign and gesture production are discussed.

  5. Multidisciplinary System Reliability Analysis

    Mahadevan, Sankaran; Han, Song; Chamis, Christos C. (Technical Monitor)


    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.

  6. CT "halo sign" in pulmonary tuberculoma.

    Gaeta, M; Volta, S; Stroscio, S; Romeo, P; Pandolfo, I


    The CT halo sign has been described as the CT finding of a low-attenuation zone surrounding a pulmonary nodule. It is an early clue to the diagnosis of invasive pulmonary aspergillosis. We describe a case of CT halo sign associated with a pulmonary tuberculoma. Therefore, we think that a diagnosis other than invasive pulmonary aspergillosis should be considered in the presence of the CT halo sign in immunocompetent patients.

  7. An electronic dictionary of Danish Sign Language

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas


    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, m......, 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....

  8. An electronic dictionary of Danish Sign Language

    Kristoffersen, Jette Hedegaard; Troelsgård, Thomas


    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....

  9. Sensitivity Analysis of Component Reliability



    In a system, Every component has its unique position within system and its unique failure characteristics. When a component's reliability is changed, its effect on system reliability is not equal. Component reliability sensitivity is a measure of effect on system reliability while a component's reliability is changed. In this paper, the definition and relative matrix of component reliability sensitivity is proposed, and some of their characteristics are analyzed. All these will help us to analyse or improve the system reliability.

  10. 33 CFR 127.113 - Warning signs.


    ...) WATERFRONT FACILITIES WATERFRONT FACILITIES HANDLING LIQUEFIED NATURAL GAS AND LIQUEFIED HAZARDOUS GAS Waterfront Facilities Handling Liquefied Natural Gas § 127.113 Warning signs. (a) The marine transfer...


    S. N. Omkar


    Full Text Available In the recent years many approaches have been made that uses computer vision algorithms to interpret sign language. This endeavour is yet another approach to accomplish interpretation of human hand gestures. The first step of this work is background subtraction which achieved by the Euclidean distance threshold method. Thinning algorithm is then applied to obtain a thinned image of the human hand for further analysis. The different feature points which include terminating points and curved edges are extracted for the recognition of the different signs. The input for the project is taken from video data of a human hand gesturing all the signs of the American Sign Language.

  12. Iconicity and Sign Lexical Acquisition: A Review

    Ortega, Gerardo


    The study of iconicity, defined as the direct relationship between a linguistic form and its referent, has gained momentum in recent years across a wide range of disciplines. In the spoken modality, there is abundant evidence showing that iconicity is a key factor that facilitates language acquisition. However, when we look at sign languages, which excel in the prevalence of iconic structures, there is a more mixed picture, with some studies showing a positive effect and others showing a null or negative effect. In an attempt to reconcile the existing evidence the present review presents a critical overview of the literature on the acquisition of a sign language as first (L1) and second (L2) language and points at some factor that may be the source of disagreement. Regarding sign L1 acquisition, the contradicting findings may relate to iconicity being defined in a very broad sense when a more fine-grained operationalisation might reveal an effect in sign learning. Regarding sign L2 acquisition, evidence shows that there is a clear dissociation in the effect of iconicity in that it facilitates conceptual-semantic aspects of sign learning but hinders the acquisition of the exact phonological form of signs. It will be argued that when we consider the gradient nature of iconicity and that signs consist of a phonological form attached to a meaning we can discern how iconicity impacts sign learning in positive and negative ways. PMID:28824480

  13. Symptoms and signs of syncope: a review of the link between physiology and clinical clues

    W. Wieling; R.D. Thijs; N. van Dijk; A.A.M. Wilde; D.G. Benditt; J.G. van Dijk


    Detailed history taking is of paramount importance to establish a reliable diagnosis in patients with transient loss of consciousness. In this article the clinical symptoms and signs of the successive phases of a syncopal episode are reviewed. A failure of the systemic circulation to perfuse the bra

  14. Objects in Films: analyzing signs

    GAMBARATO, Renira Rampazzo


    Full Text Available The focus of this essay is the analysis of daily objects as signs in films. Objects from everyday life acquire several functions in films: they can be solely used as scene objects or to support a particular film style. Other objects are specially chosen to translate a character’s interior state of mind or the filmmaker’s aesthetical or ethical commitment to narrative concepts. In order to understand such functions and commitments, we developed a methodology for film analysis which focuses on the objects. Object interpretation, as the starting point of film analysis, is not a new approach. For instance, French film critic André Bazin proposed that use of object interpretation in the 1950s. Similarly, German film theorist Siegfried Kracauer stated it in the 1960s. However, there is currently no existing analytical model to use when engaging in object interpretation in film. This methodology searches for the most representative objects in films which involves both quantitative and qualitative analysis; we consider the number of times each object appears in a film (quantitative analysis as well as the context of their appearance, i.e. the type of shot used and how that creates either a larger or smaller relevance and/or expressiveness (qualitative analysis. In addition to the criteria of relevance and expressiveness, we also analyze the functionality of an object by exploring details and specifying the role various objects play in films. This research was developed at Concordia University, Montreal, Canada and was supported by the Foreign Affairs and International Trade, Canada (DFAIT.

  15. Sign Language to Speech Translation System Using PIC Microcontroller

    Gunasekaran. K


    Full Text Available The advancement in embedded system, provides a space to design and develop a sign language translator system to assist the dumb people. This paper mainly addresses to facilitate dumb person's lifestyle. Dumb people throughout the world use sign language to communicate with others, this is possible for those who has undergone special trainings. Common people also face difficult to understand the gesture language. To overcome these real time issues, this system is developed. Whenever the proposed system senses any sign language, it plays corresponding recorded voice. This reduces the communication gap between dumb and ordinary people. This proposed model consist of four modules, they are sensing unit, processing unit, voice storage unit and wireless communication unit. It is achieved by integrating flux sensor and APR9600 with PIC16F877A. The flux sensors are placed in gloves, which respond to gesture. By using suitable circuit response of the sensor is given to the microcontroller based on the response microcontroller plays the recorded voice using APR9600. A snapshot of the entire system, advantage over existing methods and simulation output of the process is discussed in this work. Thissystem offers high reliability and fast response. This method is more precise on hand movement and different languages can be installed without altering the code in PIC microcontroller.

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

    Bañuls, Mari Carmen; Cirac, J Ignacio; Jansen, Karl; Kühn, Stefan; Saito, Hana


    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 a...

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

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


    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.

  18. Bedside ultrasonography for verification of shoulder reduction: A long way to go

    Koorosh Ahmadi; Amir Masoud Hashemian; Kaveh Sineh-Sepehr; Monavvar Afzal-Aghaee; Saba Jafarpour; Vafa Rahimi-Movaghar


    Purpose:Shoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments.Pre-and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction.However,shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination.This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.Methods:This was a prospective observational study.All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint.The examiners were blinded to the result of the other imaging modality.Results of the two methods were then compared.Results:Overall,108 patients with confirmed anterior shoulder dislocation were enrolled in the study.Ninety-one (84.3%) of the patients were males.Mean age of the participants was (30.11 ± 11.41) years.The majority of the patients had a recurrent dislocation.Bedside ultrasonography showed a sensitivity of 53.8% (95% CI:29.1%-76.8%) and a specificity of 100% (95% CI:96.1%-100%) in detecting inadequate reductions.The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa-0.672,p < 0.001).Conclusion:The results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.

  19. Who Should Be at the Bedside 24/7: Doctors, Families, Nurses?

    Gershengorn, Hayley B; Garland, Allan


    Critical illness does not keep to regular, daytime business hours; we must provide high-quality care and support for intensive care unit (ICU) patients 24 hours per day, 7 days per week. Whether this mandates the presence of similar numbers and types of personnel throughout all hours of the day, however, has been the subject of much debate and substantial research. In this article, we review the available literature on the consequences of having three groups of care providers at a patient's bedside overnight: physicians, visitors, and nurses. Though few of the studies on this topic are randomized and prospective, several themes have emerged from the existing data. First, there is dramatic variation in practice between and within countries. Second, the weight of evidence does not indicate that patient outcomes are improved by having an intensivist present overnight in ICUs that are staffed by intensivists during the daytime hours. Third, although visitation is highly restricted in many ICUs-out of concerns for disruption of care and a negative physiological or psychological impact on patients-the available data suggest that patients and their families generally benefit from open visitation policies. And finally, although there is little debate that nurses are (and should be) available in the ICU 24/7, existing data do not provide much of a consensus about the details. Uncertainties include whether outcomes are better when each nurse is assigned only one patient (or, more generally, the optimal patient:nurse ratio), who these nurses should be (e.g., registered nurses vs. other personnel), and what their roles should entail (e.g., managing ventilators). As such, we cannot yet identify the optimal overnight nurse staffing strategy. What is clear is that the critical care community needs more and better data to further define these aspects of the relationship between ICU structure and ICU outcomes.

  20. Bedside method to estimate actual body weight in the Emergency Department.

    Buckley, Robert G; Stehman, Christine R; Dos Santos, Frank L; Riffenburgh, Robert H; Swenson, Aaron; Mjos, Nathan; Brewer, Matt; Mulligan, Sheila


    Actual body weight (ABW) is important for accurate drug dosing in emergency settings. Oftentimes, patients are unable to stand to be weighed accurately or clearly state their most recent weight. Develop a bedside method to estimate ABW using simple anthropometric measurements. Prospective, blinded, cross-sectional convenience sampling of adult Emergency Department (ED) patients. A multiple linear regression equation from Derivation Phase (n = 208: 121 males, 87 females) found abdominal and thigh circumferences (AC and TC) had the best fit and an inter-rater correlation of 0.99 and 0.96, respectively: Male ABW (kg) = -47.8 + 0.78 ∗ (AC) + 1.06 ∗ (TC); Female ABW = -40.2 + 0.47 ∗ (AC) + 1.30 ∗ (TC). Derivation phase: Number of patients (%) with a body weight estimation (BWE) > 10 kg from ABW for males/females were: 7 (6%)/1 (1%) for Patients, 46 (38%)/28 (32%) for Doctors, 38 (31%)/24 (27%) for Nurses, 75 (62%)/43 (49%) for 70 kg/60 kg convention, and 14 (12%)/8 (9%) using the anthropometric regression model. For validation phase (55 males, 44 females): Gold standard ABW mean (SD) male/female = 83.6 kg (14.3)/71.5 kg (18.9) vs. anthropometric regression model = 86.3 kg (14.7)/73.3 kg (15.1). R(2) = 0.89, p 10 kg using the anthropometric regression model = 8 (15%)/11 (27%). For male patients, a regression model using supine thigh and abdominal circumference measurements seems to provide a useful and more accurate alternative to physician, nurse, or standard 70-kg male conventional estimates, but was less accurate for use in female patients. Published by Elsevier Inc.

  1. 'Bedside assessment' of acute hantavirus infections and their possible classification into the spectrum of haemophagocytic syndromes.

    Clement, J; Colson, P; Saegeman, V; Lagrou, K; Van Ranst, M


    Hantavirus infections, recently renamed 'hantavirus fever' (HTVF), belong to the most common but also most underestimated zoonoses in the world. A small number of reports described the so-called 'lipid paradox' in HTVF, i.e. the striking contrast between a very low serum total cholesterol and/or high-density lipoprotein cholesterol (HDLc), and a paradoxical concomitant hypertriglyceridaemia. In a prospective study, with patients being their own control after illness, we wanted to verify if this quick and easy 'bedside test' was robust enough to warrant a preliminary diagnosis of acute kidney injury (AKI) caused by HTVF. The study cohort consisted of 58 Belgian cases (mean age 44 years), admitted with varying degrees of AKI and of thrombocytopaenia, both characteristic for presumptive HTVF. All cases were sero-confirmed as having acute HTVF. At or shortly after hospital admission, a significant (p hantavirus cardio-pulmonary syndrome' (HCPS) cases, mostly described hitherto in the New World. In more severe AKI cases, the mean total cholesterol was significantly lower (p = 0.02) than in milder cases, i.e. cases with peak serum creatinine levels of < 1.5 mg/dL. Thrombocytopaenia, generally accepted as the severity index in HTVF, appeared, moreover, significantly correlated with serum levels of total cholesterol (R = 0.52, p < 0.001) and with serum levels of HDLc (R = 0.45, p < 0.01). A link with the novel clinical entity of haemophagocytic syndromes, also characterised by manifest hypertriglyceridaemia, is discussed.

  2. Mentoring and supervising clinical pharmacist students at patients' bedside: which benefits?

    Rouzaud-Laborde, Charlotte; Damery, Léa; Cestac, Philippe; Sallerin, Brigitte; Calvet, Pauline


     Hospital clinical pharmacists are involved in teaching students during professional internship. Organization between the unit care and the pharmacy place is complicated. This study evaluated the effectiveness of two pharmaceutical teams: an experienced pharmacist in the pharmacy place, reachable by phone (team 1) or an experienced pharmacist in the ward, near patients and students (team 2). Pharmaceutical interventions were collected during two successive time periods, each of 6 months in a 15-bed unit (neurology). During the first time period, prescriptions were analyzed by the student (resident) in the ward and experienced pharmacist in the pharmacy place. During the second time period, prescriptions were analyzed by both experienced pharmacist and the resident in the ward. We compared the number, the type, the approval of pharmaceutical interventions and the medication reconciliation activities. Proportions were compared by a chisquared test (or Fisher exact test) as well as the quantitative value was calculated by a Student test. 'Mentoring and supervising' students in the ward increased significantly the number of pharmaceutical interventions (PI; 104 interventions for 1408 analyzed prescriptions (7.4%) by the students in the ward and 317 interventions for 1391 (22.8%) by both the experienced pharmacist and the students in the ward (P = 0.002). Furthermore, specific interventions from medication reconciliation were significantly increased by the presence of experienced pharmacist in the ward (0.96% vs. 8.83% P = 0.018). Effectiveness of clinical pharmacists can be improved by the presence of experienced pharmacist at patients' bedside, near students. © 2015 John Wiley & Sons, Ltd.

  3. Bedside echo for chest pain: an algorithm for education and assessment

    Amini R


    Full Text Available Richard Amini, Lori A Stolz, Jeffrey Z Kartchner, Matthew Thompson, Nicholas Stea, Nicolaus Hawbaker, Raj Joshi, Srikar Adhikari Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ, USA Background: Goal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training.  Objectives: We describe a novel undifferentiated chest pain goal-directed ultrasound algorithm-focused education workshop for the purpose of enhancing emergency medicine resident training in ultrasound milestones competencies.  Methods: This was a cross-sectional study performed at an academic medical center. A novel goal-directed ultrasound algorithm was developed and implemented as a model for teaching and learning the sonographic approach to a patient with undifferentiated chest pain. This algorithm was incorporated into all components of the 1-day workshop: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Performance comparisons were made between postgraduate year (PGY levels.  Results: A total of 38 of the 40 (95% residents who attended the event participated in the chest pain objective standardized clinical exam, and 26 of the 40 (65% completed the entire questionnaire. The average number of ultrasounds performed by resident class year at the time of our study was as follows: 19 (standard deviation [SD]=19 PGY-1, 238 (SD=37 PGY-2, and 289 (SD=73 PGY-3. Performance on the knowledge-based questions improved between PGY-1 and PGY-3. The application of the novel algorithm was noted to be more prevalent among the PGY-1 class.  Conclusion: The 1-day algorithm-based ultrasound educational workshop was an engaging learning technique at our institution. Keywords: point-of care ultrasound, algorithm education, education, chest pain, bedside ultrasound, POCUS

  4. Palliative Care Bedside Teaching: A Qualitative Analysis of Medical Students' Reflective Writings after Clinical Practices.

    Rojí, Rocío; Noguera-Tejedor, Antonio; Pikabea-Díaz, Fernando; Carrasco, José Miguel; Centeno, Carlos


    A mandatory course in palliative care (PC) is organized for all final-year medical students at the University of Navarre. It consists of 24 lectures, 4 workshops, and 1 scheduled five hour clinical PC service experience at two different sites. In the 48 hours after the visit and related to the clinical experience, each student has to complete a 500-word reflective writing (RW) piece. To investigate how a brief PC clinical experience helps equip the medical student. Qualitative study of RW. Two researchers produced a content analysis of students' RW. They collaboratively developed themes and categories with a constant review of the classification tree and an exhaustive collection of quotes. Differences between services were analyzed (λ(2)). One hundred sixty-seven RW were analyzed from the 197 students on the course (response rate 85%). Six major themes emerged: All the students identified central aspects of PC work dynamics; students acquired specific PC knowledge (86%); the personal influence of the experience was reported (68%); students described how patients and their caregivers deal with the patients' illness (68%); students talked about the essence of PC and essential aspects of medicine (42%); students reported spontaneously having changed their assumptions about PC (15%); and they realized that the experience was relevant to all clinical practice. Categories such as teamwork, the expression of patients' and caregivers' feelings, and family devotion showed statistical differences between services (λ(2) p < 0.05). A short bedside clinical experience in PC, encouraging student reflection, provides a deeper understanding of PC and even of core medicine values. The data we gather cannot explain only new skill acquisition but seems to suggest a life-changing personal experience for the student.

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

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


    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

  6. Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain

    John Jarrell


    Full Text Available Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA, perineal cutaneous allodynia (pCA, abdominal and perineal myofascial trigger points (aMFTP and (pMFTP, and reduced pain thresholds (RPTs. Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+ and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0, pCA-2.91 (1.19, 7.11, aMTRP-4.19 (1.46, 12.0, pMFTP-1.35 (0.86, 2.13, and RPT-1.14 (0.85, 1.52, respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

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

    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.

  8. What Are the Signs and Symptoms of Heart Disease?

    ... Twitter. What Are the Signs and Symptoms of Heart Disease? The signs and symptoms of coronary heart disease ( ... will have signs and symptoms of the disease. Heart Disease Signs and Symptoms The illustration shows the major ...


    Тамаргазін, О. А.; Національний авіаційний університет; Власенко, П. О.; Національний авіаційний університет


    Airline's operational structure for Reliability program implementation — engineering division, reliability  division, reliability control division, aircraft maintenance division, quality assurance division — was considered. Airline's Reliability program structure is shown. Using of Reliability program for reducing costs on aircraft maintenance is proposed. Рассмотрена организационная структура авиакомпании по выполнению Программы надежности - инженерный отдел, отделы по надежности авиацио...

  10. Ultra reliability at NASA

    Shapiro, Andrew A.


    Ultra reliable systems are critical to NASA particularly as consideration is being given to extended lunar missions and manned missions to Mars. NASA has formulated a program designed to improve the reliability of NASA systems. The long term goal for the NASA ultra reliability is to ultimately improve NASA systems by an order of magnitude. The approach outlined in this presentation involves the steps used in developing a strategic plan to achieve the long term objective of ultra reliability. Consideration is given to: complex systems, hardware (including aircraft, aerospace craft and launch vehicles), software, human interactions, long life missions, infrastructure development, and cross cutting technologies. Several NASA-wide workshops have been held, identifying issues for reliability improvement and providing mitigation strategies for these issues. In addition to representation from all of the NASA centers, experts from government (NASA and non-NASA), universities and industry participated. Highlights of a strategic plan, which is being developed using the results from these workshops, will be presented.

  11. Photovoltaic module reliability workshop

    Mrig, L. (ed.)


    The paper and presentations compiled in this volume form the Proceedings of the fourth in a series of Workshops sponsored by Solar Energy Research Institute (SERI/DOE) under the general theme of photovoltaic module reliability during the period 1986--1990. The reliability Photo Voltaic (PV) modules/systems is exceedingly important along with the initial cost and efficiency of modules if the PV technology has to make a major impact in the power generation market, and for it to compete with the conventional electricity producing technologies. The reliability of photovoltaic modules has progressed significantly in the last few years as evidenced by warranties available on commercial modules of as long as 12 years. However, there is still need for substantial research and testing required to improve module field reliability to levels of 30 years or more. Several small groups of researchers are involved in this research, development, and monitoring activity around the world. In the US, PV manufacturers, DOE laboratories, electric utilities and others are engaged in the photovoltaic reliability research and testing. This group of researchers and others interested in this field were brought together under SERI/DOE sponsorship to exchange the technical knowledge and field experience as related to current information in this important field. The papers presented here reflect this effort.

  12. Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents.

    Clay, Ryan D; Lee, Elizabeth C; Kurtzman, Marc F; Dversdal, Renee K


    A growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach. To implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures. The study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns. This was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention. Thirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099. A single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.

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

    Lee, Heon [Seoul Medical Center, Seoul (Korea, Republic of)


    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.

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

    Ramires Jose F


    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.

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

    Ahmad, Tariq; Desai, Nihar; Wilson, Francis; Schulte, Phillip; Dunning, Allison; Jacoby, Daniel; Allen, Larry; Fiuzat, Mona; Rogers, Joseph; Felker, G Michael; O'Connor, Christopher; Patel, Chetan B


    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 simultaneous

  16. A hand-held ultrasound machine vs. conventional ultrasound machine in the bedside assessment of post-liver transplant patients.

    Trinquart, Ludovic; Bruno, Onorina; Angeli, Maria Luigia; Belghiti, Jacques; Chatellier, Gilles; Vilgrain, Valérie


    The purpose was to assess the diagnostic accuracy of a hand-held Doppler ultrasound (US) machine for the bedside detection of liver and vascular abnormalities after liver transplantation in the intensive care unit. The IRB approved this study, and written informed consent was obtained from all patients or the patient's legal representative. Any liver transplant recipient at our institution who needed a bedside Doppler US examination in the intensive care unit was eligible. Patients underwent routine grey-scale, colour, and spectral Doppler US examinations of the liver with a conventional machine, which was taken as the reference method, and with a hand-held machine on the same day. Examinations followed one another and were performed in a blinded fashion by two radiologists. Over a 4-month period, 24 consecutive patients (16 men, median age 54 years old; 16 cadaveric and 8 living related right liver transplantations) underwent 43 examinations with both conventional and hand-held machines. Image quality and overall satisfaction scores of grey-scale were lower with the hand-held than with the conventional machine. The hand-held was similar to the conventional machine for assessing the patency of portal veins, hepatic veins and the IVC in all patients but one. The hand-held machine failed to detect signals in the right branch of the hepatic artery and in the hilum in two and one cases, respectively. There was no abnormal hepatic arterial flow with the conventional machine in any of the patients, and the results were the same with the hand-held machine. Total examination time was significantly longer with the hand-held machine. The hand-held US machine had a high diagnostic accuracy for both parenchymal and vascular analyses compared with a conventional US machine in the bedside assessment of post-liver transplant patients.

  17. American Sign Language Comprehension Test: A Tool for Sign Language Researchers.

    Hauser, Peter C; Paludneviciene, Raylene; Riddle, Wanda; Kurz, Kim B; Emmorey, Karen; Contreras, Jessica


    The American Sign Language Comprehension Test (ASL-CT) is a 30-item multiple-choice test that measures ASL receptive skills and is administered through a website. This article describes the development and psychometric properties of the test based on a sample of 80 college students including deaf native signers, hearing native signers, deaf non-native signers, and hearing ASL students. The results revealed that the ASL-CT has good internal reliability (α = 0.834). Discriminant validity was established by demonstrating that deaf native signers performed significantly better than deaf non-native signers and hearing native signers. Concurrent validity was established by demonstrating that test results positively correlated with another measure of ASL ability (r = .715) and that hearing ASL students' performance positively correlated with the level of ASL courses they were taking (r = .726). Researchers can use the ASL-CT to characterize an individual's ASL comprehension skills, to establish a minimal skill level as an inclusion criterion for a study, to group study participants by ASL skill (e.g., proficient vs. nonproficient), or to provide a measure of ASL skill as a dependent variable.

  18. ["The two fontanelles sign": A new clinical sign for quality control in fetal head position diagnosis?

    Dupuis, O; Brocco, B; Decullier, E; Coulange-Benevise, L


    Determine the frequency at which palpation of two fontanelles is possible, in order to describe a new clinical diagnosis approach: "the two fontanelles sign". Descriptive study established in the obstetric and gynecology department at Lyon-Sud university hospital between March and November 2013. We followed-up one thousand successive singleton deliveries in cephalic presentation after 30 weeks of gestation. Before starting expulsive efforts, the number of fontanelles perceived (1, 2 or any) was documented. If the number of fontanelles were not noted, the patient was excluded. Nine hundred and seventy-eight patients were included. In 39.3% of cases (n=384), 2 fontanelles were found, in 57.5% (n=563) only one and in 3.2% (n=31), none. Both fontanelles palpation is frequently possible and enables quality control of fetal head presentation variety without ultrasound assessment. In order to prove the reliability of clinical examination, study comparing presentation ultrasonography and digital examination finding 2 fontanelles is needed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. God and the World of Signs

    Kristensen, Johanne Stubbe T


    Review of Robinson, Andrew (Andrew John Nottage). God and the world of signs: Trinity, evolution, and the metaphysical semiotics of C. S. Peirce. Publisher: Leiden: Brill, 2010. ISBN: 9789004187993......Review of Robinson, Andrew (Andrew John Nottage). God and the world of signs: Trinity, evolution, and the metaphysical semiotics of C. S. Peirce. Publisher: Leiden: Brill, 2010. ISBN: 9789004187993...

  20. Mental Illness in Children: Know the Signs

    ... Autism spectrum disorder: Signs and symptoms. Centers for Disease Control and Prevention. Accessed Dec. 8, 2014. Feb. 11, 2015 Original article: ...

  1. 46 CFR 154.1830 - Warning sign.


    ... (2) Facing outboard towards the water so that the sign may be seen from the water. (b) Except as provided in paragraph (e) of this section, each warning sign must have the following words: (1) Warning. (2) Dangerous Cargo. (3) No Visitors. (4) No Smoking. (5) No Open Lights. (c) Each letter in the words on...

  2. Sign Language and the Brain: A Review

    Campbell, Ruth; MacSweeney, Mairead; Waters, Dafydd


    How are signed languages processed by the brain? This review briefly outlines some basic principles of brain structure and function and the methodological principles and techniques that have been used to investigate this question. We then summarize a number of different studies exploring brain activity associated with sign language processing…

  3. 14 CFR 406.111 - Signing documents.


    ... individual's knowledge, information, and belief, the document is— (1) Consistent with these rules; (2... signed in violation of this section; (2) Strike the request for discovery or the discovery response signed in violation of this section and preclude further discovery by the party; (3) Deny the motion...

  4. Historical Development of Hong Kong Sign Language

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


    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…

  5. Research Ethics in Sign Language Communities

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


    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…

  6. Phonological Awareness for American Sign Language

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


    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…

  7. China and Chile Signing Free Trade Agreement

    Shen; Danyang


      Mr. Bo Xilai, Minister of Commerce of China, and Mr.Walker, Foreign Minister of Chile, signed the China-Chile FTA on behalf of their respective government on November 18, 2005. Chinese President Hu Jintao and Chile President Lagos attended the signing ceremony, according to a press release on the website of Network Center of MOFCOM.……

  8. China and Chile Signing Free Trade Agreement

    Shen Danyang


    @@ Mr. Bo Xilai, Minister of Commerce of China, and Mr.Walker, Foreign Minister of Chile, signed the China-Chile FTA on behalf of their respective government on November 18, 2005. Chinese President Hu Jintao and Chile President Lagos attended the signing ceremony, according to a press release on the website of Network Center of MOFCOM.

  9. The Functional Use of a Mathematical Sign

    Berger, Margot


    The question of how a mathematics student at university-level makes sense of a new mathematical sign, presented to her or him in the form of a definition, is a fundamental problem in mathematics education. Using an analogy with Vygotsky's theory (1986, 1994) of how a child learns a new word, I argue that a learner uses a new mathematical sign both…

  10. Signs and Symptoms of Congenital Heart Defects

    ... Twitter. What Are the Signs and Symptoms of Congenital Heart Defects? Many congenital heart defects cause few or no signs and symptoms. A ... lips, and fingernails) Fatigue (tiredness) Poor blood circulation Congenital heart defects don't cause chest pain or other painful ...

  11. Atrophic vaginitis: signs, symptoms, and better outcomes.

    Reimer, Annabelle; Johnson, Laura


    Atrophic vaginitis is a common finding in women with low estrogen states. Many women believe their symptoms are expected signs of aging. NPs can provide therapeutic options to improve vaginal health and quality of life. This article reviews physiology, clinical manifestations, signs, symptoms, and treatment methods for atrophic vaginitis.

  12. Numeral Variation in New Zealand Sign Language

    McKee, David; McKee, Rachel; Major, George


    Lexical variation abounds in New Zealand Sign Language (NZSL) and is commonly associated with the introduction of the Australasian Signed English lexicon into Deaf education in 1979, before NZSL was acknowledged as a language. Evidence from dictionaries of NZSL collated between 1986 and 1997 reveal many coexisting variants for the numbers from one…

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


    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.

  14. Signs, dispositions, and semiotic scaffolding.

    Fernández, Eliseo


    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

  15. Reliability Centered Maintenance - Methodologies

    Kammerer, Catherine C.


    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.

  16. Three-view bedside ultrasound for the differentiation of acute respiratory distress syndrome from cardiogenic pulmonary edema.

    Mantuani, Daniel; Nagdev, Arun; Stone, Michael


    Bedside ultrasound is being increasingly used by emergency physicians (EPs) for the differentiation of acute dyspnea in critically ill patients. Lung ultrasound is emerging as a highly sensitive tool in diagnosing alveolar interstitial edema with the presence of diffuse “B-lines” arising from the pleural line. However, when used independently, lung ultrasound is unable to differentiate between cardiogenic and noncardiogenic causes of pulmonary edema. This case report describes a rapid 3-view or “triple scan” sonographic examination to differentiate acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema.

  17. From bench to bedside: successful translational nanomedicine: highlights of the Third Annual Meeting of the American Academy of Nanomedicine.

    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


    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.

  18. [Focused surgical bedside ultrasound: E-FAST (focused assessment with sonography in trauma) - abdominal aortic aneurysm - cholecystolithiasis - acute appendicitis].

    Studer, Maria; Studer, Peter


    Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. The goal of ICAN is to improve and expand the education of surgeons in Switzerland. This article provides a short review of the most frequent surgical pathologies encountered in the emergency room.

  19. Eigen-Gradients for Traffic Sign Recognition

    Sheila Esmeralda Gonzalez-Reyna


    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.

  20. Road Signs for UV-Completion

    Dvali, Gia; Gomez, Cesar


    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.

  1. Sharing Vital Signs between mobile phone applications.

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


    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.

  2. Gearbox Reliability Collaborative Update (Presentation)

    Sheng, S.; Keller, J.; Glinsky, C.


    This presentation was given at the Sandia Reliability Workshop in August 2013 and provides information on current statistics, a status update, next steps, and other reliability research and development activities related to the Gearbox Reliability Collaborative.

  3. Building an Assessment Use Argument for sign language: the BSL Nonsense Sign Repetition Test

    Mann, W.; Marshall, C. R.


    In this article, we adapt a concept designed to structure language testing more effectively, the Assessment Use Argument (AUA), as a framework for the development and/or use of sign language assessments for deaf children who are taught in a sign bilingual education setting. By drawing on data from a recent investigation of deaf children's nonsense sign repetition skills in British Sign Language, we demonstrate the steps of implementing the AUA in practical test design, development and use. Th...


    M. Soilán


    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.

  5. System Reliability Analysis: Foundations.


    performance formulas for systems subject to pre- ventive maintenance are given. V * ~, , 9 D -2 SYSTEM RELIABILITY ANALYSIS: FOUNDATIONS Richard E...reliability in this case is V P{s can communicate with the terminal t = h(p) Sp2(((((p p)p) p)p)gp) + p(l -p)(((pL p)p)(p 2 JLp)) + p(l -p)((p(p p...For undirected networks, the basic reference is A. Satyanarayana and Kevin Wood (1982). For directed networks, the basic reference is Avinash

  6. The First Signs of Language: Phonological Development in British Sign Language

    Morgan, Gary; Barrett-Jones, Sarah; Stoneham, Helen


    A total of 1,018 signs in one deaf child's naturalistic interaction with her deaf mother, between the ages of 19 and 24 months were analyzed. This study summarizes regular modification processes in the phonology of the child sign's handshape, location, movement, and prosody. First, changes to signs were explained by the notion of phonological…

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

    Wang, Jihong; Napier, Jemina


    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…

  8. Sign Vocabulary in Deaf Toddlers Exposed to Sign Language since Birth

    Rinaldi, Pasquale; Caselli, Maria Cristina; Di Renzo, Alessio; Gulli, Tiziana; Volterra, Virginia


    Lexical comprehension and production is directly evaluated for the first time in deaf signing children below the age of 3 years. A Picture Naming Task was administered to 8 deaf signing toddlers (aged 2-3 years) who were exposed to Sign Language since birth. Results were compared with data of hearing speaking controls. In both deaf and hearing…

  9. Signs and the Process of Interpretation: Sign as an Object and as a Process

    Saenz-Ludlow, Adalira


    Historically the words representation and symbol have had overlapping meanings, meanings that usually disregard the role played by the interpreter. Peirce's theory of signs accounts for these meanings and also for the role of the interpreter. His theory draws attention to the static and dynamic nature of signs. Sign interpretation can be viewed as…

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

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


    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…

  11. Wet voice as a sign of penetration/aspiration in Parkinson's disease: does testing material matter?

    Sampaio, Marília; Argolo, Natalie; Melo, Ailton; Nóbrega, Ana Caline


    Wet voice is a perceptual vocal quality that is commonly used as an indicator of penetration and/or aspiration in clinical swallowing assessments and bedside screening tests. Our aim was to describe the clinimetric characteristics of this clinical sign using various fluid materials and one solid food in the Parkinson's disease (PD) population. Consecutive PD individuals were submitted for simultaneous fiberoptic endoscopic evaluation of swallowing (FEES) and voice recording. Speech therapists rated the presence or absence of wetness and other voice abnormalities. Two binary endpoints of FEES were selected for comparison with an index test: low penetration (LP) and low penetration and/or aspiration (LP/ASP). The accuracy of wet voice changed according to the testing material in PD patients. Overall, the specificity of this indicator was better than its sensitivity, and the wafer cookie and yogurt drink yielded the best indices. Our data show that wet voice is clearly indicative of LP or LP/ASP in PD patients in case of positive test. However, in the case of a negative result, the wet voice test should be repeated or combined with other clinical tests to include or exclude the risk of LP or LP/ASP.

  12. Mini-Mental Parkinson: First Validation Study of a New Bedside Test Constructed for Parkinson’s Disease

    F. Mahieux


    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.

  13. Expert system aids reliability

    Johnson, A.T. [Tennessee Gas Pipeline, Houston, TX (United States)


    Quality and Reliability are key requirements in the energy transmission industry. Tennessee Gas Co. a division of El Paso Energy, has applied Gensym`s G2, object-oriented Expert System programming language as a standard tool for maintaining and improving quality and reliability in pipeline operation. Tennessee created a small team of gas controllers and engineers to develop a Proactive Controller`s Assistant (ProCA) that provides recommendations for operating the pipeline more efficiently, reliably and safely. The controller`s pipeline operating knowledge is recreated in G2 in the form of Rules and Procedures in ProCA. Two G2 programmers supporting the Gas Control Room add information to the ProCA knowledge base daily. The result is a dynamic, constantly improving system that not only supports the pipeline controllers in their operations, but also the measurement and communications departments` requests for special studies. The Proactive Controller`s Assistant development focus is in the following areas: Alarm Management; Pipeline Efficiency; Reliability; Fuel Efficiency; and Controller Development.

  14. Reliability based structural design

    Vrouwenvelder, A.C.W.M.


    According to ISO 2394, structures shall be designed, constructed and maintained in such a way that they are suited for their use during the design working life in an economic way. To fulfil this requirement one needs insight into the risk and reliability under expected and non-expected actions. A ke

  15. Reliability based structural design

    Vrouwenvelder, A.C.W.M.


    According to ISO 2394, structures shall be designed, constructed and maintained in such a way that they are suited for their use during the design working life in an economic way. To fulfil this requirement one needs insight into the risk and reliability under expected and non-expected actions. A ke

  16. The value of reliability

    Fosgerau, Mogens; Karlström, Anders


    We derive the value of reliability in the scheduling of an activity of random duration, such as travel under congested conditions. Using a simple formulation of scheduling utility, we show that the maximal expected utility is linear in the mean and standard deviation of trip duration, regardless...

  17. Parametric Mass Reliability Study

    Holt, James P.


    The International Space Station (ISS) systems are designed based upon having redundant systems with replaceable orbital replacement units (ORUs). These ORUs are designed to be swapped out fairly quickly, but some are very large, and some are made up of many components. When an ORU fails, it is replaced on orbit with a spare; the failed unit is sometimes returned to Earth to be serviced and re-launched. Such a system is not feasible for a 500+ day long-duration mission beyond low Earth orbit. The components that make up these ORUs have mixed reliabilities. Components that make up the most mass-such as computer housings, pump casings, and the silicon board of PCBs-typically are the most reliable. Meanwhile components that tend to fail the earliest-such as seals or gaskets-typically have a small mass. To better understand the problem, my project is to create a parametric model that relates both the mass of ORUs to reliability, as well as the mass of ORU subcomponents to reliability.

  18. Avionics Design for Reliability


    Consultant P.O. Box 181, Hazelwood. Missouri 63042, U.S.A. soup ""•.• • CONTENTS Page LIST OF SPEAKERS iii INTRODUCTION AND OVERVIEW-RELIABILITY UNDER... primordial , d’autant plus quo dans co cam ia procg- dure do st~lection en fiabilitg eat assez peu efficaco. La ripartition des pannes suit

  19. Wind Energy - How Reliable.


    The reliability of a wind energy system depends on the size of the propeller and the size of the back-up energy storage. Design of the optimum system...speed incidents which generate a significant part of the wind energy . A nomogram is presented, based on some continuous wind speed measurements

  20. The reliability horizon

    Visser, M


    The ``reliability horizon'' for semi-classical quantum gravity quantifies the extent to which we should trust semi-classical quantum gravity, and gives a handle on just where the ``Planck regime'' resides. The key obstruction to pushing semi-classical quantum gravity into the Planck regime is often the existence of large metric fluctuations, rather than a large back-reaction.

  1. Reliability of semiology description.

    Heo, Jae-Hyeok; Kim, Dong Wook; Lee, Seo-Young; Cho, Jinwhan; Lee, Sang-Kun; Nam, Hyunwoo


    Seizure semiology is important for classifying patients' epilepsy. Physicians usually get most of the seizure information from observers though there have been few reports on the reliability of the observers' description. This study aims at determining the reliability of observers' description of the semiology. We included 92 patients who had their habitual seizures recorded during video-EEG monitoring. We compared the semiology described by the observers with that recorded on the videotape, and reviewed which characteristics of the observers affected the reliability of their reported data. The classification of seizures and the individual components of the semiology based only on the observer-description was somewhat discordant compared with the findings from the videotape (correct classification, 85%). The descriptions of some ictal behaviors such as oroalimentary automatism, tonic/dystonic limb posturing, and head versions were relatively accurate, but those of motionless staring and hand automatism were less accurate. The specified directions by the observers were relatively correct. The accuracy of the description was related to the educational level of the observers. Much of the information described by well-educated observers is reliable. However, every physician should keep in mind the limitations of this information and use this information cautiously.

  2. High reliability organizations

    Gallis, R.; Zwetsloot, G.I.J.M.


    High Reliability Organizations (HRO’s) are organizations that constantly face serious and complex (safety) risks yet succeed in realising an excellent safety performance. In such situations acceptable levels of safety cannot be achieved by traditional safety management only. HRO’s manage safety

  3. The Babinski sign--a reappraisal.

    Kumar, S P; Ramasubramanian, D


    In 1896, Joseph Babinski, a French neurologist, first described the best known neurologic eponym 'the Babinski sign'. This sign is characterised by dorsiflexion of the big toe and recruitment of the extensor hallucis longus muscle, on stimulating the sole of the foot. He has emphasised from the outset, the intimate relationship between this sign and the shortening movement in other leg muscles, which form the flexion synergy of the lower limb. The Babinski sign is not a new reflex, rather it is released as a result of breakdown of the harmonious integration of the flexion and extension components of the normal defence reflex mechanism, due to pyramidal tract dysfunction. A pathological Babinski sign should be clearly distinguished from upgoing toes that may not always be a part of the flexion synergy. This article reviews the Babinski sign in detail, focusing on the historical perspectives, role of pyramidal tract dysfunction and art of elicitation and interpretation. The significance of assessing this phenomenon in the entire leg, and the clinical clues that will help to dispel the myths regarding the Babinski sign, have been emphasised.

  4. The Babinski sign--a critical review.

    Kumar, S P


    In 1896, Josph Babinski, a French neurologist, first described the best known neurologic eponym--"the Babinski sign". This sign is characterised by dorsiflexion of the big toe, by recruitment of the extensor hallucis longus muscle, on stimulating the sole of the foot. He himself emphasised from the outset the intimate relationship between this sign and the shortening movement in other leg muscles, which forms the flexion synergy of the lower limb. The Babinski sign is not a new reflex, rather it is released as a result of breakdown of the harmonious integration of the flexion and extension component of the normal defence reflex mechanism, due to pyramidal tract dysfunction. A pathological Babinski sign should be clearly distinguished from upgoing toes that may not always be a part of the flexion synergy. This article reviews the Babinski sign in detail, focusing on the historical perspectives, role of pyramidal tract dysfunction, art of elicitation and interpretation. The significance of assessing this phenomenon in the entire leg and the clinical clues that will help to dispel the myths regarding the Babinski sign has been emphasized.

  5. Sign variation, the Grassmannian, and total positivity

    Karp, Steven N


    The totally nonnegative Grassmannian is the set of k-dimensional subspaces V of R^n whose nonzero Pluecker coordinates all have the same sign. Gantmakher and Krein (1950) and Schoenberg and Whitney (1951) independently showed that V is totally nonnegative iff every vector in V, when viewed as a sequence of n numbers and ignoring any zeros, changes sign at most k-1 times. We generalize this result from the totally nonnegative Grassmannian to the entire Grassmannian, showing that if V is generic (i.e. has no zero Pluecker coordinates), then the vectors in V change sign at most m times iff certain sequences of Pluecker coordinates of V change sign at most m-k+1 times. We also give an algorithm which, given a non-generic V whose vectors change sign at most m times, perturbs V into a generic subspace whose vectors also change sign at most m times. We deduce that among all V whose vectors change sign at most m times, the generic subspaces are dense. These results generalize to oriented matroids. As an application o...

  6. Evaluating the informatics for integrating biology and the bedside system for clinical research

    Meystre Stéphane M


    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

  7. Design and evaluation of a mobile bedside PET/SPECT imaging system

    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

  8. The Phonetics of Head and Body Movement in the Realization of American Sign Language Signs.

    Tyrone, Martha E; Mauk, Claude E


    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.


    Johanna Mesch


    Full Text Available Tactile sign language is a variety of a national sign language. Tactile signing among persons with deafblindness also includes some minor variations. Early analyses of tactile Swedish Sign Language (e.g. Mesch 1998, 2001 show how interactants use both their hands in tactile communication in two different positions: dialogue position and monologue position. This paper examines the signing variations that partially or functionally blind signers encounter when using one hand to communicate with each other in a conversation dyad in what is one of the most advanced types of sign language communication. In tactile one-handed signing, the signer uses her right hand both for producing and receiving signs, while the addressee uses her left hand not only for receiving but also for producing signs after turn-taking, even though it is the non-dominant hand and, therefore, is not normally used to produce one-handed signs. In this study, conversation analysis was conducted on the discourse of four groups. The results show that some variations depend on the linguistic background of individuals and their everyday communication. A comparative study of a two-handed and a one-handed system is then presented, focusing on issues of simplicity, flexibility, turn-taking, and feedback. Some results showing changes in the sign structures of both communication types are also presented.

  10. The "shirt collar sign" of cervical dystonia.

    Silver, Michael R; Hanfelt, John; Factor, Stewart A


    The diagnosis of cervical dystonia (CD) is clinical. We describe a physical examination observation that has been noted in CD patients. There is a tendency for their shirt collars to be shifted to one side. We validated this apparently consistent finding by having blinded evaluators rating the symmetry of the shirt collars in CD and non-cervical dystonia control subjects. A high correlation was found between the physical finding which we call "shirt collar sign" and the diagnosis. "Shirt collar sign" may be a helpful sign in diagnosing CD.

  11. How to estimate the signs' configuration in the directed signed social networks?

    Guo, Long; Gao, Fujuan; Jiang, Jian


    Inspired by the ensemble theory in statistical mechanics, we introduce a reshuffling approach to empirical analyze signs' configuration in the directed signed social networks of Epinions and Slashdots. In our reshuffling approach, each negative link has the reshuffling probability prs to exchange its sign with another positive link chosen randomly. Many reshuffled networks with different signs' configuration are built under different prss. For each reshuffled network, the entropies of the self social status are calculated and the opinion formation of the majority-rule model is analyzed. We find that Souts reach their own minimum values and the order parameter |m* | reaches its maximum value in the networks of Epinions and Slashdots without the reshuffling operation. Namely, individuals share the homogeneous properties of self social status and dynamic status in the real directed signed social networks. Our present work provides some interesting tools and perspective to understand the signs' configuration in signed social networks, especially in the online affiliation networks.

  12. Optical bedside monitoring of cerebral perfusion: technological and methodological advances applied in a study on acute ischemic stroke

    Steinkellner, Oliver; Gruber, Clemens; Wabnitz, Heidrun; Jelzow, Alexander; Steinbrink, Jens; Fiebach, Jochen B.; MacDonald, Rainer; Obrig, Hellmuth


    We present results of a clinical study on bedside perfusion monitoring of the human brain by optical bolus tracking. We measure the kinetics of the contrast agent indocyanine green using time-domain near-IR spectroscopy (tdNIRS) in 10 patients suffering from acute unilateral ischemic stroke. In all patients, a delay of the bolus over the affected when compared to the unaffected hemisphere is found (mean: 1.5 s, range: 0.2 s to 5.2 s). A portable time-domain near-IR reflectometer is optimized and approved for clinical studies. Data analysis based on statistical moments of time-of-flight distributions of diffusely reflected photons enables high sensitivity to intracerebral changes in bolus kinetics. Since the second centralized moment, variance, is preferentially sensitive to deep absorption changes, it provides a suitable representation of the cerebral signals relevant for perfusion monitoring in stroke. We show that variance-based bolus tracking is also less susceptible to motion artifacts, which often occur in severely affected patients. We present data that clearly manifest the applicability of the tdNIRS approach to assess cerebral perfusion in acute stroke patients at the bedside. This may be of high relevance to its introduction as a monitoring tool on stroke units.

  13. Development of the four-item Letter and Shape Drawing test (LSD-4): A brief bedside test of visuospatial function.

    Williams, Olugbenga Alaba; O'Connell, Henry; Leonard, Maeve; Awan, Fahad; White, Debbie; McKenna, Frank; Hannigan, Ailish; Cullen, Walter; Exton, Chris; Enudi, Walter; Dunne, Colum; Adamis, Dimitrios; Meagher, David


    Conventional bedside tests of visuospatial function such as the Clock Drawing (CDT) and Intersecting Pentagons (IPT) lack consistency in delivery and interpretation. We compared performance on a novel test of visuospatial ability - the LSD - with the IPT, CDT and MMSE in 180 acute elderly medical inpatients [mean age 79.7±7.1 (range 62-96); 91 females (50.6%)]. 124 (69%) scored ≤23 on the MMSE; 60 with mild (score 18-23) and 64 with severe (score ≤17) impairment. 78 (43%) scored ≥6 on the CDT, while for the IPT, 87 (47%) scored ≥4. The CDT and IPT agreed on the classification of 138 patients (77%) with modest-strong agreement with the MMSE categories. Correlation between the LSD and visuospatial tests was high. A four-item version of the LSD incorporating items 1,10,12,15 had high correlation with the LSD-15 and strong association with MMSE categories. The LSD-4 provides a brief and easily interpreted bedside test of visuospatial function that has high coverage of elderly patients with neurocognitive impairment, good agreement with conventional tests of visuospatial ability and favourable ability to identify significant cognitive impairment. [181 words].

  14. [Conventional radiology, digital radiology with photostimulable phosphor, laser digitalization of thoracic radiographic films at the bedside. A comparative study].

    Miceli, M; Stamati, R; Burci, P; Guidarelli, G; Sartoni Galloni, S


    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).

  15. The Effects of the Transforming Care at the Bedside Program on Perceived Team Effectiveness and Patient Outcomes.

    Lavoie-Tremblay, Mélanie; O'Connor, Patricia; Biron, Alain; Lavigne, Geneviéve L; Fréchette, Julie; Briand, Anaïck

    The objective of the study was to document the impact of Transforming Care at the Bedside (TCAB) program on health care team's effectiveness, patient safety, and patient experience. A pretest and posttest (team effectiveness) and a time-series study design (patient experience and safety) were used. The intervention (the TCAB program) was implemented in 8 units in a multihospital academic health science center in Montreal, Quebec, Canada. The impact of TCAB interventions was measured using the Team Effectiveness (TCAB teams, n = 50), and Clostridium difficile-associated diarrhea and vancomycin-resistant Enterobacter rates (patient safety) and Hospital Consumer Assessment of Healthcare Providers and Systems (patient experience; n = 551 patients). The intervention was composed of 4 learning modules, each lasting 12 to 15 weeks of workshops held at the start of each module, combined with hands-on learning 1 day per week. Transforming Care at the Bedside teams also selected 1 key safety indicator to improve throughout the initiative. Pretest and posttest differences indicate improvement on the 5 team effectiveness subscales. Improvement in vancomycin-resistant Enterococcus rate was also detected. No significant improvement was detected for patient experience. These findings call to attention the need to support ongoing quality improvement competency development among frontline teams.

  16. Reliability in the utility computing era: Towards reliable Fog computing

    Madsen, Henrik; Burtschy, Bernard; Albeanu, G.


    This paper considers current paradigms in computing and outlines the most important aspects concerning their reliability. The Fog computing paradigm as a non-trivial extension of the Cloud is considered and the reliability of the networks of smart devices are discussed. Combining the reliability...... requirements of grid and cloud paradigms with the reliability requirements of networks of sensor and actuators it follows that designing a reliable Fog computing platform is feasible....

  17. Human Reliability Program Workshop

    Landers, John; Rogers, Erin; Gerke, Gretchen


    A Human Reliability Program (HRP) is designed to protect national security as well as worker and public safety by continuously evaluating the reliability of those who have access to sensitive materials, facilities, and programs. Some elements of a site HRP include systematic (1) supervisory reviews, (2) medical and psychological assessments, (3) management evaluations, (4) personnel security reviews, and (4) training of HRP staff and critical positions. Over the years of implementing an HRP, the Department of Energy (DOE) has faced various challenges and overcome obstacles. During this 4-day activity, participants will examine programs that mitigate threats to nuclear security and the insider threat to include HRP, Nuclear Security Culture (NSC) Enhancement, and Employee Assistance Programs. The focus will be to develop an understanding of the need for a systematic HRP and to discuss challenges and best practices associated with mitigating the insider threat.

  18. Accelerator reliability workshop

    Hardy, L.; Duru, Ph.; Koch, J.M.; Revol, J.L.; Van Vaerenbergh, P.; Volpe, A.M.; Clugnet, K.; Dely, A.; Goodhew, D


    About 80 experts attended this workshop, which brought together all accelerator communities: accelerator driven systems, X-ray sources, medical and industrial accelerators, spallation sources projects (American and European), nuclear physics, etc. With newly proposed accelerator applications such as nuclear waste transmutation, replacement of nuclear power plants and others. Reliability has now become a number one priority for accelerator designers. Every part of an accelerator facility from cryogenic systems to data storage via RF systems are concerned by reliability. This aspect is now taken into account in the design/budget phase, especially for projects whose goal is to reach no more than 10 interruptions per year. This document gathers the slides but not the proceedings of the workshop.

  19. Reliability and construction control

    Sherif S. AbdelSalam


    Full Text Available The goal of this study was to determine the most reliable and efficient combination of design and construction methods required for vibro piles. For a wide range of static and dynamic formulas, the reliability-based resistance factors were calculated using EGYPT database, which houses load test results for 318 piles. The analysis was extended to introduce a construction control factor that determines the variation between the pile nominal capacities calculated using static versus dynamic formulae. From the major outcomes, the lowest coefficient of variation is associated with Davisson’s criterion, and the resistance factors calculated for the AASHTO method are relatively high compared with other methods. Additionally, the CPT-Nottingham and Schmertmann method provided the most economic design. Recommendations related to a pile construction control factor were also presented, and it was found that utilizing the factor can significantly reduce variations between calculated and actual capacities.

  20. Improving Power Converter Reliability

    Ghimire, Pramod; de Vega, Angel Ruiz; Beczkowski, Szymon


    The real-time junction temperature monitoring of a high-power insulated-gate bipolar transistor (IGBT) module is important to increase the overall reliability of power converters for industrial applications. This article proposes a new method to measure the on-state collector?emitter voltage...... of a high-power IGBT module during converter operation, which may play a vital role in improving the reliability of the power converters. The measured voltage is used to estimate the module average junction temperature of the high and low-voltage side of a half-bridge IGBT separately in every fundamental...... is measured in a wind power converter at a low fundamental frequency. To illustrate more, the test method as well as the performance of the measurement circuit are also presented. This measurement is also useful to indicate failure mechanisms such as bond wire lift-off and solder layer degradation...